Republicans in Congress have been unable to agree on a way to repeal and replace the Affordable Care Act — and now they’re divided on whether they should give up on their GOP-only approach.

Sen. John McCain urged fellow senators Friday to “start fresh” and seek a bipartisan plan, hours after he provided the decisive vote against his chamber’s latest Affordable Care Act change proposal. “We can do this,” the Arizona Republican said in a statement.

(Related: 5 NewCare Systems That Could Make You More Popular)

Other Republicans insist they got too close to a GOP-only agreement on demolishing the health law to turn back from that idea. The Senate fell one vote short of advancing a partial repeal of some parts of the Affordable Care Act early Friday, with opposition from McCain and two other Republicans. In May, the House passed its replacement plan on a razor-thin 217-213 vote.

House Freedom Caucus Chairman Mark Meadows said he has no intention of working with Democrats. “In the end, we will prevail,” the North Carolina Republican told reporters Friday. “I fully expect we’ll have something on the president’s desk in September.”

Senate Republican hardliner Ted Cruz of Texas also dismissed the idea of bipartisanship out of hand.

“It’s a hit in the gut; now we’re reacting, what do we do,” Rep. Dave Brat, a Virginia Republican, told reporters.

Allowing Failure

President Donald Trump’s impulse has been do nothing, let the current system die and wait for Democrats to come to him to seek new legislation.

“They should have approved health care last night but, boy oh boy, the swamp,” Trump said in a speech Friday in Ronkonkoma, New York. “I said from the beginning let Obamacare implode.”

There have been repeated hints that the president could stop making the health-care law’s cost-sharing payments for low-income people, which insurers and analysts have warned would cause a spike in premiums and perhaps even a pullout from more markets.

But that’s a risky strategy, with Republicans in charge of all of Washington and the president already facing historically low poll ratings heading into a midterm election year.

White House budget director Mick Mulvaney expressed disappointment in an interview with Bloomberg TV.

“We had hoped to clear the decks of health care last night so we could move our full attention to tax reform,” Mulvaney said. With the Senate scheduled to remain in session for two more weeks before taking an August recess, he added: “All I know is we still expect them to do something before they leave town.”

McCain’s Return

Earlier this week McCain made a dramatic return to the Senate following brain-cancer treatment to cast the 50th vote to start debate on the bill. But he gave the decisive thumbs-down during Friday’s vote on a bare-bones Affordable Care Act change bill designed to jump-start bicameral talks on a final bill. The final tally was 49-51, with Republicans Susan Collins of Maine and Lisa Murkowski of Alaska also voting no.

Senate Democratic Leader Chuck Schumer (Photo: Schumer)

Senate Democratic Leader Chuck Schumer (Photo: Schumer)

The collapse was a blow to Majority Leader Mitch McConnell of Kentucky, who has previously said if Republicans failed they would need to cut a deal with Democrats to stabilize the markets. After the dramatic failure of his bill, the flush-faced leader declared he wasn’t interested in a “bailout” of insurance companies but wanted to hear what other ideas Democrats have.

In the Senate, half a dozen Republican and Democratic senators have discussed alternatives to the embattled GOP health-care bill. They mostly center on creating a reinsurance fund and authorizing cost-sharing payments for insurers on the Affordable Care Act public health insurance exchanges so they don’t have to raise prices for covering a sicker pool of customers. Another Democratic idea would take a bite out of drug company payments and plow the savings into the system.

‘Trade Ideas’

Senate Minority Leader Chuck Schumer of New York told reporters Friday he’s optimistic that members of both parties can work together to stabilize insurance markets and then “sit down and trade ideas” for the long run.

“Change it, improve it, but don’t just take a knife and try to destroy it and put nothing in its place,” Schumer said.

Sen. Lindsey Graham, a South Carolina Republican, met with Trump Friday to talk about his Affordable Care Act replacement proposal with GOP Sen. Bill Cassidy of Louisiana, according to a Republican aide. The plan, which was never embraced by McConnell or Democrats, would redirect much of the federal funding for health insurance as block grants to states to use for health-care spending.

Senate Health Chairman Lamar Alexander of Tennessee, who voted against a broad repeal-and-delay bill this week, is focused on ensuring that people have at least some option for buying insurance. He has said his committee will hold hearings to explore options.

Sen. Bill Nelson, a Florida Democrat, said in a statement that he and Collins met this week with a small bipartisan group of senators to start discussing solutions.

Collins said in a statement that lawmakers “need to approach reforms in a very careful way.”

“That means going through the regular process of committee hearings; receiving input from expert witnesses such as actuaries, governors, advocacy groups, and health care providers; and vetting proposals with our colleagues on both sides of the aisle,” she said.

Rep. Mike Simpson of Idaho said he agrees with McCain that the next step should be a bipartisan approach. He said Republicans will be asking Democrats, “Can we do some of the things you want to do also and repeal some of the bad parts of it?”

Sen. Tom Carper, a Delaware Democrat and former governor, has said he’s speaking with senators in both parties and governors of a number of states about a possible bipartisan plan.

“We need to do a fair amount more than shoring up the exchanges,” Carper said.

Carper wants more generous subsidies for poorer people buying insurance in the exchanges. States should be allowed to experiment with ideas that might even include a single-payer approach, he said.

Republican Meeting

For Republicans, there is risk of inaction after seven years of vowing to overturn the Affordable Care Act, President Barack Obama’s signature accomplishment.

House Republicans focused their ire on their Senate GOP counterparts. They entered a closed door meeting Friday with the song, “The Wreck of the Edmund Fitzgerald” blaring over a speaker. The song by singer-songwriter Gordon Lightfoot was about the sinking of the bulk carrier on Lake Superior in 1975.

Multiple members said they believed House Republican leaders intentionally chose the song because Speaker Paul Ryan of Wisconsin remarked that the ship had been close to shore when it went down — “just 15 miles or so,” said Republican Deputy Whip Dennis Ross of Florida.

“That was the point — the ship was that close, and so were we,” said Ross.

—With assistance from Terrence Dopp, Justin Sink, Billy House, Sahil Kapur and Anna Edgerton.

—-Check out Firm Places $10.5 Million Bet on Affordable Care Act Suit on ThinkAdvisor.

Copyright 2018 Bloomberg. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.