Donald Trump suffered a bitter defeat last night as his cornerstone campaign pledge to repeal and replace Obamacare failed to pass in Congress.
Mr Trump instructed that the vote on the "Trumpcare" bill be "pulled" moments before it was due to take place, as support among Republican congressmen evaporated.
It was a huge blow for the president and raised doubts about his ability to enact other major promises such as tax reform and infrastructure investment.
Mr Trump was said to have been "agitated" by the reluctance of Freedom Caucus members - a group of conservative Republican congressmen - to vote for the American Health Care Act, known as 'Trumpcare'. They did not believe it went far enough in dismantling Obamacare, as the Affordable Care Act is commonly known.
Democrats were universally against the bill, calling it "pure greed that will see real people suffer and die".
Sean Spicer, Mr Trump's White House spokesman, said: "You can't force people to vote. At the end of the day, this isn't a dictatorship. The president left it all on the field. He has given it his all."
Shortly before the vote, Paul Ryan, the Republican House Speaker who championed the bill in Congress, went to the White House to tell Mr Trump it did not have enough support.
Mr Trump then called 'Washington Post' journalist Robert Costa. Mr Costa claimed Mr Trump said: "Look, I'm pulling the bill, I just made the decision. That's life, we move on."
Mr Costa said Mr Trump was "pretty calm, not angry or ranting, and spoke in an even-tempered voice".
"We're going to have to come back to healthcare at some point, this year he thinks, but for now it's over. No vote. It's pulled," he quoted the president as saying.
Speaking after the defeat Mr Trump said: "We were very close, we had no Democrat support... The best thing we can do politically speaking is to let Obamacare explode."
Mr Ryan said: "We came really close today but we came up short. I will not shirk this. This is a disappointing day for us. Doing big things is hard. We will need time to reflect. We will be living with Obamacare for the foreseeable future."
Obamacare, signed into law by Barack Obama seven years ago, was the former president's signature domestic policy achievement and resulted in an additional 20 million Americans obtaining health insurance.
Trumpcare would have eliminated Obamacare's unpopular fines on those who do not buy health insurance, but would also have removed subsidies for people on low incomes.
It would have used tax credits based on age, not income like Obamacare. A recent poll showed only 33pc of Americans thought Trumpcare would be an "improvement" on Obamacare, while 49pc thought it would not be.
Republican moderates as well as the most conservative lawmakers had objected to the legislation. The White House and House leaders were unable to come up with a plan that satisfied both moderates and conservatives.
"I will not sugarcoat this. This is a disappointing day for us," Mr Ryan said at a news conference, adding that his fellow Republicans are experiencing what he called "growing pains" transitioning from an opposition party to a governing party.
"Doing big things is hard," Mr Ryan added, noting that he got close but failed to muster the 216 votes needed to pass it.
Mr Ryan said he did not know what the next steps would be on healthcare, but called Obamacare so flawed that it would be hard to prop up.
Mr Trump told the 'Washington Post' the healthcare bill would not be coming up again in the near future and that he wanted to see if Democrats who uniformly objected to the Republican plan would come to him to work on healthcare legislation, a 'Washington Post' reporter said on MSNBC.
Repealing and replacing Obamacare was a top campaign promise by Mr Trump in the 2016 presidential election, as well as by most Republican candidates, "from dog-catcher on up," as Mr Spicer put it during a briefing yesterday.
News that the bill had been pulled before a final vote was greeted initially with a small sigh of relief by US equity investors, who earlier in the week had been fretful that an outright defeat would damage Mr Trump's other priorities.