WASHINGTON — The Senate on Friday rejected a new, scaled-down Republican plan to repeal parts of the Affordable Care Act, seemingly derailing the Republicans’ seven-year campaign to dismantle the health care law.

Senator John McCain, Republican of Arizona, cast the decisive vote to defeat the proposal, joining two other Republicans, Susan Collins of Maine and Lisa Murkowski of Alaska, in opposing it.

The 49-to-51 vote was a huge setback for the majority leader, Mitch McConnell of Kentucky, who has spent the last three months trying to devise a repeal bill that could win support from members of his caucus.

The truncated Republican plan was far less than what Republicans once envisioned. Republican leaders, unable to overcome complaints from both moderate and conservative members of their caucus, said the skeletal plan was just a vehicle to permit negotiations with the House, which passed a much more ambitious repeal bill in early May.

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Repealing Obamacare
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The so-called “skinny” repeal bill, as it became known at the Capitol this week, would still have broad effects on health care. The bill would increase the number of people who are uninsured by 15 million next year compared with current law, according to the nonpartisan Congressional Budget Office. Premiums for people buying insurance on their own would increase by roughly 20 percent, the budget office said.