Republicans in the US Congress were in turmoil over healthcare legislation after a second attempt to pass a bill in the Senate collapsed late on Monday, with President Donald Trump calling for an outright repeal of Obamacare, which he is trying to replace and others seeking a change in direction toward bipartisanship.
Chaos resulted after two more US Republican senators announced their opposition to their party's efforts to revamp the Affordable Care Act widely known as Obamacare, derailing the controversial legislation in its current form and potentially dealing a monumental setback to President Trump.
"Regretfully, it is now apparent that the effort to repeal and immediately replace the failure of Obamacare will not be successful," Senate Majority Leader Mitch McConnel said in a statement.
Republicans control 52 of the chamber's 100 seats. Democrats are united against the controversial legislation, while Republicans Susan Collins and Rand Paul declared their opposition last week.
So when Senate conservatives Mike Lee and Jerry Moran announced late Monday they could not support the bill, the news sent shockwaves across Washington.
"We should not put our stamp of approval on bad policy," Moran - who faced considerable opposition at home in Kansas to the measure - said in a statement, adding that the new bill "fails to repeal the Affordable Care Act or address health care's rising costs".
For Lee, "in addition to not repealing all of the Obamacare taxes, it doesn't go far enough in lowering premiums for middle class families; nor does it create enough free space from the most costly Obamacare regulations".
Their defections mean that the bill has no chance of even getting a vote on the Senate floor unless McConnell decides to make significant changes.
Over the weekend, McConnell delayed a vote to proceed on the bill, after Senator John McCain, 80, underwent surgery to remove a blood clot above his eye and said he would recuperate at home in Arizona for at least a week. But McCain's absence is now somewhat immaterial.
Several Republicans had already expressed concern that the new bill could slash funding for Medicaid, the health insurance programme for the poor and the disabled.
The new bill would gradually roll back the programme, a move that some Republicans warn could lead to millions losing coverage.
The latest defections also show that conservatives are frustrated that the new bill does not repeal the Obamacare taxes.
"Republicans should just REPEAL failing ObamaCare now & work on a new Healthcare Plan that will start from a clean slate. Dems will join in!" Trump tweeted after Lee and Moran made their opposition known.
It was the latest in a series of healthcare setbacks for Republicans, despite their control of both chambers of Congress.
It also came after seven straight years of promising voters that they would repeal Obamacare if they were to control Congress and the White House, only to find that the public liked Obamacare more than their proposed substitutes, according to public opinion polls.
The non-partisan Congress Budget Office has determined that the various versions of Republican healthcare legislation would result in anywhere from 18 million to 23 million people losing their health insurance.
However, Republicans argue that Obamacare is a government over-reach and costs too much money.
Monday's developments had an immediate impact on financial markets as Asian shares stepped back from more than two-year highs on Tuesday and the dollar extended losses.
But the latest setback delivered a major political blow to Trump, who has failed to win any major legislative initiative in the first six months of his presidency.
McConnell, apparently backing Trump's latest approach, announced that he would try to bring legislation to repeal Obamacare to the Senate floor in coming days.
Republicans in Congress had been hoping to settle on a healthcare bill before an upcoming August recess so they could begin work in earnest in September on a wide-ranging rewrite of the US tax code.
There is little institutional support for the bill, and even less for an amendment introduced by Senator Ted Cruz that would allow insurers to offer bare-bones plans that do not comply with Obamacare's coverage requirements.
The chief executives of America's Health Insurance Plans and the Blue Cross Blue Shield Association called it "simply unworkable in any form."
A Washington Post poll released Sunday showed Americans preferred Obamacare to the Republican plan by 50 per cent to 24 per cent.