Updated July 28, 2017 23:46:52

Donald Trump has told Republicans to "let Obamacare implode" after the US Senate rejected a measure to repeal parts of the healthcare system, dealing a serious blow to the President's agenda.

Three Republican senators voted down the slimmed-down version of the repeal, leaving it unclear whether there will be any advance on efforts to wind back Barack Obama's signature legislation.

After the vote, Mr Trump tweeted: "3 Republicans and 48 Democrats let the American people down. As I said from the beginning, let Obamacare implode, then deal. Watch!"

Mr Trump had repeatedly taken to Twitter in recent days to publicly urge his Republican colleagues to vote to repeal Obamacare and tried a last-ditch effort a few hours before the bill was brought before the Senate.

A key vote to defeat the measure was cast by Senator John McCain, who returned to the Senate this week after receiving a diagnosis of brain cancer.

In an impassioned speech the day he returned, the veteran Arizona senator called for bipartisanship on major issues of national concern, and a return to the "regular order" of legislating by committee.

Photo: During the campaign, Donald Trump repeatedly promised to remove Obamacare "on day one". (Reuters: Kevin Lamarque)

Three Republicans, including Senator McCain, joined with all the Democrats to reject the amendment, which would have repealed a mandate that most individuals get health insurance among other measures.

"It's time to turn the page," Senate Minority Leader Charles Schumer said.

"We are not celebrating. We are relieved."

The final vote was 49-51. Republicans Lisa Murkowski and Susan Collins joined Senator McCain in voting against the bill.

The amendment was a last resort for Senate Republicans to pass any legislation that would trigger negotiations with the House.

"It's time to move on," Senate Majority Leader Mitch McConnell said on the Senate floor after the vote that unfolded at roughly 1:30am.

"This is clearly a disappointing moment."

After a comprehensive healthcare bill failed on the Senate floor, and a straight-up repeal of Obamacare failed as well, Senator McConnell and his top lieutenants turned toward a lowest-common-denominator solution known as "skinny repeal".

It was not intended to become law, but to open a path for a House-Senate conference committee to try to work out comprehensive legislation Congress could pass and send to Mr Trump.

Buoyed by a signal from House Speaker Paul Ryan that Republicans in the House would be "willing" to talk in order to "move forward", Senator McConnell introduced the pared-down healthcare bill late on Thursday (local time).

Senator McConnell had called his measure the Health Care Freedom Act.

It would have repealed the unpopular Affordable Care Act requiring most people to have health insurance or risk a fine from the IRS. A similar requirement on larger employers would have been suspended for eight years.

Additionally, it would have denied funding to Planned Parenthood for a year, and suspended for three years a tax on medical device manufacturers.

States could seek waivers from consumer protections in the Obama-era law, and individuals could increase the amount they contribute to tax-sheltered health savings accounts for medical expenses.

On their own, the changes in the skinny bill could roil insurance markets. Yet the scenario at hand, with senators trying to pass something while hoping it would not clear the House or become law, was highly unusual.

"We're in the twilight zone of legislating," Democratic Senator Claire McCaskill said.

Photo: Senator John McCain was one of at least three Republicans who voted against the repeal. (Reuters: Aaron Bernstein)

AP

Topics: health, health-policy, world-politics, united-states

First posted July 28, 2017 15:51:37