BREAKING: Senate GOP leaders admitted defeat late Monday afternoon in their latest attempt to undo the Affordable Care Act, as a third Republican lawmaker said she would not support the legislation.
Senate Finance Committee Chairman Orrin G. Hatch (R-Utah) told reporters that he did not think the measure would come up for a floor vote by the end of the week, after which point Republicans lose the budget authority they need to pass a health-care bill by a simple majority. A short time later, Sen. Susan Collins (R-Maine) announced her opposition.
Collins’s decision followed a preliminary projection from the Congressional Budget Office that said “millions” fewer Americans would have insurance coverage by 2026 under the Cassidy-Graham proposal. In a statement, Collins said the analysis “confirms that this bill will have a substantially negative impact on the number of people covered by insurance.”
Both GOP Sens. Rand Paul (Ky.) and John McCain (Ariz.) also have said they would not vote for the bill.
Senate Republicans aired the details of the latest effort to undo the Affordable Care Act at a raucous hearing before the Senate Finance Committee on Monday, with little evidence that the last-minute changes would secure enough votes for the legislation’s passage.
Of at least four Republican senators seen as crucial to the bill’s success, none indicated Monday that they were any closer to backing the proposal after its sponsors, Republican Sens. Bill Cassidy (La.) and Lindsey O. Graham (S.C.), rewrote portions of it in an effort to win their support.
Sen. Rand Paul (Ky.), who is one of two GOP senators against the bill, reiterated his opposition to the updated measure, and the other lawmaker, Sen. John McCain (Ariz.), has objected to it on the grounds that there has been no bipartisan outreach.
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 he did not commit to a vote. Nor did he offer any timeline under which the legislation might be considered by the full Senate.
Instead, McConnell’s comments had an air of finality. 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 — Lisa Murkowski (Alaska) and Susan Collins (Maine) — have expressed concerns, but not yet declared how they would vote on the measure.
The contentious debate erupted into public view Monday afternoon as protesters chanted so loudly at the hearing’s outset that the panel’s chairman, Orrin G. Hatch (R-Utah), 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.
The drama in the hearing room, however, will do little to determine the bill’s final outcome. Instead, an upcoming congressional analysis due out later Monday and a behind-the-scenes push by the legislation’s authors will likely decide its fate.
In an interview Monday, 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.”
A vote by Collins or any other senator would be enough to defeat the bill, since no Democrat is expected to support it. 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.
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 come as GOP leaders are 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 and Collins 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.
A critical question facing the bill’s proponents is whether they can woo Collins, a moderate Republican who has opposed previous efforts that cut Medicaid and eased coverage requirements. She said Sunday on CNN’s “State of the Union” that it was “very difficult” to envision herself voting for it, citing concerns about how it would affect Medicaid recipients and people with preexisting conditions, among other things.
Collins voted against a repeal bill in July, and she is a key vote in the current dynamic. She said she chatted at length with 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 making a final decision.
The CBO will issue a preliminary analysis of an updated version of the bill later Monday, it announced in a blog post, though the report will address only the legislation’s fiscal impact and not its effects on the number of Americans with health coverage or on insurance premiums.
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.
Other Republicans also have expressed reservations about the latest effort to unwind the ACA. Sen. Ted Cruz (R-Tex.) — a conservative who has advocated a more far-reaching repeal — said at the Texas Tribune Festival in Austin that he and at least one other conservative, Sen. Mike Lee (R-Utah), do not back the measure “right now.”
Cruz said he and Lee met with Graham and Cassidy last week to propose changes to the measure that would get them to yes. Their changes were not included in the latest draft.
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.
Paige Winfield Cunningham, Elise Viebeck and Mike DeBonis contributed to this report.