Sen. John McCain, R-Ariz., leaves the Senate floor during debate on healthcare reform and repeal on Capitol Hill in Washington, DC on July 27, 2017. McCain voted no on a “skinny repeal” bill put forth by his Republican colleagues.

The GOP Affordable Care Act also known as Obamacare repeal fails in a dramatic late-night vote with Republican Senators John McCain, Lisa Murkowski and Susan Collins joining with Democrats to oppose the efforts to repeal and replace the Affordable Care Act, a major blow to President Donald Trump and the Republican congressional agenda.

The Arizona Republican, diagnosed with brain cancer last week, returned to Washington on Tuesday and delivered a stirring address calling for a bipartisan approach to overhauling the ACA, while criticizing the process that produced the current legislation and laying groundwork for the dramatic vote.

According to CNN, McCain’s surprise vote came after a prolonged drama on the Senate floor. Multiple Republican colleagues, including Vice President Mike Pence, engaged in animated conversations with the Arizona senator who has long cherished his reputation as a maverick.

“Senators McCain, Lisa Murkowski and Susan Collins stood up for the American people in the Affordable Care Act vote,” Andrew Maconigee said, a second-year Juris Doctorate student at Yale University said. “There were many things that were not right in the ‘skinny repeal’ of the Affordable Care Act. If Republicans want to pass the repeal of the Affordable Care Act, the best decision is for the bill to be sent back to the floor for better revisions. The ‘skinny repeal’ should not have rushed while deserving the American people.”

The failure lays bare a hard-to-swallow political reality for Republicans after months of painful negotiations and soul-searching.

The vote was 49 to 51 — all 48 members of the Democratic caucus joined with McCain and Sens. Susan Collins (R-Maine) and Lisa Murkowski (R-Alaska) to block the legislation.

According to CNN, at one point before the final vote, Trump called Pence, who handed the phone to McCain. The call, just off the Senate floor, was brief and ultimately unsuccessful.

Speaking after the vote, Senate Majority Leader Mitch McConnell looked stunned and lamented the vote and the inability of the GOP to fulfill its long-term campaign pledge.

“This is clearly a disappointing moment,” McConnell said. “Our constituents have suffered through an awful lot under Obamacare. We thought they deserved better. It’s why I and many of my colleagues did as we promised and voted to repeal this failed law. We told our constituents we would vote that way. And when the moment came, when the moment came, most of us did.”

President Trump in an early morning tweet reacted to the Senate vote, writing “3 Republicans and 48 Democrats let the American people down. As I said from the beginning, let ObamaCare implode, then deal. Watch!”

After the vote, McCain called for a return to the committee process and criticized the partisan manner of the current health care effort.

“I’ve stated time and time again that one of the major failures of Obamacare was that it was rammed through Congress by Democrats on a strict-party line basis without a single Republican vote,” McCain said in a statement. “We must now return to the correct way of legislating and send the bill back to committee, hold hearings, receive input from both sides of aisle, heed the recommendations of nation’s governors, and produce a bill that finally delivers affordable health care for the American people. We must do the hard work our citizens expect of us and deserve.”

According to CNN Politics, McCain and several of his colleagues had thrown the Republican negotiations into turmoil earlier in the day, when they threatened to scuttle the bill unless they were offered guarantees that the House would enter negotiations after the Senate passed it. The fear was that the House would end up passing the “skinny bill” rather than a more comprehensive effort.

“I’m not going to vote for a bill that is terrible policy and politics just to get something done,” Sen. Lindsey Graham said at a news conference, joined by McCain, Ron Johnson and Bill Cassidy.