The announcements, first by Mr. McCain, then by Mr. McConnell, dealt another setback to the effort to repeal the Affordable Care Act, which once seemed inevitable after years of promises by congressional Republican leaders that they would dismantle it.
With control of the White House and both houses of Congress, Republican leaders foresaw a quick strike coming as soon as January or February. But the House struggled to pass its version of the bill, and the Senate has had even more troubles. Mr. McConnell had to postpone the first votes before the July 4 recess when it was clear he did not have enough support for a procedural motion to take up the bill.
A revised measure unveiled last week was supposed to win over more Republicans, but it was greeted quickly with two Republican defections: Senators Susan Collins of Maine, a moderate, and Rand Paul of Kentucky, a conservative. Both have said they oppose the bill in its current form, for very different reasons, and will not vote even to begin debate.
That left Mr. McConnell without a vote to spare. Mr. McCain’s ailment cost him the final vote — at least for now.
Mr. McCain’s absence will give the forces of opposition — which include scores of health care provider organizations and patient advocacy groups — more time to mobilize.
On Friday, in a joint letter, the insurance industry lobby and the association that represents Blue Cross Blue Shield plans came out strongly against one of the innovations in the latest draft. They joined consumer groups, patient advocates and organizations representing doctors, hospitals, drug abuse treatment centers and religious leaders who have expressed opposition to the bill.
With Mr. McCain missing, Senate Republicans would have only 49 potential votes to move ahead with the legislation because all Senate Democrats and the two independent senators oppose it.
Mr. McCain, 80, announced Saturday night that he had the surgery at Mayo…