Directly behind the spot where he cast that vote, Sen. Lisa Murkowski, R-Alaska, watched McCain enter the chamber. Moments earlier, she too had cast a "no" vote, but to much less fanfare.
But the senior senator from Alaska endured more intense pressure from the Trump administration in getting to that vote than McCain, who, at 80, is likely serving his last term in Congress. And Murkowski has far more to lose for her stand in her resource-rich state .
Leading up to the series of health-care votes this week, Murkowski was the target of an aggressive persuasion campaign from members of the Trump administration - and the president himself.
President Donald Trump tweeted on Wednesday morning: "Senator @lisamurkowski of the Great State of Alaska really let the Republicans, and our country, down yesterday. Too bad!" The president had called the day before to try and convince Murkowski to support starting debate on health care, said Murkowski's office. The senator told E&E News that "it was not a very pleasant call," but she wasn't swayed.
So on Wednesday, Trump dispatched Ryan Zinke, who as secretary of the Department of the Interior runs agencies that collectively control more than 55 percent of Alaska's land, to make separate phone calls to Murkowski and the state's other Senate Republican, Dan Sullivan. Zinke, the Alaska Dispatch News reported, implied that the interests of their state was at risk because of Murkowski's health-care stance.
"What the secretary shared with me was that the president was not pleased," Murkowski told reporters Thursday, according to The Hill. "I think it's very clear, based on my conversation with the secretary, that he was just sharing the concern that the president had expressed to him to pass on to me."
Despite the high-profile contacts, Murkowski not only opposed opening debate but was one of three Republicans who voted against a bare-bones package on Friday morning, dealing a final blow to the GOP health-care push.
"I pledged early on that I would work with the President to help advance Alaska's interests," she said in a statement Friday. "I will continue to do that."
But she seemed as if she had little patience for Trump's governing style, likening him to the kind of teacher at which her children chafed.
"I tell my kids that you do not get to pick the boss of your choice," she said during stops between town halls earlier this month in Homer, Alaska. "I've got to figure out how I can work with President Trump and this new administration."
The choice of messenger relayed just as much the message itself.
For decades, the Murkowski family -- Frank Murkowski represented Alaska for more than two decades in the Senate before his daughter took over his seat in 2002 -- has sought, often unsuccessfully, to free up more federal land in Alaska for hunting and energy development.
For that, she needs the cooperation of Trump's Interior Department.
"When you talk about energy dominance," Sullivan told reporters, using a Trump administration buzzword for more oil, gas and coal development, "Alaska has to be a key part of that."
He continued,"So from my perspective, the sooner we can get back to that kind of cooperation between the administration and the chairman of the ENR Committee, the better for Alaska and the better for the country."
But Zinke may need Murkowski more than she needs him. As chair of both the Energy and Natural Resources Committee and the Interior Appropriations subcommittee, Murkowski has oversight over not only the department's activities but also its budget.
On Thursday, Murkowski postponed a vote on six Trump administration nominees, including three to Interior. Murkowski spokesperson Nicole Daigle said the meeting was delayed "due to uncertainty of the Senate schedule."
So far, the Trump administration, along with GOP lawmakers, has obliged in addressing the provincial concerns of the Alaska congressional delegation.
Congress has lifted a ban on aerial shooting and other hunting practices on Alaska's wildlife refuges. Zinke signed a secretarial order beginning an oil and gas leasing plan for the National Petroleum Reserve-Alaska, or NPR-A, and an assessment of reserves under both NPR-A and part of the Arctic National Wildlife Refuge.
Last week, the House sent to the Senate a bill to approve construction of a 20-mile road through the Izembek National Wildlife Refuge, which would connect the small village of King Cove to the larger town of Cold Bay. King Cove has no road out, so it relies on air and marine transport. Murkowski has introduced the Senate version.
And Murkowski and Sen. Maria Cantwell, D-Wash., want to pass a comprehensive bipartisan energy bill updating a host of oil and gas leasing, electric grid and other policies.
Before the recent confrontation, Murkowski had advocated on Zinke's behalf within the White House, arguing to the president and his aides they needed to name more political appointees to Interior. Murkowski got to know Zinke when the two traveled to Alaska's North Slope over Memorial Day.
Legal experts say an administration can choose its priorities, though House Democrats have asked Interior's Office of Inspector General to investigate Zinke's calls.
"I am unable to identify any ethical rule or legal obligation requiring a cabinet member to make a senator's priorities the same as the administration's priorities," said Jan W. Baran, an ethics and lobbying expert at Wiley Rein.
But David Hayes, a former Interior Department deputy secretary under both Presidents Obama and Clinton, said Zinke's words deserve "careful scrutiny" even if "cabinet officials have some leeway to lobby Congress."
"It appears that Zinke was lobbying for a health-care bill, not on an Alaska-related issue within Interior's area of responsibility," Hayes said. "Even more troubling ... he reportedly put the discharge of his statutory responsibilities in Alaska in play."
The Washington Post's Elise Viebeck and Kyle Hopkins contributed to this report.