The latest Republican effort to repeal "Obamacare" was fatally wounded in the Senate when two more party senators announced their opposition to legislation strongly backed by President Donald Trump.
The announcements from senators Mike Lee of Utah and Jerry Moran of Kansas left the Republican Party's long-promised efforts to get rid of President Barack Obama's health care legislation reeling.
Mr Trump, who predicted success for the legislation just hours earlier, responded with a tweet urging: "Republicans should just REPEAL failing ObamaCare now & work on a new Healthcare Plan that will start from a clean slate. Dems will join in!"
Republicans should just REPEAL failing ObamaCare now & work on a new Healthcare Plan that will start from a clean slate. Dems will join in!— Donald J. Trump (@realDonaldTrump) July 18, 2017
But Republican leaders rejected that clean-repeal approach months ago because it could not pass Congress.
Mr Lee and Mr Moran both said they could not support Majority Leader Mitch McConnell's legislation in its current form.
They joined Republican senators Susan Collins of Maine and Rand Paul of Kentucky, who both announced their opposition after Mr McConnell released the bill last Thursday.
Mr McConnell is now at least two votes short in the closely divided Senate and may have to go back to the drawing board or even begin to negotiate with Democrats, a prospect he has threatened but resisted so far.
Mr Moran said Mr McConnell's legislation failed to repeal the Affordable Care Act or address health care's rising costs.
"For the same reasons I could not support the previous version of this bill, I cannot support this one," he said.
It was the second failure on the issue for Mr McConnell, who had to cancel a vote on an earlier version of the bill last month when defeat became inevitable.
It was a major blow for the president as he has failed to rally support for what has been his party's trademark issue for seven years - ever since Mr Obama and the Democrats passed the Affordable Care Act in the first place.
The Senate bill eliminated mandates and taxes under Obamacare, and unravelled a Medicaid expansion.
But for conservatives like Mr Lee and Mr Paul it did not go far enough in delivering on Republican Party promises to undo Mr Obama's law, while moderates like Ms Collins viewed the bill as too extreme in removing insurance coverage from millions.
Democrats could barely contain their glee, with Senate Minority Leader Chuck Schumer of New York saying: "This second failure of Trumpcare is proof positive that the core of this bill is unworkable.
"Rather than repeating the same failed, partisan process yet again, Republicans should start from scratch and work with Democrats on a bill that lowers premiums, provides long term stability to the markets and improves our health care system."