(Bloomberg) -- A months-long effort by Senate Republicans topass health legislation collapsed early Friday after GOP SenatorJohn McCain joined two of his colleagues to block a stripped-downObamacare repeal bill.

“I regret that our efforts were simply not enough, this time,”Senate Majority Leader Mitch McConnell said on the Senate floorafter the vote. “This is clearly a disappointing moment.”

“It’s time to move on,” he added after pulling the bill from thefloor.

The decision by McCain to vote no came after weeks ofbrinkmanship and after his dramatic return from cancer treatment tocast the 50th vote to start debate on the bill earlier this week.The GOP’s “skinny” repeal bill was defeated 49-51, falling justshort of the 50 votes needed to advance it. Republicans SusanCollins of Maine and Lisa Murkowski of Alaska also voted againstit.

It wasn’t immediately clear what the next steps would be for theRepublicans. The repeal effort had appeared to collapse severaltimes before, only to be revived. And several Republicanspleaded for their colleagues not to give up, even as PresidentDonald Trump blasted the vote.

Related: What's next for health carereform?

‘Let ObamaCare implode’

“3 Republicans and 48 Democrats let the American people down, AsI said from the beginning, let ObamaCare implode, then deal.Watch!” he wrote on Twitter at 2:25 am Washington time.

Speaking on Fox News Friday morning, Republican NationalCommittee Chairman Ronna Romney McDaniel said “it’s a tough day forRepublicans,” while insisting party lawmakers will continue theirdrive to replace the Affordable Care Act.

Related: Reports say Trump administration hobblingACA

“We campaigned on this for seven years,” McDaniel said. The vastmajority of congressional Republicans supported replacementlegislation in votes this year, she said, adding that “we’re notdone.”

But McConnell has struggled to find a compromise that satisfiesconservatives, who have demanded a wholesale repeal of Obamacare,and moderates, who have been unnerved by predictions the bill wouldsignificantly boost the ranks of uninsured Americans.

Democrats immediately called for a bipartisan debate on how tofix Obamacare.

“We are not celebrating. We’re relieved,” Senate Minority LeaderChuck Schumer said after the vote. “Let’s turn the page and worktogether to improve our health care system.” He also said Democratswould be willing to help expedite bipartisan legislation and toadvance Trump administration nominations.

Republicans have been under intense pressure to deliver on theirrepeal promises. But repeated pleas -- and threats -- from theWhite House and conservative groups weren’t enough to push the billthrough.

"I sadly feel a great many Americans will feel betrayed, thatthey were lied to, and that sentiment will not be unjustified. Youcannot campaign against Obamacare and then vote for Obamacare,"Republican Senator Ted Cruz said early Friday.

Loud gasps

In a dramatic vote in the early morning hours on Friday, Collinsvoted no first, then Murkowski, followed by McCain, who came to thewell of the Senate and gave a thumbs down, dooming the repeal billto loud gasps, mostly from the Democratic side of the aisle.Republican leaders stood together looking grim as their back-uprepeal plan appeared to collapse.

Of the three, Collins had been opposed to every GOP proposal onthe table. Murkowski had also been critical of them, even afterInterior Secretary Ryan Zinke called her and fellow AlaskaRepublican Senator Dan Sullivan and threatened them withretribution on major energy and public-lands decisions if theyvoted against repeal.

McCain was a bigger surprise. He has long called for repeal, butgrew frustrated over the secretive process that GOP leadersemployed to draft various repeal measures. When he returned thisweek, he made an impassioned speech on the Senate floor forbipartisanship, making it clear he was prepared to vote against thelegislation if it didn’t satisfy his concerns.

“We must now return to the correct way of legislating and sendthe bill back to committee, hold hearings, receive input from bothsides of aisle, heed the recommendations of nation’s governors, andproduce a bill that finally delivers affordable health care for theAmerican people,” McCain said in a statement after the vote. “Wemust do the hard work our citizens expect of us and deserve.”

Promises from Ryan

On Thursday evening, several Republicans were making the unusualargument that they would only vote to advance the measure if theygot guarantees it wouldn’t pass the House. House Speaker Paul Ryanassured several senators that his chamber would start a conferencenegotiation if the Senate passed the bill.

McConnell released the long-awaited text of his so-called skinnyrepeal bill late Thursday, only a few hours before the pivotalvote. It would end the requirement that individuals buy healthinsurance, and suspend through 2026 the requirement that companiesprovide it for their workers.

It would also extend a moratorium on the tax on medical-devicemakers through 2020 and increases the amount that individuals cancontribute to health-savings accounts. The measure would alsodefund Planned Parenthood for one year.

The Congressional Budget Office said late Thursday that the billwould result in an additional 15 million Americans without healthinsurance next year. It also said the measure would reduce thefederal deficit by $178.8 billion over a decade.

The defeat of the “skinny” repeal bill came after several othermeasures put forward by GOP leaders were also blocked.

The Senate rejected a fuller repeal of Obamacare 45-55Wednesday. Seven Republicans voted against it, including SenateHealth Chairman Lamar Alexander of Tennessee and McCain. LateTuesday, a 43-57 Senate vote swept aside a revised version ofMcConnell’s Obamacare replacement, a measure negotiated in secretduring weeks of tense GOP talks.

Republicans had said late Thursday their plan was to get the“skinny” bill through the Senate and then negotiate with the Houseon a broader agreement to repeal and replace Obamacare.

“Passing this legislation will allow us to work with ourcolleagues in the House toward a final bill that can go to thepresident, repeal Obamacare, and undo its damage,” McConnell saidThursday night on the Senate floor. “I urge everyone to supportit.”

By early Friday morning, McConnell admitted defeat, saying his“only regret” is that they failed.

Toomey ‘disappointed’

Several Senate Republicans said they hoped this wasn’t the endof the debate.

“I am disappointed with this setback on efforts to fix ourbroken health care system,” Republican Senator Pat Toomey ofPennsylvania said in a statement. “Congress must not give up onrepealing and replacing the failed health care law.”

A crestfallen Bill Cassidy said he hopes Democrats are nowinterested in working on a broader deal, like the one he developedwith Susan Collins.

“I’ve tried in the past, as has Susan, to have a dialogue. Ithasn’t worked. Maybe this had to happen to begin to have aconversation,” the Louisiana Republican said.

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