Sen. Lindsey Graham’s quest to fulfill his party’s promise to repeal and replace the Affordable Care Act appeared all but doomed on Friday after his close friend, Sen. John McCain, said he’d oppose the effort.
The sudden shift in momentum was jarring. Graham, R-S.C., had left Washington on Wednesday, confident he and his allies would find enough support to pass his bill to radically transform the American health care system.
President Donald Trump was committed to helping. Senate Majority Leader Mitch McConnell said he intended to schedule a vote. The powerful Senate Finance Committee scheduled a Monday hearing. Graham and his partner in the legislative effort, Louisiana Sen. Bill Cassidy, were set to appear on CNN in prime time Monday evening to defend their bill against two Senate progressives, Vermont Independent Bernie Sanders and Minnesota Democrat Amy Klobuchar.
Friday, though, Graham found his bid suddenly, stunningly, on the brink of collapse.
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McCain, R-Ariz., announced he could not “in good conscience” vote for Graham’s bill, which would send Obamacare money back to the states as block grants. McCain was concerned about a process that had not allowed for hearings, amendments or a full analysis by the nonpartisan Congressional Budget Office.
His statement came after Sen. Susan Collins, R-Maine, said Friday morning that she was “leaning towards” a no vote, according to the Portland Press-Herald. Sen. Rand Paul, R-Ky., has said all week he’s a no. He objects to how the plan maintains the current law’s taxes on the wealthy.
Since Republicans control 52 of the Senate’s 100 seats, and no Democrat is expected to back Graham’s bill, a loss of three GOP votes imperils the legislation. Graham faced a deadline of Sept. 30 to move his bill, the day the ability to cut off debate with 51 votes ends. After that, it will take 60 votes to stop a filibuster.
McCain was regarded as one of the holdouts. He, Collins and Sen. Lisa Murkowski, R-Alaska, had opposed an Obamacare “skinny repeal” effort this summer, dooming that effort.
GOP leaders this week were reportedly trying to woo Murkowski on the Graham bill by offering her state the option to essentially continue to operate under the Obamacare framework. If those reports were correct, it didn’t immediately appear the bid was enough to convince Murkowski to go along.
Norman Ornstein, a resident scholar at the American Enterprise Institute and a longtime expert on Congress, said the only path to victory he could see at this point was in making concessions to Paul to move the bill further to the right.
“But I don’t quite see how they do that over the weekend,” Ornstein said. “And if they make any of those changes, I don’t see how Murkowski can vote for this.”
Graham’s bill, also sponsored by Republican Sens. Bill Cassidy of Louisiana, Dean Heller of Nevada and Ron Johnson of Wisconsin, was widely panned by the health care community. Advocates warned there were few promises that individuals with preexisting conditions would be protected and little guarantee Medicaid would not suffer devastating cuts.
Even staunch Senate Republicans such as Chuck Grassley of Iowa readily acknowledged there were reasons to oppose the measure, but insisted it was necessary to forge ahead as a way to keep the party’s seven-year-old pledge to replace the Democratic-authored health care law.
A recent analysis from the UC Berkeley labor center estimated the bill would leave 62,400 Merced County residents without coverage by 2027, including 16,800 local children.
Kathleen Grassi, director of Merced County’s Public Health Department said the bill would be bad for valley residents and further undermine access to health care for struggling families.
“I can say that I’m worried,” Grassi said. “It worries me. I don’t think it's a good solution.”
The ACA brought prevention programs and services that were reimbursed through Medi-Cal in California, Grassi said, and the passing of the Graham-Cassidy bill would reallocate the money used for those services.
Insurers would have more flexibility to exclude covering those with preexisting conditions and could eliminate essential services like maternity care.
“These are things that would essentially undermine gains and strides made in last 3 years around the ACA,” she said. “Getting individuals covered with not only some level of coverage but really comprehensive care for all needs.”
Stephanie Nathan, program manager with the Merced County Health Department, said the ACA emphasized preventative care and allowed people to head off health issues before a trip to the emergency room was necessary.
“With this bill unfortunately that’s at risk,” she said.
Grassi said young children, especially from lower-income families, could be left out under the bill.
“It’s the vulnerable populations that tend to be left out … the ACA is not perfect but did have a vision and intent to cover our most vulnerable population,” Grassi said.
Michael Tanner, a senior fellow at the libertarian Cato Institute, predicted the GOP would pay a political price if the bill dies.
“It’s been seven years,” he told McClatchy. “Republicans never actually knew what they wanted in a bill. And this bill was symptomatic of it.”
On Friday afternoon, Graham released a statement saying his friendship with McCain, who was recently diagnosed with an aggressive form of brain cancer, remained strong.
“My friendship with John McCain is not based on how he votes but respect for how he’s lived his life and the person he is,” Graham said.
While he could not say with certainly whether his bill still had a lifeline, Graham made it clear he didn’t plan on giving up the fight.
“Obamacare is collapsing in Arizona, South Carolina, and across the nation – driving up premiums and reducing choices,” Graham said. “I feel an obligation to fix this disaster and intend to push forward for state-centric health care versus Washington-knows-best health care.
“I’m excited about the solutions we have found,” he continued. “We press on.”
Emma Duman @emma_dumain