Updated 3:10 a.m. | In a dramatic early Friday morning vote, the Senate voted down the Republican effort to overhaul the U.S. health insurance system, 49-51, with GOP Sen. John McCain of Arizona’s dramatic “no” — to gasps in the chamber — providing the key vote to send the bill to defeat.

Lobbying from top GOP leaders, McCain’s colleague from Arizona Jeff Flake, Vice President Mike Pence and a swath of Republicans were not enough to sway McCain. Pence himself spent more than 20 minutes trying to get McCain to change his mind.

GOP Sens. Lisa Murkowski of Alaska and Susan Collins of Maine were expected to vote “no,” but Republicans were confident shortly before the vote they could get to a 50-50 tie, and bring in Pence to break it.

Before he cast his “no” vote, McCain had gathered with a sizable group of jovial Democrats on the other side of the Senate chamber. He returned to the Republican side, walking right past Majority Leader Mitch McConnell of Kentucky.

Watch John McCain Cast His Decisive Vote Against the GOP Health Care Bill

GOP disappointment

Republicans, in the chamber, however, were very quiet.

McCain’s vote came after a period of tense suspended animation, when much of the attention was on the Arizona Republican, who seemed to be returning to his maverick persona at just the wrong time for McConnell.

“This is clearly a disappointing moment,” McConnell said after the vote gaveled down. “I regret that our efforts were simply not enough — this time.”

President Donald Trump called out the three GOP ‘no’ votes on Twitter, saying, “3 Republicans and 48 Democrats let the American people down. As I said from the beginning, let ObamaCare implode, then deal. Watch!”

3 Republicans and 48 Democrats let the American people down. As I said from the beginning, let ObamaCare implode, then deal. Watch!

— Donald J. Trump (@realDonaldTrump) July 28, 2017

No time for complacency

After the vote, protesters outside chanted, “Thank you, John McCain!” as Senate Democrats addressed them, and thanked them for keeping the pressure on. 

“This is not a time to gloat,” Sen. Al Franken of Minnesota told the cheering crowd. “It is a time to build on the [2010 health care law’s] successes.” 

Minority Leader Charles E. Schumer, greeted by the crowds to chants of “Chuck! Chuck!” also thanked the crowds, who had spent hours on the East Front of the Capitol. 

“We are a great team, the inside and the outside,” the New York Democrat said. “Keep it up.”

A dramatic return

McCain had returned to Washington after surgery that removed a malignant brain tumor. He defied prudent medical guidance, arriving just in time to provide an essential Senate procedural vote in favor of his party’s effort to rewrite the 2010 health care law.

He addressed his colleagues in the Senate on the day he returned. McCain was critical of former President Barack Obama’s signature law — but also of the approach that Republicans had taken in their attempt to replace it.

“We Republicans have looked for a way to end it and replace it with something else without paying a terrible political price,” he said. “We haven’t found it yet, and I’m not sure we will. All we’ve managed to do is make more popular a policy that wasn’t very popular when we started trying to get rid of it.”

McCain’s comments left little doubt that McConnell was the target of much of his displeasure.

“We’ve tried to do this by coming up with a proposal behind closed doors in consultation with the administration, then springing it on skeptical members, trying to convince them it’s better than nothing — better than nothing — asking us to swallow our doubts and force it past a unified opposition,” the longtime Arizona senator said. “I don’t think that is going to work in the end. And it probably shouldn’t.”

McCain flashback

McCain’s vote was likely not a surprise as a senator who built his national reputation as a maverick. Though he has also fought alongside his fellow Republicans in some partisan fights.

When Republicans were united against the Democratic effort to pass the 2010 health care law, it was McCain who boosted their spirits. But seven and a half years ago, McCain was the man standing in the way of the GOP effort to dismantle the law.

McConnell described in his memoir “The Long Game” how McCain addressed the caucus at a lunch just before Christmas 2009, when they were voting on the legislation that became known as Obamacare. 

“As our presidential candidate, he was the best-known member of our caucus,” McConnell wrote. “If this were the Constitutional Convention, he’d be our George Washington.”

During that caucus lunch, McCain recalled spending Christmas as a prisoner of war in Vietnam, when one of his captors took him outside and drew a cross on the dirt in front of him, to signify that it was December 25.

“I know we’re going to lose this, but I believe that in staying together for a principle, we are also making it our finest hour,” McCain told the GOP senators that year, McConnell recalled. “And it’s made me think of the camaraderie and friendship I felt with the guys I had around me those years. I thank every one of you for keeping us this fight.”

But in the early hours of Friday morning, McCain is the senator who blocked McConnell’s exhaustive effort to dismantle the health care law. McCain had long criticized the backdoor legislative process that led to the GOP’s health care plan. And he could not support the skinny repeal bill unveiled just a few hours before the vote.

It was not the first time this year that McCain went against Republicans on a key vote when Pence had already appeared as a potential tie-breaker. McCain cast the deciding vote to kill a resolution disapproving of an Obama-era methane rule.

Niels Lesniewski, Bridget Bowman, Joe Williams, Lindsey McPherson and Jason Dick contributed to this report.