Two holdout GOP Senators - Susan Collins (Maine) and Lisa Murkowski (Alaska) - voted No on skinny repeal, but this still meant that the bill could pass, with VP Mike Pence casting the tie-breaking vote.
McCain cast his vote around 1:30 a.m. Friday. Eastern time in the nation's capital.
The "Skinny Repeal" would entail eliminating the 'Individual Mandate, ' which requires all Americans to carry health insurance or pay a fine. One way the Senate can overcome a filibuster is through "budget reconciliation", which only needs 51 votes to get legislation through.
Three Republican senators, John McCain of Arizona, Lisa Murkowski of Alaska and Susan Collins of ME, voted against the bill along with the entire Democratic caucus.
He claimed the current checks and balances are making the Republicans "look like fools" and called on the party's Senate leader, Mitch McConnell, to scrap the "outdated" rule.
"I hear from fishermen who can't afford the coverage that they have, small business owners who can't afford insurance at all, and those who have gained coverage for the first time in their life", she said. "The process on this bill has been bad from the beginning and the Senate as an institution failed the American people".
But it is not as if Democrats were excluded from the repeal effort.
Trump has repeatedly insisted Obamacare is failing or "dead" and has promised a better healthcare deal. Amy Klobuchar's ear: "I'm going to vote 'no'".
McCain was a bigger surprise.
McCain returned to Washington specifically to vote on health care reform after being diagnosed with brain cancer, following a surgery to remove a blood clot from above his eye.
But McCain was not the only Republican to play a role in blocking the final version of the overhaul bill.
California Sen. Kamala Harris was not happy about the late-night nature of the debate. "We are not celebrating; we are relieved", he says. And business owners were watching and reacting along with the C-SPAN footage.
The Massachusetts Democrat lauded Americans who protested, contacted their lawmakers and pushed back against the ACA repeal effort, offering that "the energy inside the Capitol a few hours ago didn't come from senators like (her, ) it came from people like you". Unfortunately, Sen. Cory Gardner of Colorado was not that fearless and voted against the citizens of Colorado and the nation.