WASHINGTON (AP) — Facing assured defeat, Republican leaders decided Tuesday not to even hold a vote on the GOP's latest attempt to repeal the Obama health care law, surrendering on their last-gasp effort to deliver on the party's banner campaign promise.

"The bill is dead as a door nail," said Sen. John Kennedy, R-La., leaving a luncheon where GOP senators decided against holding a futile roll call.

The decision marked the latest stinging rejection on the issue for President Donald Trump and Senate Majority Leader Mitch McConnell. In July, the Republican-controlled Senate rejected three similar GOP measures, a failure that infuriated conservatives and prompted Trump to spend much of his summer tweeting insults at McConnell and other Republican senators for falling short.

McConnell and other Republicans characterized the decision as a short-term setback. They needed to vote on the measure this week because procedural protections against a bill-killing Democratic filibuster expire Sunday, but they could revisit the issue in the future.

"We haven't given up on changing the American health care system," McConnell, R-Ky., told reporters. "We aren't going to be able to do it this week."

But he made it clear that it was time for Republicans to turn away from trying to repeal President Barack Obama's health care. They've been promising to erase that law since its 2010 enactment but have never rallied behind a plan to replace it.

"Where we go from here is tax reform," he said, citing the next big GOP goal.

Rejection became all but inevitable on Monday after Maine GOP Sen. Susan Collins announced she opposed the legislation. She joined Republican Sens. John McCain of Arizona, Rand Paul of Kentucky and Texas' Ted Cruz who'd already said they opposed the measure. Cruz aides said he was seeking changes that would let him vote yes.

Sen. Lisa Murkowski, R-Alaska, did not reveal a definitive position but said that while changes in Obama's law are needed, "substance matters." Her state has extremely high health care costs, in part because of its many remote communities.

Because of their narrow majority and unified Democratic opposition, Republicans could lose just two GOP votes and still push the legislation through the Senate.

The retreat left the GOP's next steps on health care unclear, especially with a president who in recent weeks has reached out to congressional Democratic leaders on high-agenda items like the budget and immigration.

Trump said in a meeting Tuesday with Republican and Democratic House members that he would work with Democrats on health care if the Republicans "didn't get repeal done," according to Rep. Richard Neal, R-Mass. Neal quoted Trump as saying, "You get a better deal if it's bipartisan."

It was unclear what compromise Trump could strike with Democrats between his stated desire to uproot the health care statute and Democrats defending what was perhaps Obama's proudest domestic achievement.

Sens. Lamar Alexander, R-Tenn., and Patty Murray, D-Wash., have been working on a bipartisan bill that would buttress Obama's law by continuing federal subsidies to insurers for lowering costs for lower-earning consumers. Trump has threatened to block those payments.

Murray called the GOP bill "the worst one yet" while House Minority Leader Nancy Pelosi, D-Calif., hailed the defeat of "this deadly bill."

In choosing whether to hold the roll call, McConnell faced some Republicans arguing that lawmakers can't be seen as abandoning a pledge that Trump and countless GOP have run on. Others challenged the value of shining a fresh spotlight on their inability to pass the bill.

"Putting it out on the floor and forcing a lot of people to make a vote that maybe they don't want to make isn't the best, in my view, long term pathway to success," No. 3 Senate Republican leader John Thune of South Dakota said before the vote.

The abandoned bill would transform much of "Obamacare's" spending into $1.2 trillion worth of grants through 2026 that states could spend on health programs with few constraints. It would also give states far more power — without federal approval — to loosen strings on insurers, letting them charge seriously ill people higher premiums and sell low-cost, low-coverage policies.

The nonpartisan Congressional Budget Office said "millions" of Americans would lose coverage under the bill and projected it would impose $1 trillion in Medicaid cuts through 2026.

GOP leaders revised the measure several times, adding money late Sunday for Alaska, Arizona, Maine, Kentucky and Texas in a clear pitch for Republican holdouts. They also gave states the ability — without federal permission — to permit insurers to charge people with serious illnesses higher premiums and to sell low-premium policies with big coverage gaps and high deductibles.

Before the vote, Trump lashed out at GOP lawmakers for deserting the measure, telling reporters, "We are disappointed in certain so-called Republicans."

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Associated Press congressional correspondent Erica Werner and writers Ken Thomas and Marcy Gordon contributed to this report.