When Sen. John McCain returned to Washington from cancer surgery, Republicans thought he would be the final vote they needed to conclude a seven-year effort to repeal Obamacare.

Instead, the Arizona maverick cast the vote that killed a Republican health care bill and delivered a severe political defeat for President Donald Trump and Senate Majority Leader Mitch McConnell (R-Ky.).

McCain said a “skinny” bill that the Senate considered fell short of meaningful reform and urged Republicans to “start fresh” on a new bill and give up the effort to ram through a measure without public hearings or input from Democrats.

McCain made the call shortly after dramatically walking to the front of the Senate floor around 1:30 a.m. Friday, holding out his arm and turning his thumb down — meaning a 51-49 defeat for the bill Republicans called the Health Care Freedom Act. McCain joined with fellow Republicans Susan Collins of Maine and Lisa Murkowski of Alaskaand all 48 Democrats in the chamber to vote no.

Narrower than a previously defeated Obamacare repeal proposal, the bill would have ended the mandate that all individuals obtain health insurance, terminated a tax on medical devices, and left untouched a Medicaid expansion created by Obamacare. It would have resulted in the loss of health insurance for 15 million people over the next decade and a 20 percent increase in insurance premiums, the nonpartisan Congressional Budget Office estimated.

In a statement later Friday morning, McCain bashed the lack of transparency and bipartisan input, along with GOP leaders’ attempts to slam through a vote on a bill.

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“The United States Senate has a long history of comity, trust and bipartisanship. Sadly, those qualities have been absent in recent years and we have seen the world’s greatest deliberative body succumb to partisan rancor and gridlock,” McCain said.

“The vote last night presents the Senate with an opportunity to start fresh,” the Republican 2008 presidential candidate continued. “It’s now time to return to regular order, with input from all our members — Republicans and Democrats — and bring a bill to floor of the Senate for amendment and debate . . . I encourage colleagues on both sides of the aisle to trust each other, stop the political gamesmanship and put the health care needs of the American people first. We can do this.”

In a separate tweet, McCain said the “skinny repeal [bill] fell short because it fell short of our promise to repeal and replace Obamacare w/ meaningful reform.” Days earlier, he perhaps forecast his vote when he said “the Obama administration and congressional Democrats shouldn’t have forced through Congress, without any opposition support, a social and economic change as massive as Obamacare. And we shouldn’t do the same with ours.”

The Republican blame game began immediately after.

Trump, who visited Long Island Friday to talk about gang violence, tweeted: “3 Republicans and 48 Democrats let the American people down. As I said from the beginning, let Obamacare implode, then deal. Watch!”

But to some Republicans, Trump shares a good deal of the blame. He never outlined his own plan or did much leg work for the congressional plan.

“One of the failures was the president never laid out a plan or his core principles and never sold them to the American people,” Rep. Charlie Dent (R-Pa.) told The Associated Press. “Outsourced the whole issue to Congress.”

House Speaker Paul Ryan (R-Wis.) issued a statement saying he was “disappointed and frustrated” with the Senate outcome.

Senate Minority Leader Chuck Schumer (D-N.Y.) said the fight over health care wasn’t over.

“We are not celebrating. We are relieved,” Schumer said after the vote. He praised McCain and made a similar call for bipartisanship.

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“So let’s turn the page and work together to improve our health care system, and let’s turn the page in another way,” Schumer said. “All of us were so inspired by the speech and the life of the senator from Arizona, and he asked us to go back to regular order.”