A partial repeal of the Affordable Care Act failed in dramatic fashion in the early hours of Friday morning in Washington, sunk by an unexpected defection from Arizona Sen. John McCain even though Nevada’s long-wavering Republican Sen. Dean Heller had finally come around to a “yes.”

Senate Majority Leader Mitch McConnell appeared dejected as he pronounced the death of the measure, which failed 49-51 after more than three days of debate and intense vote-wrangling through a highly unusual, fast-track process. A vote to refer the legislation to a committee hearing was held up for nearly an hour as McConnell and Vice President Mike Pence bided time trying to woo the three eventual Republican “no” votes — McCain, Alaska Sen. Lisa Murkowski and Maine Sen. Susan Collins.

“This is clearly a disappointing moment. Skyrocketing costs to plummeting choices and collapsing markets, our constituents have suffered through an awful lot under Obamacare,” McConnell said on the Senate floor just after the measure failed. “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.”

The weary majority leader announced that the Senate would restart its work Friday on a completely unrelated project — a defense spending bill.

McCain had made a triumphant return to the Senate days earlier, fresh from surgery and newly diagnosed with a malignant brain tumor. The 80-year-old lawmaker was expected to help the Republicans’ repeal project cross its final hurdle but instead cast the decisive vote sending the legislation to its grave.

The eight-page proposal unveiled just hours before the final vote — the Health Care Freedom Act — would have removed fines for people who don’t have insurance (the individual mandate), revoked the requirement that employers buy their workers insurance (the employer mandate) and extended a moratorium on taxing medical devices such as pacemakers or hip implants. It also would have increased the amount a person can contribute to a health savings account and, for one year, would barred federal funds from being used to fund organizations that provide abortions — a provision aimed at defunding Planned Parenthood.

Heller said on Wednesday that he would likely support a skinny repeal before reversing course on Thursday morning, saying he was “undecided.” It was also a roller coaster day for influential Republicans including McCain and Lindsey Graham, the latter who had called the skinny repeal a “fraudulent disaster” before getting assurances from House Speaker Paul Ryan that the bill would get further work in a conference committee. Graham then fell in line with most of his party.

All Democrats, including Nevada Sen. Catherine Cortez Masto, voted in opposition to the bill.

Republican Gov. Brian Sandoval and nine other governors sent a letter to Senate leadership on Wednesday declaring their opposition to a skinny repeal.

“The Senate should also reject efforts to amend the bill into a ‘skinny repeal,’ which is expected to accelerate health plans leaving the individual market, increase premiums, and result in fewer Americans having access to coverage,” the governors wrote. “Instead, we ask senators to work with governors on solutions to problems we can all agree on: fixing our unstable insurance markets. Improvements should be based on a set of guiding principles, which include controlling costs and stabilizing the market, that will positively impact the coverage and care of millions of Americans, including many who are dealing with mental illness, chronic health problems, and drug addiction.”

A spokeswoman for Sandoval did not respond to multiple requests for comment on Thursday.

Democrats railed against the proposal and the procedure, with Connecticut Sen. Chris Murphy describing it as “nuclear-grade bonkers.” They pleaded for a return to normal procedure and a committee hearing to get feedback from doctors, patients and others.

The skinny repeal was the option of last resort from Senate Republicans to pass some sort of health care legislation to send back to the House. McConnell pitched the legislation as allowing the health debate to continue in a conference committee, where lawmakers from both the House and Senate would be able to continue to hash out a health care bill that enough members of their respective caucuses would agree to.

An additional 15 million Americans were projected to be uninsured by 2026 under the skinny repeal, with 28 million uninsured in 2017 to 43 million uninsured in 2026, according to an updated analysis from the nonpartisan Congressional Budget Office released Thursday evening. The office also projected Wednesday that skinny repeal would have resulted in premiums that are 20 percent higher than they are currently.

Healthcare Freedom Act (Skinny Repeal) by Michelle Rindels on Scribd