McCain casts crucial vote to kill 'skinny' ObamaCare repeal

Sen. John McCainJohn Sidney McCainGOP senator says Republicans didn't control Senate when they held majority Pence met with silence after mentioning Trump in Munich speech Mark Kelly's campaign raises over M in days after launching Senate bid MORE (R-Ariz.) cast the crucial surprise vote that killed Senate Republicans' last-resort ObamaCare repeal bill early Friday morning in a shocking moment that at least temporarily ended the GOP's hopes of eliminating the former president's signature law.

Voting shortly after midnight, McCain — who returned to the Senate on Tuesday after being diagnosed with brain cancer the week before — joined GOP Sens. Susan CollinsSusan Margaret CollinsGOP Green New Deal stunt is a great deal for Democrats On unilateral executive action, Mitch McConnell was right — in 2014 Congress must step up to protect Medicare home health care MORE (Maine) and Lisa MurkowskiLisa Ann MurkowskiOn unilateral executive action, Mitch McConnell was right — in 2014 The Hill's 12:30 Report — Presented by Kidney Care Partners — Trump escalates border fight with emergency declaration On The Money: Trump declares emergency at border | Braces for legal fight | Move divides GOP | Trump signs border deal to avoid shutdown | Winners, losers from spending fight | US, China trade talks to resume next week MORE (Alaska) and all Democrats in opposing the measure that would have repealed key parts of ObamaCare.

McCain cast the no vote two days after a dramatic return to the Senate floor during which he called on his colleagues to work together on major issues, which has long been a Senate tradition until the upsurge of partisanship in recent years.

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The vote cements McCain's status as the Senate's maverick, a role he relished earlier in his career when President George W. Bush occupied the White House.

McCain, who was defeated in the 2008 presidential election that brought Barack ObamaBarack Hussein ObamaGovernment's misguided holiday to celebrate itself Virginia can be better than this Democrats have a chance of beating Trump with Julian Castro on the 2020 ticket MORE to power, has emerged this year as one of President Trump’s most outspoken critics in Congress.

The two feuded during Trump's presidential campaign; at one point, Trump mocked McCain for being a prisoner of war, saying he liked war heroes who were not captured.

That history simply added to the drama of Friday morning's vote.

The bare-bones healthcare proposal, dubbed the “skinny” repeal because it left untouched big sections of ObamaCare, would have resulted in 16 more million people being without insurance over a decade, according to the Congressional Budget Office.

The CBO also estimated that it would increase premiums by 20 percent compared to current law.

Given those statistics, there was speculation early in the week about whether McCain would vote with his party given his own health news.

McCain did vote with Republicans to start debate on Tuesday but warned he was opposed to the current version of their repeal-and-replace legislation.

He further warned on Thursday that he did not want the skinny bill to become law and asked for assurances from Speaker Paul RyanPaul Davis RyanUnscripted Trump keeps audience guessing in Rose Garden Coulter defends Paul Ryan: This is 100 percent Trump's fault The Hill's 12:30 Report — Presented by Kidney Care Partners — Trump escalates border fight with emergency declaration MORE (R-Wis.) that there would be a conference and that the House would not just pick up the skinny bill and pass it.

Other senators aligned with him seemed reassured by a Ryan statement and backed the skinny bill. But McCain appeared to feel differently with his own vote.

Senate Majority Leader Mitch McConnellAddison (Mitch) Mitchell McConnellDemocrats brush off GOP 'trolling' over Green New Deal Trump should beware the 'clawback' Congress Juan Williams: America needs radical solutions MORE (R-Ky.) pushed the skinny bill as a backup proposal after Republicans failed to agree on a bigger bill that repealed and replaced the pillars of ObamaCare or on a repeal-only measure that passed both chambers in 2015.

He appeared almost distraught after McCain’s surprise vote and seemed close to choking up on the floor after falling short of his promise to repeal ObamaCare.

“This is clearly a disappointing moment,” he said.

“I regret that our efforts were simply not enough this time. Now, I imagine many of our colleagues on the other side are celebrating. Probably pretty happy about all this. But the American people are hurting, and they need relief.”

Many Republican senators, however, did not support the substance of the skinny legislation. They decided to vote for it as a way to prolong the healthcare negotiation by setting up a conference negotiation with the House.

Still, McCain’s vote surprised many Republicans, including Sen. Bill Cassidy (La.), who said he thought the Arizona Republican was in favor of the legislation.

Sen. Ron JohnsonRonald (Ron) Harold JohnsonWhite House, GOP defend Trump emergency declaration GOP senator says Republicans didn't control Senate when they held majority GOP senator voices concern about Trump order, hasn't decided whether he'll back it MORE (R-Wis.) told reporters, “I’m shocked at this.”

Vice President Pence was spotted lobbying McCain on the Senate floor shortly before the crucial vote. He also worked on Collins while other GOP leaders focused on Murkowski.

But those efforts fell short.

Senate Republican Conference Chairman John ThuneJohn Randolph ThunePolls: Hiking estate tax less popular than taxing mega wealth, income Will Trump sign the border deal? Here's what we know Key GOP senator pitches Trump: Funding deal a 'down payment' on wall MORE (R-S.D.) said McCain was wrestling with the decision all day but in the end would not budge.

“He had made up his mind and I’m not sure there was much that could have been done about it,” he said.

McCain declined to outline his thought process when reporters asked him about his vote.

Whatever he may have thought about, the diagnosis of brain cancer he received from doctors last week hovered over his decision.

None of his colleagues mentioned it explicitly, but many Democrats thought it would be a sad irony if the lawmaker voted for legislation the CBO projected would cause 16 million more people to be without health insurance at a time when he was depending on doctors in his fight against cancer.

In addition, McCain was never a big fan of the Senate healthcare reform effort, which would have cut billions of dollars in Medicaid funding for his home state of Arizona, one of 30 states that expanded enrollment under ObamaCare.

He raised Republican suspicions and Democratic hopes shortly before the vote when he declined to tell reporters how he would vote on the latest idea from the GOP leadership, the skinny repeal.

One Republican leadership source predicted earlier in the day that it had a “nine out of 10” chance of passing.

But McCain’s defection became apparent when he began huddling with Democrats on the Senate floor.

He complained earlier this month after Senate GOP leaders left out three Medicaid-related amendments that Arizona Gov. Doug Ducey (R) asked to be included in the bill.

McCain joined Johnson, Cassidy and Sen. Lindsey GrahamLindsey Olin GrahamCongress closer to forcing Trump’s hand on Saudi support Democrats brush off GOP 'trolling' over Green New Deal Warren: Officials have duty ‘to invoke 25th amendment’ if they think Trump is unfit MORE (R-S.C.) at a press conference a few hours before the vote, during which they asked for assurances from House GOP leaders that the skinny bill would be revised substantially in a conference negotiation with the House.

Ryan tried to provide some assurance by telling senators that he was willing to work with them, but a Ryan spokesperson earlier in the day described a conference negotiation as an “option” but not a certainty.

“If moving forward requires a conference committee, that is something the House is willing to do,” Ryan said in a statement.

But McCain told reporters that pledge did not go far enough.

“I would like to have the kind of assurances he did not provide,” he said. 

Updated at 7:12 a.m. Jordain Carney, Rachel Roubein and Peter Sullivan contributed.