A last-ditch ObamaCare repeal effort by Republicans was all but dead on Monday after Sen. Susan Collins became the third Republican to oppose the measure.

Collins announced her opposition minutes after the Congressional Budget Office released an analysis predicting that millions would lose insurance under the proposal if it became law.

That was enough for Collins, who had long been seen as an almost certain ‘no’ vote on the measure.

She joins Sens. John McCain (Ariz.) and Rand Paul (Ky.) as GOP “no” votes. Republicans can only afford two defections and still muscle the bill through the Senate.

In a lengthy statement, Collins said the most recent ObamaCare repeal bill, which had been reshaped Sunday in an effort to win her over, “was as deeply flawed as its previous iterations.”

She cited the CBO’s score as one of her reasons for opposing the legislation authored by GOP Sens. Lindsey Graham (S.C.) and Bill Cassidy (La.), while also criticizing its cuts to Medicaid, its weakening of protections for people with preexisting conditions and predictions by insurers, hospitals and other groups that it would lead to higher premiums and less coverage for people.

Collins also decried a Senate process that she said had been rushed along.

“Sweeping reforms to our health care system and to Medicaid can’t be done well in a compressed time frame, especially when the actual bill is a moving target,” said Collins, one of three Republicans along with McCain and Sen. Lisa Murkowski (Alaska) to vote “no” on a previous slimmed-down ObamaCare repeal bill in July that appeared to end the debate.

“This is simply not the way we should be approaching an important and complex issue that must be handled thoughtfully and fairly for all Americans.”

It’s not clear whether Senate Majority Leader Mitch McConnell (R-Ky.) will still try to hold a floor vote later this week, something some GOP donors and the White House may want to see just to get senators on the record.

“I think we’re going to need to have a meeting of our conference tomorrow … so we can kind of see where everybody is before there will be any news,” Sen. John Cornyn (R-Texas) told reporters after a meeting in McConnell’s office on Monday evening.

It’s possible there could be more defections than just the three public GOP “no” votes, as Republicans in the center and on the right have both raised reservations about the measure.

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