In a major defeat for President Trump and Speaker of the House Paul Ryan, House Republicans pulled their bill to repeal the Affordable Care Act (ACA, or Obamacare). Ryan canceled a vote on the bill Friday afternoon when it became clear they did not have the necessary votes.

Greg Walden, a key Republican who helped craft the bill—called the American Health Care Act (AHCA)—says this means it is now “Dead. DOA,” according to reporters quoted in Vox. And though it is theoretically possible for Republican lawmakers to draft a compromise that would win the required support, it is unlikely to happen.

A vote on the AHCA was originally scheduled for Thursday, March 23, the seventh anniversary of the passage of Obamacare. When it became clear that the bill lacked support, the vote was postponed until Friday afternoon before Ryan pulled it altogether.

The AHCA was doomed because it failed to unite Republicans who felt the bill was too extreme and those who believed it didn’t go far enough.

“This provision is so cartoonishly malicious that I can picture someone twirling their mustache as they drafted it in their secret Capitol lair last night,” Representative Jim McGovern (D–Mass.) told The New York Times. “This backroom deal will kill the requirement for insurance companies to offer essential health benefits such as emergency services, maternity care, mental health care, substance addiction treatment, pediatric services, prescription drugs and many other basic essential services.”

The Times notes that the bill’s defeat could end up forcing Republicans and Democrats to work together to repair the existing health care law, which most lawmakers on both sides of the aisle agree needs improving.

As POZ reported earlier, the GOP’s replacement bill was met with resounding criticism from AIDS groups. One main reason is that it would end Obamacare’s expansion of Medicaid, the state and federal health plan for low-income Americans. As The HIV Medicine Association noted, “Forty percent of individuals with HIV in care rely on the Medicaid program for their health care coverage.”

A report by the Congressional Budget Office (CBO) had estimated that Medicaid spending under the GOP plan would have been 25 percent less than it is today. What’s more, about 24 million Americans would have lost insurance over the next 10 years.