What's next after Obamacare repeal bill failure?

US Republicans failed on Friday in their latest effort to dismantle Obamacare, leaving the party shocked and in disarray, and signalling the potential death knell for President Donald Trump's dream of repealing his predecessor's health reform.

Voting in the early hours, three Republican senators, John McCain, Susan Collins and Lisa Murkowski, crossed party lines to join Democrats in a dramatic 49-to-51 vote to reject a "skinny repeal" bill that would have killed some parts of Obamacare. It was the third vote Republicans have lost since they forced open debate on the issue earlier this week in the Senate.

The Affordable Care Act (ACA), known informally as Obamacare, brought insurance to 20 million previously uninsured Americans and was the signature domestic achievement of former Democratic President Barack Obama.

Republicans have been vowing for seven years to do away with the ACA, saying it is too costly and represents undue government interference in people's healthcare.

The Senate's rejection of ACA repeal leaves President Trump without any major legislative victories, despite Republicans controlling the White House, Senate and House.

Trump had made the abolition of Obamacare a key campaign pledge, and was quick to respond to his defeat.

The BBC said the Senate's rejection of the bill makes further moves against Obamacare uncertain and that Republicans will have to work with Democrats to rework Obamacare or "move on to other topics, like taxes or infrastructure spending."

One of the Republicans, who voted against the "skinny" bill, agreed. After the voting, Murkowski said the Obamacare status quo was still unacceptable and unsustainable.

"We have to regroup. We have to come together" and work in a committee process to craft improvements to the law, she said.

Let-down for markets?

Financial and stock markets are unlikely to treat failure of the bill kindly, as Trump's election had led to expectations of rapid changes to healthcare, taxes and infrastructure spending.

After the bill's defeat, Senate Minority leader Chuck Schumer told the Senate that it was time to heed McCain's call this week to return to a more transparent and bipartisan legislative process.

Democrats, and some Republicans, said the bill's failure could present an opportunity for the two parties to work together to fix problematic areas of the Obamacare law without repealing it.

Moving to other topics

Other Republicans said that it was time to move on to other legislative priorities such as tax reform.

"This was a heavy lift. We should have taken our time. We should have first turned to tax reform and that's what we'll do now," Republican Senator Ron Johnson said.

The voting down of the bill still leaves uncertainty in the healthcare industry, with insurers not sure how long the Trump administration will continue to make billions of dollars in Obamacare payments that help cover out-of-pocket medical expenses for low-income Americans.

Insurers have until September to set rates for 2018 health plans in many marketplaces.

Some insurers, including Anthem Inc, Humana and Aetna have pulled out of Obamacare markets, citing the uncertainty over the payments.

Others have raised rates by double digits.