The US President Donald Trump failed to pass his Obamacare repeal bill, after Arizona senator, John McCain, delivered an unpredictable blow by voting against it. 

According to reporters, McCain’s “no” vote was followed by gasps, with Senate Majority Leader Mitch McConnell calling the defeat a “disappointing moment.” The 80-year-old McCain, with a visible scar on his face after getting diagnosed with brain cancer, surprised everyone by doing, as he said, “the right thing.” And the right thing happened, despite attempts by Paul Ryan and Mike Pence to persuade him, with Pence allegedly spending 20 minutes with him, and Trump later trying to change his mind over the phone. McCain, however, was determined to vote “no,” and after 1:30am Friday morning he cast his shocking vote, which has finally put an end to the Republicans’ hopes, turning from “savior” to “executioner,” not to mention a “hero for Democrats.”

Two other Senate Republicans, Susan Collins of Maine and Lisa Murkowski of Alaska, also voted against the bill supporting Senate Democrats to reject the so-called skinny repeal by a 51-49 vote. 

The Senate Democratic leader, Chuck Schumer, said that McCain’s “stature, his remarks at the beginning when he came in, moved everybody and I think that helped. He’s a hero. He’s a hero of mine.”

The failure of Republicans to repeal Obamacare hurts Trump’s presidency, who has been unable to show any major legislative victories six months into his administration. Republicans have been trying for seven years now to remove President Obama’s Affordable Care Act, but their dream seems to have sunk forever since replacing or even repealing parts of it seems now unimaginable. 

Trump complained that those senators who opposed the bill “let the American people down” and he urged: “let Obamacare implode, then deal.” A few days earlier though, before McCain’s surprising vote, Trump praised him saying in a tweet that he was a “Brave American hero!”

The skinny repeal bill, which Republicans called the Health Care Freedom Act, would have left around 16 million more Americans without health insurance by 2026. Premiums in the nongroup market would rise "by roughly 20 percent relative to current law in all years between 2018 and 2026," the CBO estimated.

What was in the skinny repeal?

The “skinny” of the repeal bill has been added by reporters, but it’s misleading in the sense that the bill isn’t skinny at all, but rather costly, with millions of Americans losing their coverage and premiums rising by 20%.

The skinny repeal cancels the requirement that almost every American has to have health insurance or pay a penalty. 

It removes the employer mandate for eight years, which means companies would not have to provide affordable insurance for a minimum of eight years. Employers with 50 employees or more had to provide affordable coverage otherwise they paid a fine. With the skinny repeal measure they wouldn’t face any penalties.

The skinny repeal bill would have enabled states to have more flexibility in implementing certain regulations, such as maternity and mental health.

The bill would eliminate funding for planned parenthood and would provide funds to community health centres. The $422m that would have been injected into community health centres to care for 25m low-income patients, wouldn’t have been enough to cover the loss of planned parenthood, which provides sexual and reproductive health care services to 2.4m Americans at around 600 locations. 

It would repeal the medical device tax for three years. The 2.3% tax on medical device manufacturers was opposed by both Republicans and Democrats.

The bill would allow people to save money in Health Savings Accounts for three years. These are used by wealthy Americans who can save for future health care bills.

The Prevention and Public Health Fund: Republicans would end their support for the Centers for Disease Control and Prevention (DCD) of the Prevention and Public Health Fund. 

“Let ObamaCare implode”

Not passing the skinny bill, however, doesn’t mean that Obamacare is safe. It might not implode, but it has problems. Trump tweeted that “3 Republicans and 48 Democrats let the American people down. As I said from the beginning, let ObamaCare implode, then deal. Watch!” It is possible that the Trump administration could refuse to pay “cost-sharing subsidies,” which means they won’t pay insurance companies that make insurance more affordable. Without subsidies, things will get much more expensive with monthly payments increasing, and “deductibles”—thousands of dollars paid before insurance begins—rising.

The repeal bill has become unpopular and many Americans don’t support any efforts to repeal the Affordable Care Act. If the skinny repeal bill did pass, it would allow Republicans to say that they have done something. But last night’s dramatic conclusion marked a significant movement and from now on Democrats would have to make new suggestions. As Senate Majority Leader Mitch McConnell said: "It's time to move on."