The latest Republican attempt to repeal and replace Obamacare appeared headed for defeat after Senator Susan Collins said she doesn’t see herself backing the plan and Texas Senator Ted Cruz said he’s currently “not a yes.”

Senate Majority Leader Mitch McConnell can afford to lose no more than two votes on the Graham-Cassidy health care bill. Two Republicans have so far said they oppose the measure. The White House continues to hold out hope that one, Rand Paul of Kentucky, can be persuaded to change his position -- but the senator pushed back on the effort.

Collins said the bill has been rushed too fast for a thorough study of its full affects. She said her concerns include keeping protections for pre-existing conditions and not decimating Medicaid, the state-federal health program for the poor.

“It’s very difficult for me to envision a scenario where I end up voting for this bill,” Collins said Sunday on CNN’s “State of the Union.” “I have a number of serious reservations about it.” In a separate appearance on CBS, Collins said the sole hearing to consider a measure that would drastically alter many elements of health care in the U.S., scheduled for Monday, is “not even close to enough.”

Collins was one of three Republicans to sink the previous effort to repeal and replace former President Barack Obama’s signature health care law, along with Arizona’s John McCain and Lisa Murkowski of Alaska, who hasn’t announced a position on the current measure.

Senator Susan Collins, a Republican from Maine, speaks to members of the media in the basement of the U.S. Capitol in Washington
Senator Susan Collins, a Republican from Maine, speaks to members of the media in the basement of the U.S. Capitol in Washington Andrew Harrer/Bloomberg

Fast-track effort

The Senate must act by Sept. 30 to use a fast-track procedure that would keep Democrats from blocking the proposal. Republicans have pledged for seven years to overturn the law, and President Donald Trump made doing so a central theme of his 2016 campaign.

Given the opposition from Paul and McCain, a decisive “no” from Collins would be enough to kill the measure, which may not be put up for a vote if its prospects seem doomed.

White House legislative director Marc Short said on “Fox News Sunday” that the administration is trying to flip Paul’s vote, although the lawmaker appeared resolute in an appearance on NBC’s “Meet the Press.”

The Graham-Cassidy proposal would turn Obamacare funds into block grants for the states, which would create their own health care plans for residents. States that expanded Medicaid under Obamacare would be hardest hit by spending cuts, losing $180 billion from 2020 to 2026, according to the Kaiser Family Foundation. States that rejected the Medicaid expansion, many with Republican leadership, would gain $73 billion.


‘Food fight’

Paul said the Graham-Cassidy measure “basically keeps most of the Obamacare spending, almost all of the spending, and just reshuffles it.” He said Medicaid block grants would shift money from Democratic-leaning states to Republican ones and set up a “food fight” every time partisan control of Congress shifts.

“I’ve always been a ‘yes’ for repeal,” Paul said on NBC’s “Meet the Press.” “This is a bad idea; it’s not repeal.”

Later, on Twitter, Paul said that he “didn’t run to put a cap ON Obamacare, I ran to put a cap IN Obamacare,” adding “#nofakerepeal.”

Adding further uncertainty, Cruz raised the prospect of being another holdout if certain changes aren’t made to the bill. “Right now they don’t have my vote, and I don’t think they have Mike Lee’s either,” he said during a panel discussion at the Texas Tribune Festival in Austin, referring to the Utah Republican.

The Republican drive to gut the Affordable Care Act is using a dramatically short-circuited process that seeks to replace the landmark health law with another introduced just two weeks ago.


‘Moving forward’

McConnell has said he intended to hold a Senate vote in the coming week, before the deadline to use the fast-track procedure allowing a simple majority vote. Short said he thinks a vote will come on Wednesday.

Republican Senator Lindsey Graham, who brought the bill with Senator Bill Cassidy of Louisiana, said on ABC’s “This Week” he thinks the measure still has a chance to pass and that there’s no possibility for a bipartisan repeal-and-replace effort that would bring Democrats into the process -- an outcome that Collins urged.

“We’re moving forward, and we’ll see what happens next week,” Graham said. “I’m very excited about it.”

Graham made a plea to Paul to reconsider his opposition: “Rand Paul objects to the taxes, but when you look at the bill, Rand, we save a lot of money over time from Medicaid,” Graham said on ABC. “We’ve put a cap on Obamacare growth to make it more sustainable, more affordable, more flexible.

Trump warned on Twitter on Friday that “Rand Paul, or whoever votes against Hcare Bill, will forever (future political campaigns) be known as ‘the Republican who saved ObamaCare.’” The president continued on Saturday to call out Republican Senators who are either against the measure or haven’t stated their position.


Stakeholders opposed

A coalition of major health care stakeholders -- including doctors, hospitals, and insurers -- issued a joint statement on Saturday against the Graham-Cassidy bill, saying the Senate “should reject it.”

“While we sometimes disagree on important issues in health care, we are in total agreement that Americans deserve a stable health care market that provides access to high-quality care and affordable coverage for all. The Graham-Cassidy-Heller-Johnson bill does not move us closer to that goal,” said the coalition, which included the American Medical Association, the Federation of American Hospitals, and America’s Health Insurance Plans.

At least 21 million fewer Americans would have health-care coverage from 2020 to 2026 under the Graham-Cassidy plan, according to an estimate by the Brookings Institution.

Bloomberg News