With John McCain’s defection yesterday afternoon, Republicans are scrambling to try and salvage one of their most notable campaign promises: Getting rid of the Affordable Care Act. In an effort to make sense of what’s been happening, here’s the state of play for the Obamacare repeal and replace reform effort commonly known as Graham-Cassidy.

The bill has been rendered all but dead thanks to the efforts of Rand Paul and John McCain. Their “No” votes leave the bill at a Senate 50/50 tie, with Vice President Mike Pence having to break that tie when the bill comes to the floor.

However, the vote does not appear to need a tiebreaker, as two of the most liberal Republicans in the Senate, Lisa Murkowski and Susan Collins, are firmly in the “Leaning No” category, and McCain’s announcement yesterday could well provide them the chance to break away from their caucus (again) and kill the bill. This, despite talk of exempting Murkowski’s state of Alaska from Medicaid cuts (along with other states like Montana), means that a handful of Republicans are going to effectively vote to keep Obamacare completely and totally in place.

Now, let’s be clear: Graham-Cassidy does not keep the promises of the last six years to repeal Obamacare. It leaves most of Obamacare in place. What made it appealing even to people who were thoroughly upset about the state of Obamacare repeal is the issue of block granting money to states and getting rid of the individual and employer mandates. This victory, however small, would have done more to advance conservative policy with regard to health care reform than any other attempt before – and likely after.

The key complaints about the Graham-Cassidy bill from the Right are sound ones. The fact that it is a broken promise is a huge disappointment. It still leaves regulations that negatively impact insurance markets in place. But, the chance to create multiple health insurance systems in each state to see what works was well worth it. It is the federalism we’ve long been looking for.

But, with Paul and McCain, and possibly Murkowski and Collins, we won’t likely get the chance to create those systems anytime soon. We have sacrificed the chance to make small gains because of liberal-minded Senators and a libertarian who is opposing some reform because it is not complete reform.

And the Republicans have run out of time to make the change. September 30, 2017 is the end of the fiscal year, and you can only pass major legislation by reconciliation once per fiscal year. If you’re wondering why not FY17-18, the answer is simple: Tax reform.

That is the next push, spear-headed by Paul Ryan and endorsed by Donald Trump. However, Mitch McConnell’s mismanagement of the Senate, allowing liberals like McCain, Collins, and Murkowski to continue to derail the Republican agenda, has prevented the Republican Party from keeping good on its promises.

Graham-Cassidy is very likely dead. Which is unfortunate. At this point, we can try to offset some of the damage with tax reform, but it won’t be enough to completely fix what’s broken. And that is on Paul, McCain, Murkowski, and Collins. Oh, and McConnell.