"If you're not willing to vote the way you voted in 2015, then you need to go back home and you need to explain to Republicans why you're no longer for repealing Obamacare". "We're not going to do that".

A long-time opponent of Obamacare, Mr McCain said soon after the vote in the early hours of Friday morning: "From the beginning, I have believed that Obamacare should be repealed and replaced with a solution that increases competition, lowers costs, and improves care for the American people".

Republicans not only killed efforts to dismantle Obamacare, but also joined Democrats in supporting a new sanctions regime against Russian Federation. Susan Collins of ME and Lisa Murkowski of Alaska were widely considered out of reach for supporting the repeal, so the GOP could only lose one other vote among its 52 senators. John McCain was hoping to pass the bill this week before he has to return to Arizona for cancer treatment. People got exhausted of me bringing up the 60 vote requirement in the Senate over the last few years - but it's very important.

One moderate Republican said Trump shared responsibility. You know me - don't show us bullet points - give us a bill with real legislative text.

In the immediate aftermath of the bill's defeat, the president reacted to the news by targeting those Republicans that voted against the bill. They've given us the presidency.

"Republican Senate must get rid of 60 vote NOW!"

At a House GOP conference Friday morning, Ryan reportedly recited the lyrics to "The Wreck of the Edmund Fitzgerald", a metaphor he suggested for the sinking of the GOP's seven-year journey to repeal Obamacare. "Any I'm not pointing my finger at any one person, I think this is an institutional problem for the Senate", Rep. Bradley Byrne, R-Alabama, told CNN. "Outsourced the whole issue to Congress".

The measure defeated Friday would have repealed an Obama mandate that most people get health insurance and would have suspended a requirement that larger companies offer coverage to their employees. It also would have suspended the medical device tax for three years while allowing greater contributions into Health Savings Accounts.

"It's a disappointing moment", said McConnell, blinking back tears moments after the vote was final. "I regret that our efforts were not enough this time". "It's time to move on".

And the bill would have made it easier for states to get waivers from the federal government, giving them a little more leeway to redirect money that's supposed to help people buy health insurance.

Heller, meanwhile, has opened himself up to a primary challenge, said Adam Brandon, president of the conservative activist group FreedomWorks who asked which constituency the lawmaker was serving "by bending over backwards to save Medicaid expansion".

When President Trump criticized the House bill as "mean", the Republican-controlled Senate took up the task of writing new legislation. On July 19, the President also had Senate leadership at the White House where he told them not to quit.

As CNBC's John Harwood told Joy Reid, with health care repeal and the rest of the disarray and scandal surrounding this administration, if Trump wants someone to blame, he ought to take a look in the mirror.

Trump went on to lambaste the Republican senators, following the failure of a GOP-backed effort to repeal the Affordable Care Act without a complete replacement. Chris Murphy of CT pointed out on the floor just prior to the vote, could have been House Republicans throwing up their hands and simply approving the Senate's "skinny bill" - it was eight pages long - so they could claim to have kept seven years' worth of promises to their base to repeal Obamacare.