Drained by self-inflicted wounds, shifting aims and unrelenting protests, Republicans’ push to kill off President Obama’s signature health law sputtered out of gas early Friday, as Senate leaders failed to rally the votes for a significantly pared-down repeal bill in a vote after midnight.

Sen. John McCain, the Arizona Republican who stormed back to Washington after a shocking cancer diagnosis, cast a pivotal “no” vote as three Republicans linked arms with every Democrat to doom the plan.

The vote leaves President Trump without a clear path to repeal and heaps grave doubt on the GOP’s seven-year promise to dismantle the Affordable Care Act, though Mr. Trump quickly pivoted to a new Plan B — “let ObamaCare implode.”

Republican Sens. Susan Collins of Maine and Lisa Murkowski of Alaska also rejected the plan, though both had balked at GOP efforts earlier in the week, casting Mr. McCain’s vote as the decider.

Mr. Trump took to Twitter after the vote early Friday to declare that “3 Republicans and 48 Democrats let the American people down. As I said from the beginning, let ObamaCare implode, then deal. Watch!”

Earlier this week the Arizona senator saved Mr. Trump’s push to for repeal, yet he scolded his colleagues over the one-sided process that led to the debate.

Vice President Mike Pence, who was on hand to break a potential tie, huddled on the Senate floor with Mr. McCain and other holdouts for a long time before the vote, but couldn’t change their minds.

“This is clearly a disappointing moment,” Senate Majority Leader Mitch McConnell said, his voice wavering, noting Obamacare’s struggles with high premiums and dwindling choices would live on.

Explaining his vote in a statement early Friday, Mr. McCain said he’d warned colleagues he wanted bipartisanship and would shy away from any GOP-only plan.

“I’ve stated time and time again that one of the major failures of Obamacare was that it was rammed through Congress by Democrats on a strict-party line basis without a single Republican vote. We should not make the mistakes of the past that has led to Obamacare’s collapse,” he said.

He said the bill should be sent back to go through the usual legislative process rather than the speedy budget process that allowed the GOP to avoid a Democratic filibuster.

But Democrats have shown little interest in working toward the GOP’s idea of a total overhaul of Obamacare, instead calling for boosting the government control and taxpayer spending that are at the heat of the 2010 law.

Mr. McConnell said now it’s time for Democrats to offer their ideas, but said “bailing out insurance companies with no thought of any kind of reform, is not something I want to be part of.”

He also pointed to a vote on Thursday that saw Democrats shy away from backing the single-payer “Medicare for all” system that their liberal leaders have called for. Democrats said the vote, orchestrated by Republicans, was a sham.

In the wake of Friday’s vote, Minority Leader Charles E. Schumer said Democrats were relieved about the health vote, yet refused to spike the football, acknowledging that Obamacare is struggling and will need fixes in relevant committees.

“It did a lot of good things,” he said, “but it needs improvement.”

The 49-51 vote was an embarrassing blow for Senate Republican leaders who earlier this week failed to pass a robust health overhaul or the same “clean” repeal that got through the chamber 18 months ago.

They decided to buy themselves more time Thursday with a pared-down bill, dubbed “skinny repeal,” that they acknowledged was a “fraud” — but which they said they had to pass in order to keep the process alive.

Few seemed happy with idea, which was a far cry from promised or repeal-and-replace that the GOP took to voters ever since 2010, when Democrats muscled their overhaul into law.

Instead, the eight-page repeal the Senate was aiming to pass would leave Obamacare’s economics in shambles, raising the prospect of premium increases for consumers and market disruptions for insurers who prefer certainty.

With no other option alive, however, GOP senators said that was better than admitting failure — and said they would vote to approve it, with the understanding that it never become law.

“The skinny bill as policy is a disaster,” Sen. Lindsey Graham, South Carolina Republican, said. “The skinny bill as a replacement for Obamacare is a fraud.”

Realizing the peril, senators pleaded with House Republicans to agree to a conference committee to keep talking instead of actually passing the plan.

House Speaker Paul D. Ryan assured new talks, but it wasn’t enough in the end.

The political fallout was immediate, with Democratic operatives swiftly panning Sens. Dean Heller of Nevada and Jeff Flake of Arizona — the two most vulnerable senators in next year’s cycle — for supporting the plan when other Republicans didn’t.

Sen. Ted Cruz, Texas Republican, said the fight wasn’t over, but added that voters who expected a swift repeal had a right to be angry.

“I sadly feel a great many Americans will feel betrayed, that they were lied to,” he said amid a throng of reporters outside the Senate chamber. “And that sentiment will not be unjustified. You cannot campaign against Obamacare and go vote for Obamacare.”

Thursday’s skinny plan would have ditched Obamacare’s unpopular mandate requiring individuals to hold insurance and its rule requiring large employers to provide coverage.

It also would have shifted federal money from Planned Parenthood to community health centers, raised a cap on contributions to tax-advantaged savings accounts to pay for out-of-pocket costs and extended a freeze on Obamacare’s tax on medical device sales for three more years.

“The American people have suffered under Obamacare for too long. It’s time to end the failed status quo,” Mr. McConnell said.

The plan also sought to expand states’ ability to use waivers to abandon Obamacare’s list of mandated benefits, though the Senate parliamentarian flagged the language as incompatible with budget rules, giving Democrats the opportunity to block it.

The Congressional Budget Office estimated that 15 million fewer people would hold insurance next year under the plan, slightly rising to 16 million by 2026 — largely because the mandate requiring people to get coverage would go away.

GOP released the bill around 10 p.m., leaving senators and the public less than three hours to review the plan before the vote.

“This process is an embarrassment,” said Sen. Chris Murphy, Connecticut Democrat.

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