The latest Republican effort to unwind the Affordable Care Act collapsed on Monday, as a third GOP senator announced her opposition to the proposal and left it short of the votes it would need to win passage.
Sen. Susan Collins (R-Maine) announced she could not back the measure authored by Republican Sens. Bill Cassidy (La.) and Lindsey O. Graham (S.C.), moments after a much-anticipated partial analysis of the measure by the Congressional Budget Office forecast that “millions” of Americans would lose coverage by 2026 if it was enacted.
Two GOP senators — and Rand Paul (Ky.) and John McCain (Ariz.) — had already come out against the bill, even after a new round of drafting, and Collins’ announcement means it lacks the votes to pass. Republicans hold a 52-to-48 advantage in the Senate and can lose only two votes from their party and still pass legislation with the help of a tiebreaking vote from Vice President Pence.
A fourth Republican, Sen. Ted Cruz (Tex.), indicated through his aides Monday that he could not back the bill because it does not go far enough in repealing the 2010 law.
Senate Finance Committee Chairman Orrin G. Hatch (R-Utah), who had been overseeing a raucous hearing on the proposal, said Monday evening that he would only allow one more round of questions given the bill’s predicament.
“Let’s face it, we’re not getting anywhere,” he remarked.
Collins delivered a scathing assessement of the bill in a statement, saying the fourth version that the senators had produced in an effort to win over her vote and others’ “is as deeply flawed as the previous iterations.”
“Health care is a deeply personal, complex issue that affects every single one of us and one-sixth of the American economy,” she said. “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.”
The CBO also projected that a reduction in government spending on health care would lessen the federal deficit by at least as much as a $133 billion drop under an ACA-repeal bill that the House passed earlier this year.
In his opening remarks on the Senate floor Monday afternoon, Senate Majority Leader Mitch McConnell (R-Ky.) thanked Cassidy and Graham for their work, but suggested their work had stalled out. He thanked other lawmakers and committees of jurisdiction, as one might do at the official conclusion of a legislative push.
“I’d like to thank each of these committees, their chairs, their members and their staffs for their hard work to provide the American people with a better way than Obamacare and its years of failures,” McConnell said.
The legislation’s sponsors have rewritten the bill to deliver more money to Alaska and Maine than the original version. Two GOP senators in those states — Collins and Lisa Murkowski (Alaska) — had expressed concerns, but had not yet declared how they would vote on the measure by the start of the week.
The contentious debate erupted into public view Monday afternoon as protesters chanted so loudly at the hearing’s outset that the panel’s chairman, Hatch, was forced to temporarily adjourn as police officers arrested and removed several of them.
“No cuts to Medicaid! Save our liberty!” screamed one woman in a wheelchair as she was wheeled out.
After a brief recess, Hatch resumed the session, but warned the audience that if their behavior got out of hand, “I won’t hesitate to adjourn.” He added that the situation had not yet reached that point, “but it’s close.”
Sen. Ron Wyden (Ore.), the top Democrat on the panel, questioned why Republicans were rushing to pass a measure this week that was just having its first hearing, and one which he considered “a lemon.”
“Nobody has to buy a lemon, just because it’s the last car on the lot,” Wyden said.
Cassidy acted as a witness during the hearing after sitting on the panel as a member — a unique role that drew an objection from Wyden but a defense from Hatch. After listening to Graham’s opening remarks from his seat on a far end of the horseshoe-shaped dais, Cassidy took his seat at the witness table at the center of the room and told his colleagues that he pushed ahead with a GOP-only bill after years of trying to work with Democrats.
“So when I ask people, ‘Will you help me?’ — three years I’ve been doing this, and for three years I’ve was basically told, ‘Nice try,’ ” he said.
In an interview earlier in the day, Cassidy said he hoped that the new language — coupled with the fact that failing to act would keep the current Obama-era health law intact — would persuade some colleagues to change their positions.
“If there’s a billion more going to Maine … that’s a heck of a lot,” Cassidy said. “It’s not for Susan, it’s for the Mainers. But she cares so passionately about those Mainers, I’m hoping those extra dollars going to her state … would make a difference to her.”
Several Republicans close to the process have long counted Collins as an eventual no, predicting that little could be done to the bill to change her mind.
The last-minute changes over the weekend, which came as GOP leaders were racing to pass legislation before losing the budget authority Oct. 1 that lets them to pass legislation by a simply majority, underscore the tense atmosphere on the Hill.
The rush to rewrite the bill was so frenetic that Cassidy posted two separate bills on his website Monday morning. “The last version was just correcting drafting errors,” Cassidy told the Finance Committee.
Unlike earlier GOP proposals to repeal the ACA, Senate leaders have remained one step removed from the process. Asked whether any staffers outside his own had been involved in making changes to the bill over the weekend, Cassidy declined to answer.
The Cassidy-Graham legislation would overhaul the Affordable Care Act by lumping together the current law’s spending on insurance subsidies and expanded Medicaid and redistributing it to states in the form of block grants. Alaska would get 3 percent more funding between 2020 and 2026 than under current law, and Maine would get 43 percent more funding during that period under the updated bill.
While the figures in the revised bill draft aim to ease concerns of several key senators, there was no indication that the sponsors have abandoned their plan to make steep cuts to Medicaid through a per capita cap.
Such a move would end up cutting federal funding by tens of billions of dollars by 2026 and would mean that even with another carve-out for Alaska elsewhere in the bill, the state may end up losing money. And other states will still be hit hard.
Aides to Murkowski did not comment Monday on the revised bill.
Graham, who spoke quickly and intensely in support of the bill’s block grant approach before the Senate panel Monday, said it reflected his trust in politicians who have more direct interaction with their constituents.
“My goal is to get the money and power out of Washington, closer to where people live,” he said.
But even President Trump expressed skepticism Monday about the bill’s chances of passage, blaming McCain and Collins for its expected demise in an interview on the “Rick & Bubba Show,” an Alabama-based syndicated radio program.
McCain came out against the measure Friday, arguing that Republicans should work with Democrats to produce a bill that can attract wider support.
“You can call it what you want, but that’s the only reason we don’t have it, because of John McCain,” Trump said of efforts to repeal the 2010 health-care law, adding later, “Looks like Susan Collins and some others will vote against. So we’re going to lose two or three votes, and that’s the end of that.”
Trump did not mention Paul, who told reporters Monday that could not back Cassidy-Graham unless it was changed dramatically — cutting off the “entire trillion dollars” the bill devoted to block grants and having states opt in to the current law’s essential health benefits requirement.
“Republicans did not promise to block grant Obamacare; they promised to repeal,” Paul said. “I think it’s actually better to monitor the death spiral of Obamacare.”
Democrats, for their part, continued to rail against the measure during the Senate hearing. Sen. Michael F. Bennet (D-Colo.) was especially animated during his remarks, raising his voice as he questioned the motivations of Republican senators.
“Why are we here, colleagues, making matters worse?” he asked.
Sen. Cory Gardner (R-Colo.), whose state has expanded Medicaid, also has indicated that he needs to see the CBO analysis before taking a position on the legislation.
Cruz made it clear over the weekend that he had grave reservations and on a Monday call with reporters, his aides said that the senator had moved from yes to no after learning that the bill would not include the “consumer freedom” changes he’d wanted from the start.
“We had an agreement and that was moved away from us,” said the aides. “His focus is on premiums, on cost. It’s that consumers have sufficient freedom and options on the waiver pieces and the regulations.”
The bill has been roundly rejected by influential national groups representing physicians, hospitals and insurers. Over the weekend, six such organizations, including the American Medical Association and the American Hospital Association, issued a joint statement urging the Senate to reject the measure.
These groups, along with others, are escalating their efforts to derail the bill. A group of patients held a rally Monday at the U.S. Capitol, to protest its effect on Americans with preexisting conditions. And the advocacy group Save My Care is airing a new six-figure ad in Washington starting Tuesday that will highlight the opposition of not just the AMA but also AARP, Medicaid directors in all 50 states, and a range of patients’ rights organizations.
Kelsey Snell, Paige Winfield Cunningham, Amy Goldstein, Elise Viebeck and Mike DeBonis contributed to this report.