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GOP health bill in major peril as resistance hardens among key senators

 
Sen. Susan Collins, R-Maine, a moderate, said Sunday that it was “very difficult” to envision voting for this health-care bill.
Sen. Susan Collins, R-Maine, a moderate, said Sunday that it was “very difficult” to envision voting for this health-care bill.
Published Sept. 25, 2017

WASHINGTON — The floundering Republican attempt to undo the Affordable Care Act met hardening resistance from key GOP senators Sunday that left it on the verge of collapse even as advocates vowed to keep pushing for a vote this week.

With party leaders just one "no" vote away from defeat, Republican senators from across the political spectrum distanced themselves from the plan written by Sens. Bill Cassidy, R-La., and Lindsey Graham, R-S.C. They voiced opinions ranging from measured skepticism to outright hostility toward a proposal that was already trending toward failure over the last three days.

Sen. Susan Collins, R-Maine, a moderate Republican who has opposed previous efforts that cut Medicaid and lifted coverage requirements, said in a TV interview that it was "very difficult" to envision voting for the health-care bill.

Sen. Ted Cruz, R-Texas, a conservative who has advocated for a more far-reaching repeal of Obamacare, said he and at least one other colleague do not back the measure "right now."

And Sen. Rand Paul, R-Ky., who has stated definitively that he opposes the current measure, showed no signs of backing down absent dramatic changes to the bill's core approach that likely would come at the cost of other Republican votes.

Graham and Cassidy pledged to keep trying to pass their bill — but the White House and Senate Majority Leader Mitch McConnell, R-Ky., gave differing accounts of the path ahead. White House legislative affairs director Marc Short predicted a Wednesday vote, while a McConnell spokesman declined to publicly embrace that time line.

Speaking on CNN's State of the Union, Collins cited concerns about how the Cassidy-Graham legislation would affect Medicaid recipients and people with pre-existing medical conditions, among other things.

"It is very difficult for me to envision a scenario where I would end up voting for this bill," Collins said. "I have a number of serious reservations about it."

Collins voted against a July repeal bill and is a key swing vote in the current dynamic. She said she chatted at length with Vice President Mike Pence on Saturday, but it wasn't enough to sway her. She said she wants to see the limited analysis due out this week from the nonpartisan Congressional Budget Office before she makes a final decision.

Two Republican senators — Paul and John McCain, Ariz. — have already said they would vote against Cassidy-Graham. A third would be enough to defeat the bill, since no Democrats are expected to support it. Republicans hold a 52-48 advantage in the Senate and can lose only two of their own and still pass legislation with the help of a tiebreaking vote from Pence.

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 American Hospital Association, issued a joint statement urging the Senate to reject it.

While the CBO plans to release a "preliminary assessment" early this week, officials there have said they will not be able to provide estimates of how Cassidy-Graham would affect insurance premiums or the number of people with coverage "for at least several weeks." President Donald Trump and McConnell are trying to bring the bill to a vote by the end of this week to take advantage of a procedural rule allowing the plan to pass with just 51 votes.

It remained far from clear Sunday that they could get even close to that number.

Addressing Cassidy-Graham at the Texas Tribune Festival in Austin, Cruz said: "Right now, they don't have my vote. And I don't think they have Mike Lee's either," referring to one of Utah's senators and a fellow conservative.

Conn Carroll, a Lee spokesman, said Sunday: "We want some technical changes. We are working with Cassidy, but we haven't committed to anything yet."

Paul said in a Sunday interview that he broadly opposes a keystone of the Cassidy-Graham plan: turning funding for the ACA into block grants for states.

"The problem I have with block grants is that looks like I've affirmatively said I'm okay with 90 percent of Obamacare as long as we reshuffle it and give it to Republican states," he said. "That's a horrible message."

Paul presents another challenge, as well: Winning him over would likely alienate other Republican senators who oppose a more aggressive repeal. That left GOP leaders no better off in their quest to secure enough Republican votes to pass Cassidy-Graham.