AMY GOODMAN: In an historic defeat for the Republican Party, the Senate voted 49 to 51 early this morning against a bill that would have repealed key parts of the Affordable Care Act.

SEN. DAVID PERDUE: The ayes are 49. The nays are 51. The motion is not agreed to. The amendment is not agreed to.

AMY GOODMAN: As the bill was defeated, protesters outside the Capitol cheered and chanted “Yes, we did!” The loss was a stinging defeat for President Trump and for Republicans who have spent seven years vowing to repeal and replace Obamacare. This is Senate Majority Leader Mitch McConnell, in the Senate chamber, conceding defeat around 2:00 a.m. Eastern time.

MAJORITY LEADER MITCH McCONNELL: I also want to thank the president and the vice president, who couldn’t have been more involved and more helpful. So, yes, this is a disappointment. A disappointment indeed. Our friends over in the House, we thank them, as well. I regret that our efforts were simply not enough this time.

AMY GOODMAN: The so-called skinny repeal of Obamacare would have eliminated the individual and employer mandate, that requires certain businesses to provide health insurance to employees. Its defeat came after the Congressional Budget Office said it would have added another 16 million people to the ranks of the uninsured and increased premiums by at least 20 percent. The bill was only made public around 10:00 p.m. Eastern time Thursday night, giving senators only a few hours to review it before they had to vote. Joining every Democrat in opposing the measure were Republicans Susan Collins of Maine, Lisa Murkowski of Alaska and an ailing Arizona Senator John McCain, who had returned to Washington this week after surgery for and being diagnosed with brain cancer.

SEN. JOHN McCAIN: Right now, as I mentioned earlier, I am voting no, unless I see that there is a path to a conference that will come out with a result that will address the challenges. The status quo in my state is unsatisfactory. That’s why I’m working with the governor of my state, who has proposed three different amendments, which I will be putting up for bills—votes, as we go through. And if it satisfies the governor, then I would be satisfied. Right now, my governor is not satisfied.

AMY GOODMAN: When the actual vote came, it was Senator McCain, standing in the floor of the Senate, who gave a—with a pause, a thumbs down. There was a gasp in the Senate chamber. Senator Charles Schumer shushed the Democrats from cheering. Senator McCain’s vote derailed what at one point seemed a likely victory for Trump. In [ 2015 ], then-candidate Trump said of McCain, who was held as a prisoner of war in Vietnam for over five years, “He was a war hero because he was captured. I like people who weren’t captured. … He’s been losing so long, he doesn’t know how to win anymore,” Trump said back then.

Meanwhile, this morning, President Trump responded to the defeat on Twitter, writing, quote, “3 Republicans and 48 Democrats let the American people down. As I said from the beginning, let ObamaCare implode, then deal. Watch!” he said.

For now, the healthcare debate appears to be over. The Senate has adjourned, and there are no further votes this week.

For more, we go to Washington, D.C., where we’re joined by Margarida Jorge, co-executive director of Health Care for America Now.

Welcome to Democracy Now!, Margarida. Can you talk about what took place just hours ago?

MARGARIDA JORGE: Well, certainly, Senator McCain has long had a reputation as a maverick. And I think some of us were questioning that earlier in the week, when he voted in favor of the motion to proceed, and then gave an impassioned speech about the very secretive and, you know, corrupt process by which this whole repeal effort has moved forward. And the press conference that he and his colleagues, Lindsey Graham and Ron Johnson from Wisconsin, gave just hours before he voted against the bill, again, just—I think Senator McCaskill, from my old state of Missouri, said it well, when she said, “Working in the Senate right now is like being in the Twilight Zone.” What I—

AMY GOODMAN: Well, let me go to that press conference ahead of the vote—it was yesterday afternoon—when Republican Senator Lindsey Graham of South Carolina threatened to pull support from the so-called skinny bill.

SEN. LINDSEY GRAHAM: Here’s the problem. The whip in the House is suggesting to some that whatever we send becomes the final product, there will be no conference. And I am not going to vote for the skinny bill if I am not assured by the House there will be a conference, where my idea and other ideas can be taken up so we can actually replace Obamacare. I’m not going to vote for a bill that is terrible policy and horrible politics, just because we have to get something done.

AMY GOODMAN: That was Republican Senator Lindsey Graham. He went on to call the skinny bill a “fraud.”

MARGARIDA JORGE: Mm-hmm, that’s right.

SEN. LINDSEY GRAHAM: The skinny bill, as policy, is a disaster. The skinny bill, as a replacement for Obamacare, is a fraud. The skinny bill is a vehicle to get in conference to find a replacement. It is not a replacement in, of itself. The policy is terrible, because you eliminate the individual, employer mandate, which we all want eliminated, but we actually have a overall solution to the problem of Obamacare. So you’re going to have increased premiums, and most of Obamacare stays in place, if the skinny bill becomes law. Not only do we not replace Obamacare, we politically own the collapse of healthcare. I’d rather get out of the way and let it collapse than have a half-ass approach where it is now our problem.

AMY GOODMAN: Interestingly, Lindsey Graham, after calling the skinny bill a “fraud” and a “disaster,” actually voted for it. But the man he was standing next to, who came out with his warning, as well, that he wouldn’t vote for this unless they got a guarantee from House Speaker Ryan that the House would not just adopt the Senate bill, the man standing next to Lindsey Graham at that news conference, John McCain, voted against it. Margarida Jorge, so what happens now?

MARGARIDA JORGE: Well, I mean, I think a couple of things happen now. So, one thing is that President Trump’s comment, his tweet following the vote, that Obamacare, we should just wait for Obamacare to collapse, is not an arbitrary comment. It’s a comment that he has made many, many times: It’s going to implode, it’s going to collapse, it’s going to this, it’s going to that. And the reality is that Obamacare is fine, right? What he’s really saying is that he and his administration will do everything in their power to make sure that they do not enforce and protect this law, even though that is their job, since they run HHS.

And so, you know, one key thing, as you’ve been saying and Senator Graham just said, that would have been rolled back in the vote would have been the individual mandate. But the truth is, at the national level, President Trump and HHS have already stopped enforcing the individual mandate. And they have absolutely every intention of making sure that they sabotage Obamacare. We’re already starting to see spikes in premiums. And we know the insurance industry has commented over and over and over again that what’s driving these increases in premiums is not collapse of the law, it’s uncertainty in the market that’s being driven by the repeal efforts, the president’s refusal to enforce the law and his noncommittal stance toward cost-sharing reduction payments, that are essential to lowering costs for consumers in the law and helping insurers to be able to provide the coverage. And so, that cost-sharing reduction and sabotage is still out there. That’s going to be critical.

And the second thing that’s still out there is the attacks that we’re seeing on Medicaid and Medicare in the House—in the House budget on the GOP side. In earlier versions of this law—of the repeal bill, we saw not just a repeal of the Affordable Care Act, not just a rolling back of the expansion of Medicaid in states, in the 31 states that expanded, but an outright attack on the traditional Medicaid program—that’s turning 52, by the way, this weekend. And this is the program that’s providing healthcare to seniors, over 70 million seniors, children, people with disabilities, veterans, low-income people. And the proposal has been—all of these repeal proposals have had the proposal to create caps in Medicaid that would make dramatic changes in the program, permanently cut its funding. We see that very same proposal, except deeper cuts in the House budget, that’s moving at the same time that we’ve all been following the repeal debate. And so, the healthcare fight is really far from over, because we can expect $1.5 trillion in cuts, is what’s being proposed to Medicaid in the Republican budget, and another almost $500 billion cut to Medicare, which the Republicans are proposing to voucherize and privatize in the bill.

So, our view is that we are going to see many different kinds of attacks from many different sectors on healthcare. And the Trump sabotage piece of this is something that a lot of folks are not paying attention to. It’s critical. The sabotage of the law, and perpetuating its failure, is what the conservatives will then use as their rationale for taking a second try at repeal in the coming months.

AMY GOODMAN: As the amendments flew in the Senate Thursday, lawmakers voted down a single-payer healthcare amendment introduced by Republican Senator Steve Daines, who said it was aimed at putting Senate Democrats on the record on the issue. But Senator Bernie Sanders, longtime supporter of single payer, Medicare for all, denounced the amendment as a political trick designed to embarrass Democrats ahead of the healthcare vote.

SEN. BERNIE SANDERS: To Senator Daines, if he is prepared to vote for this legislation, and if he can get maybe five, six more Republicans to vote for this legislation, I think we can win it. And I think the United States can join the rest of the industrialized world and finally guarantee healthcare to all people.

AMY GOODMAN: So, the amendment failed to pass, after no lawmakers from either party voted for it. But, of course, we know Senator Sanders is a big proponent of Medicare for all. Margarida Jorge, what happens with that? And will Democrats move forward with that, like the Conyers bill in the House?

MARGARIDA JORGE: Well, I think Democrats will—there’s certainly a lot of openness to the bigger solutions to healthcare. You know, for years, we’ve been doing regulation and these kind of smaller fix-its here or there, but I think there’s growing recognition that the system itself is a problem because it’s driven not by healthcare, but by profit. And mostly what we’re having in this country is a conversation about the health insurance industry, not a conversation about actual healthcare. So, I think there is growing openness.

I mean, frankly, whether or not Democrats take up Medicare for all, whether or not they take up negotiations for prescription drug companies—another great bill that Senator Sanders has sponsored—really depends on grassroots pressure, in the same way that stopping repeal has really depended upon grassroots pressure. You know, this is still the United States. It’s still a democracy. If the citizenry, if constituents want something, it is up to us to organize impacted people and to show up and to make that demand, especially in district, where we have the greatest access to members. And it’s not different. You know, the same level of grassroots pressure that we saw around stopping repeal, that we expect to see around stopping the cuts to Medicaid and Medicare in order to give huge tax breaks to rich people in the budget fight, if we want Medicare for all, then we’ve got to go to Senator Sanders, and we’ve got to go to a lot of senators and show that the demand for that is out there.

AMY GOODMAN: Margarida Jorge, I want to thank you for being with us, co-executive director of Health Care for [America] Now and Health Care for [America] Now Education Fund.

This is Democracy Now! When we come back, we go to Des Moines, Iowa. Two women, two Catholic Workers, admit they committed sabotage against the Dakota Access pipeline. They’ll tell their story. Stay with us.