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The Senate in the early hours of Friday morning have rejected the slimmed-down, or "skinny", Obamacare repeal; this has derailed the seven year mission of the Republican party to dismantle the Obama-era health care law and dealing a huge political blow to Donald Trump's administration.

Senator John McCain, who just this week returned to the Senate floor after being diagnosed with brain cancer, cast the decisive vote to defeat the proposal; joining two other Republicans, Susan Collins of Maine and Lisa Murkowski of Alaska, in opposing it.

The 49-51 vote was also a humiliating setback for the Senate majority leader, Mitch McConell of Kentucky, who has nurtured his reputation as a master tactician and had spent the last three months trying to devise a repeal that could win support from members of his caucus.

The "skinny" repeal bill, as it had started to become known in the Capitol this week, would still have had broad effects on health care. The bill would have increased the amount of people who are uninsured up to 15 million by next year compared with current law, according to the nonpartisan Congressional Budget Office. Premiums for people buying insurance on their own would have increased roughly 20 percent, the office said.

Unlike previous setbacks, Friday morning's health care defeat had the ring of fatality. After the result was announced, the Senate quickly moved on to routine business. Mr. McConell cancelled a session scheduled for Friday and announced that the Senate would take up the nomination of a federal circuit judge on Monday afternoon.

The new, eight-page Senate bill, called the "Health Care Freedom Act", was unveiled just hours before the votes were cast. It would have ended the requirement that most people have health coverage, known as the individual mandate. But it would not have put in place other incentives for people to obtain coverage - a situation that insurers say would leave them with a pool of sicker, costlier customers. It would also have ended the requirement that large employers offer coverage to their employees. The "skinny" repeal would have delayed a tax on medical devices; it would have also cut off federal funds to Planned Parenthood for one year and increased federal grants to community health care centers. It would have also increased the limit on contributions to tax-favored health savings accounts.

In addition, the bill would have made it much easier for states to waive federal requirements that health insurance plans provide consumers with a minimum set of benefits like maternity care and prescription drugs. It would have eliminated funds provided by the ACA for a wide range of prevention and public health care programs.

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