A new analysis that at least 18 million people could lose health insurance in the first year if Congress repeals the Affordable Care Act without replacing it intensified the battle this week over the landmark healthcare law as US President-elect Donald Trump and Republicans try to figure out how to dismantle it.

Democrats seized on the report, issued by the nonpartisan Congressional Budget Office, to discredit Republican efforts to repeal Obamacare and rally Americans who are insured under the programme.

The report underscored the political peril that Trump faces in trying to meet one of his top campaign promises - and also the discord among Republicans about how to do it.

The political and public-relations battle over the ACA is now at full speed, with Democrats holding rallies across the country and inviting Americans to Capitol Hill to describe how their lives were improved or even saved by the law.

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Republicans accused Democrats of distorting the truth about the much-debated programme - but also revealed signs of disunity about how to meet their promise of repeal without political fallout among voters or economic calamity in the insurance market. The fact that Trump has begun to sketch out his own healthcare proposal has injected a new element of uncertainty.

On another front, Democrats attacked Betsy DeVos, Trump's education nominee, calling her unfit for the job during a contentious confirmation hearing, while Republicans defended her as a bold reformer.

DeVos told sceptical senators that she looked forward to working with them to improve the nation's schools. But she sidestepped several issues important to Democrats on guns in schools and handling sexual assault on college campuses. She called the ideas of Senator Bernie Sanders about free college "interesting".

A Michigan billionaire, DeVos has lobbied for decades to expand charter schools and taxpayer-funded vouchers for private and religious schools, but she has no professional experience in public schools, never attended public schools and did not send her own children to public schools. She also has not held public office.