Senator Susan Collins told CNN’s Jake Tapper that it’s “very difficult to envision a scenario” in which she would back back the Graham-Cassidy health care bill, and that she has “serious reservations” about it.

“What I am doing, as is my general practice, is I would like to see the Congressional Budget Office analysis, which is expected to come out tomorrow morning,” the Maine Republican said on CNN’s State of the Union.

Republicans are trying to jam Graham-Cassidy through on a rushed timeline with as little oversight as possible, and the CBO has said it does not have time to release a full analysis of the bill, which would likely show tens of millions of people losing insurance as a result. But Collins had already seemed like a probable no, telling the Portland Press-Herald on Friday that she was “leaning against” voting for it.

In a further blow to GOP efforts, Senator Ted Cruz – nobody’s idea of a moderate – said on Sunday morning that he Utah Senator Mike Lee weren’t yet on board with the bill either.

Collins was one of the three Republican senators who defeated “skinny repeal,” the GOP’s last effort to replace the Affordable Care Act, in July. (She received a hero’s welcome in Maine afterward.) John McCain, who dealt that bill its death blow, announced his opposition to Graham-Cassidy on Friday. If Collins does vote no, it would take just one more vote to blow up Obamacare repeal once again. Republicans have until September 30 to pass it under Senate reconciliation rules, which require only 50 votes; after that, they would likely – though not definitely – need to wait until next year for another shot at repeal.

Beyond McCain and Collins, the two Republicans most likely to vote no are Kentucky’s Rand Paul and Alaska’s Lisa Murkowski. Paul has been unstinting in his opposition to Graham-Cassidy because it doesn’t go far enough, and has said he “won’t be bribed or bullied” into supporting it. Murkowski voted against “skinny repeal” and has given no indication that she will support this version of repeal. Her state’s governor has also raised serious concerns. But Republicans have been busy trying to buy off her vote, and White House sources still maintain that both senators could be flipped.

Every Democrat, every health care group imaginable, and, perhaps most importantly, Jimmy Kimmel stand in opposition to the bill, which would gut Medicaid, slash protections to pre-existing conditions, and generally make life miserable for millions. Some Republicans appear to know how catastrophic Graham Cassidy’s effects would be, but will vote for it anyway to follow through on the longstanding GOP promise to repeal Obamacare.

It’s not clear whether Senate Majority Leader Mitch McConnell will hold a vote on Graham-Cassidy this week if he knows he lacks the votes to pass it , but White House Legislative Director Marc Short, after lying to Chuck Todd about its provisions, predicted that the Senate will take it up on Wednesday. </s> (Bloomberg) — 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.
• Delta Air Lines says mysterious website tricks people who put pets on jets ‘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.

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.

QuickTake Q&A: What’s in Last Republican Shot to Kill Obamacare

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.

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.

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.

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. </s> U.S. Senator Susan Collins rebuffed intense lobbying from fellow Republicans and the promise of more money for her state in deciding on Monday to oppose - and likely doom - her party's last-ditch effort to repeal Obamacare.

The most moderate of Republican senators joined John McCain and Rand Paul in rejecting the bill to end Obamacare, a top priority for President Donald Trump, who pressured Collins in a call on Monday. A sweeping cut in funding to Medicaid, a program for low income citizens and disabled children, was the main reason for opposing the bill, she told reporters.

"To take a program that has been law for more than 50 years, and make those kinds of fundamental structural changes ... and to do so without having in depth hearings to evaluate the impact on our most vulnerable citizens was unacceptable to me," Collins said outside the Senate chambers.

She also opposed the bill for weakening protections for people with pre-existing conditions, such as asthma, cancer and diabetes.

"So for those reasons, I cannot support the bill," Collins said.

Collins' decision came even after the sponsors of the bill, Senators Lindsey Graham and Bill Cassidy, offered a boost in federal health care funds of more than 40 percent for her state, Maine.

For seven years, Republicans have vowed to get rid of Democratic former President Barack Obama's signature healthcare law, which extended health insurance to some 20 million Americans. They believe it is an unwarranted and costly government intrusion into healthcare, while also opposing taxes it imposed on the wealthy.

Republicans, who hold a slim 52-48 majority in the Senate, are up against a tight September 30 deadline to pass a bill with a simple majority, instead of the 60-vote threshold needed for most measures. Senate Majority Leader Mitch McConnell wanted to hold a vote this week, but it is not clear he will do so now that three senators have said they will cast "no" votes.

Graham dismissed notions that the bill was the last chance for Republicans to get rid of Obamacare and pledged to keep working on the legislation.

Democrats kept up their pressure for killing the bill. In an evening speech on the Senate floor, Senate Democratic leader Chuck Schumer said, "The Trumpcare bill would gut Medicaid, would cause millions to lose coverage, cause chaos in the marketplace."

Schumer said once repeal of Obamacare is off the table, Democrats want to work with Republicans "to find a compromise that stabilizes markets, that lowers premiums."

Collins and McCain, who voted against the last major repeal effort in July, have both advocated for a bipartisan solution to fixing the parts of Obamacare that do not function well.

U.S. hospital stocks were down across the board as the bill struggled. Shares of HCA Healthcare Inc and Tenet Healthcare Corp were hit particularly hard, falling 2.5 percent and 5.7 percent, respectively, on Monday.

"The Graham-Cassidy bill is looking to reduce funding for Medicaid in the longer term," said Jefferies analyst Brian Tanquilut. "That is a benefit that we have seen improve the earnings outlooks for these hospitals."

Collins announced her opposition shortly after the non-partisan Congressional Budget Office said that the number of people with health insurance covering high-cost medical events would be slashed by millions if it were to become law.

CBO also found that federal spending on Medicaid would be cut by about $1 trillion from 2017 to 2026 under the Graham-Cassidy proposal, and that millions of people would lose their coverage in the program, mainly from a repeal of federal funding for Obamacare’s Medicaid expansion.

The Trump administration, including Health Secretary Tom Price had lobbied her hard in recent days, Collins said.

“The president called me today, the vice president called me in Maine over the weekend, Secretary Price has called me, it would probably be a shorter list of who hasn’t called me about this bill,” she said.

Trump had not called Collins before the vote in July.

The Senate held its first hearing all year on the proposed Obamacare repeal on Monday, but it was immediately disrupted by protesters who forced Senate Finance Committee Chairman Orrin Hatch to postpone its start by about 15 minutes.

The protesters, mainly from a disability rights group and many of whom were in wheelchairs, were forcibly removed one-by-one from the hearing room as they yelled, "No cuts to Medicaid, save our liberty." The hearing eventually proceeded for about five hours, but protests could be heard outside for more than an hour.

Police arrested 181 demonstrators, including 15 in a senate hearing room. Police removed some protesters from their wheelchairs and carried them out by the arms.

Television talk show host Jimmy Kimmel, who had become part of the debate on U.S. healthcare legislation in May after discussing his newborn son's heart surgery, had taken aim at the bill in recent days. On Monday he tweeted: "Thank you @SenatorCollins for putting people ahead of party. We are all in your debt."

A new CBS poll released earlier on Monday said that a majority of Americans - 52 percent- disapprove of the Graham-Cassidy bill. It said only 20 percent of those polled approved. The poll was taken between Sept. 21 and 24. </s> Sens. Bill Cassidy, R-La., and Lindsey Graham, R-S.C., will serve up a new version of their bill overhauling Obamacare on Monday, even as the whole grand effort appears headed for a meltdown. The new version still kind of looks the same as the old one. But it apportions bigger slices of federal health spending to the states of key senators who were leaning against -- or outright opposed -- to the original bill, endangering its success.

If you read the updated bill, which was leaked Sunday night to The Washington Post and other news outlets, it's pretty clear which senators Cassidy and Graham are playing to. A state-by-state summary claims Alaska would get 3 percent more funding, Arizona would get 15 percent more funding and Maine would get 43 percent more funding from 2020 and 2026 compared to current law.

Senators from all three of those states - Lisa Murkowski, John McCain and Susan Collins - had backed away from the bill in recent days. McCain indicated on Friday he'd oppose the bill because it wasn't going through regular order, while Collins and Murkowski said they want to better understand how it would affect their own states.

With Sen. Rand Paul, R-Ky., still insisting he won't back the bill, nabbing two of those three senators is crucial. Senate Republicans have just five days left to pass a measure repealing and replacing big parts of the Affordable Care Act. Their opportunity runs out on Oct. 1, when the budget reconciliation bill around which they'd based their entire strategy expires.

Acutely aware of the stakes, Senate GOP leadership and the White House are engaged in an all-in effort to rally the votes. But it's far from clear that they can get all but two Republicans to swallow this latest Cassidy-Graham iteration.

The plan was distributed among Republicans late Sunday. Aides to Murkowski and Collins did not immediately comment. Some 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. On Sunday night, some were once again privately pessimistic the changes would convince her to vote yes.

McCain is unlikely to bite. Even if the Senate Finance Committee considers Cassidy-Graham 2.0 in its high-profile health-care hearing Monday afternoon, there wouldn't be nearly enough time for the Congressional Budget Office to score it before a vote this week. Lawmakers do expect an analysis from the CBO Monday, but it will be based on the first version of Cassidy-Graham. And that's a far cry from the "regular order" McCain has called for.

But Cassidy and Graham, who have argued that Republicans must pass a bill repealing much of the Affordable Care Act or face serious retribution from their core voters in next year's midterms, are pressing forward. They will present their new bill as more equally distributing federal health-care spending among the states, so that no one state faces a big funding cliff.

The duo is still taking the same basic approach to revamping the ACA: The bill gathers its subsidies for private coverage and its Medicaid expansion, lumps together all of that spending, cuts it somewhat, and redistributes it to states in the form of block grants.

Under the first Cassidy-Graham bill, that would have resulted in a median change of 11 percent less funding for states that expanded Medicaid and 12 percent more for states that didn't, according to an analysis by the nonpartisan Kaiser Family Foundation. But there was a wide variation in the block grant funding; Mississippi would get 148 percent more relative to current law, while New York would get 35 percent less from the federal government, Kaiser had estimated.

The new version doesn't change the total sum of money the federal government would spend on the block grants from 2020 to 2026. Instead, it tries to smooth out the formula in what its sponsors hope is an effort to put states on a more equal footing. But the new version also creates some winners and losers: South Dakota would see the largest funding increase (88 percent) while Oregon would lose the most federal funding (17 percent).

--Let's look at Alaska and Maine. Kaiser had estimated the first version of Cassidy-Graham would result in 8 percent less block grant funding for Alaska; Republicans claim that under their latest bill Alaska would get 3 percent more. Kaiser had also estimated that Maine would get 8 percent more under the initial measure; it would get 43 percent more under the revised version of the bill, according to the GOP documents.

But let's also throw in an important caveat here: The estimates that Cassidy and Graham will publicly release Monday make some assumptions that independent analysts say are rather disingenuous.

For one thing, the state funding estimates don't take into consideration the bill's additional cuts to regular Medicaid spending. If those cuts were considered, it would be clear that states like Alaska and West Virginia would still be losing out on federal funds overall. And the GOP estimates also assume that states would slash their own funding for coverage and then factor that into the final number as "state savings."

Of course, opponents of Cassidy-Graham noted these things -- and kept sharply criticizing the bill overall -- Sunday night and into the early morning hours. Reporters also pointed out how the Republican estimates could be misleading:

From the Wall Street Journal's Michelle Hackman who tweeted:

2) do not factor in significant medicaid cuts"

From the Center on Budget and Policy Priorities's Jason Leibenluft who tweeted: </s> Sen. Susan Collins of Maine was the fourth GOP senator to announce she will not vote for Republicans’ last-ditch plan to finally repeal ObamaCare – signaling an end to the bill.

Collins said Monday that the Graham-Cassidy bill, chiefly written by Sens. Lindsey Graham of South Carolina and Bill Cassidy of Louisiana, was “deeply flawed.” She joins Sens. Rand Paul, John McCain and Ted Cruz in opposition of the legislation – although Cruz reportedly could change his vote if certain adjustments are made to the plan.

The Graham-Cassidy bill got some last-minute revisions over the weekend in an effort to garner more support, specifically from Sen. Lisa Murkowski, R-Alaska, who has not announced her decision.

The legislation, largely seen as a Hail Mary pass by Republicans to make good on their years-long promise to eradicate ObamaCare, can only afford to have two Republicans vote against the bill without any support from Democrats before it's doomed.

President Donald Trump has strongly peddled the Graham-Cassidy legislation, specifically on Twitter, and urged senators to vote for it.

Senate Republicans scrambled ahead with the new plan since they have until September 30 to push through health care reform using a special procedure to avoid a filibuster. However, Republicans are reportedly hesitant to bring this latest effort to a vote.

Read on for a look at what the Graham-Cassidy bill does.

What does the legislation do?

The Graham-Cassidy legislation would implement a block grant program that gives funding to states, which would then have a wide leeway on how that money is spent.

“We’ll allow [the] states to come up with solutions to help sick people, not just some bureaucrat in Washington,” Graham told Fox News.

“We’ll eliminate the individual mandate, the heart and soul of ObamaCare, that is gone at the federal level. We take the money and send it back to the states in a block grant formula where they can administer health care,” Graham added.

The plan would eliminate Medicaid expansion, tax credits, employer mandates and cost-sharing subsidies. It would let states ease coverage requirements.

New provisions were added over the weekend that would allocate additional money to Alaska and Wisconsin. Among others, one provision allowed for an increase in Medicaid funding to states with a high population of Native Americans, including Alaska.

Consulting firm Avalere Health predicted that Graham-Cassidy would “significantly” reduce federal funding to states by $215 billion by 2026.

Avalere also said states with a higher number of individuals in insurance affordability programs and Medicaid would face a greater impact. California would suffer the greatest loss, it said.

Sen. John McCain, R-Ariz., previously said that he would “reluctantly” vote for the measure if Gov. Doug Ducey supported it – which he does.

But McCain said Friday that he would have considered the bill from his "friends" if "it were the product of extensive hearings, debate and amendment."

"We should not be content to pass health care legislation on a party-line basis, as Democrats did when they rammed ObamaCare through Congress in 2009," McCain said.

REPUBLICANS WONDER ALOUD IF A HEALTH CARE VOTE IS WORTH THE PAIN

Sen. Lisa Murkowski, R-Alaska, who also voted against the previous “skinny repeal” in July which failed 51 to 49, has not signaled what her decision will be.

Sen. Rand Paul, R-Ky., was the first Republican who said he would vote against the bill.

Paul said the plan would further increase the nation’s debt and doesn’t “repeal a single ObamaCare insurance regulation” such as essential health benefit rules.

The bill needs 50 votes to pass, with Vice President Pence potentially casting a tie-breaking vote. Pence said he’s “all in” for the plan.

What does the Congressional Budget Office say?

The Congressional Budget Office released a preliminary assessment of the bill Monday that does not provide “point estimates that are typical” in analyses because of time constraints.

Along with the Joint Committee on Taxation, the analysis estimated that the proposal would reduce the on-budget deficit by at least $133 billion. It would also lower the number of people with comprehensive health insurance by “millions.”

“That number could vary widely depending on how states implemented the legislation, although the direction of the effect is clear,” the analysis said.

Fox News’ Chad Pergram and The Associated Press contributed to this report. </s> Sen. Ted Cruz said Sunday that Republican leaders can’t count on his vote for the GOP’s latest Obamacare repeal effort, as it currently stands, and that he suspects Sen. Mike Lee of Utah feels the same way.

“Right now, they don’t have my vote, and I don’t think they have Mike Lee’s, either,” Mr. Cruz said at the Texas Tribune Festival in Austin, referring to the Republican senator from Utah and one of his close friends.

“Now, I want to be a yes. I want to get there because I think Obamacare is a disaster,” he said.

He said it depends on what’s in the package and that the legislation being pushed by GOP Sens. Lindsey Graham of South Carolina and Bill Cassidy of Louisiana has some “very good elements.”

He said the best element of the Graham-Cassidy bill is the provision that would take federal Medicaid expansion money under Obamacare and block-grant it back to the states.

Republicans are trying to cobble together 50 votes to get the bill across the finish line this week, and can afford no more than two GOP defections in the Senate assuming no Democrats vote for it.

GOP Sens. John McCain of Arizona and Rand Paul of Kentucky have voiced their opposition, and GOP Sen. Susan Collins of Maine said Sunday on CNN it would be difficult to see a scenario where she would support it.

Mr. McCain and Mrs. Collins have expressed reservations about what they see as a rushed process, and Mr. Paul is opposed to the Medicaid block-grant provision, saying it effectively preserves part of Obamacare. </s> WASHINGTON — Republicans narrowly advanced their campaign to roll back the Affordable Care Act on Tuesday, as the Senate voted by a slim margin to begin debating legislation to repeal and potentially replace large sections of the 2010 law signed by President Barack Obama.

But the partisan 51-50 vote — with Vice President Mike Pence breaking a tie — does not assure the success of the GOP’s seven-year quest to dismantle the sweeping law, often called Obamacare.

With health coverage for tens of millions of Americans at stake, it remained unclear Tuesday what kind of health care bill — if any — might emerge by the time a final Senate vote is held, possibly as early as Thursday.

Senate Majority Leader Mitch McConnell, R-Kentucky, has set up a series of votes this week on competing proposals to repeal much of Obamacare, or repeal and replace pieces of the law.

Tuesday’s procedural vote to kick off that process marks a victory for McConnell, who has been laboring for months behind closed doors to rally his divided caucus, and for President Donald Trump, who has been publicly calling out GOP senators to stick with the repeal push.

But to get to the vote, McConnell abandoned customary legislative process, foregoing public hearings and committee debate in a way almost never seen for major legislative proposals.

And he left Republican lawmakers with a series of legislative options — which polls show are also deeply unpopular with Americans — that would leave as many as 32 million more people without health coverage and weaken health protections for tens of millions more.

The GOP plans have been widely panned by independent analysts and vigorously opposed by every major patient advocacy group and every leading organization representing physicians, nurses and hospitals.

Opponents include the American Diabetes Association, the March of Dimes, the AARP, the American Medical Association, the American Lung Association, the National Multiple Sclerosis Society, the American Heart Association and the advocacy arm of the American Cancer Society.

Republican Sens. Susan Collins of Maine and Lisa Murkowski of Alaska voted against the motion.

Collins posted on Twitter on Tuesday afternoon that she voted against the motion to proceed with debate on the bill because “when dealing w/ a complex issue that affects millions of Americans & ⅙th of our economy, we must proceed carefully.”

“Making sweeping changes to the 50-year-old Medicaid program without a single Senate hearing is a mistake,” she tweeted. “We must work in a bipartisan way to to fix the ACA’s serious flaws.”

In a statement Tuesday, Maine’s junior senator, independent Angus King, called the legislation “misguided,” adding that any version of the bill “will hurt millions of people across the country and tens of thousands of hardworking people across Maine.”

“I’ve never seen a process like this before with no hearings and it will almost certainly produce a terrible bill that will drastically raise costs for people in Maine, put coverage out of reach for many others, and reduce Medicaid funding, causing states to choose between helping seniors or children or people with disabilities,” King said. “As the Senate advances with this bill, I will continue to support and protect people in Maine and work to find solutions that keep people covered and make health care more affordable.”

GOP leaders were aided by the dramatic return to the Capitol by Sen. John McCain, R-Arizona, after surgery last week and a diagnosis of brain cancer. He arrived in the chamber to cheers and a standing ovation from his colleagues.

As Republicans next move to crafting a final bill, one leading GOP option, favored by conservatives, is to simply repeal most major parts of Obamacare, and then try to pass a new health care law in the future.

Another idea, supported at one point by GOP leaders, would replace most of the law while at the same time dramatically scaling back federal funding of the Medicaid insurance program that covers some 74 million low-income, elderly and disabled Americans.

GOP centrists have complained both of those versions would leave too many Americans without insurance, and have urged McConnell to start the process over, working on a bipartisan approach that will protect those covered under Obamacare.

So far, none of these approaches has garnered the necessary 50 votes from the Republicans’ 52-seat Senate majority.

The lack of GOP consensus prompted Senate Republican leaders to float a new idea Tuesday — a far more limited repeal bill that would target the most unpopular parts of Obamacare, including its insurance mandates.

That plan — dubbed “skinny repeal” — would eliminate only a medical device tax established by Obamacare and two mandates requiring Americans to have coverage and requiring large employers to offer health benefits.

The approach would fall far short of what Republicans have been promising for years.

If it passes, Senate Republicans could at least send something to a conference committee where lawmakers could work out a compromise with a sweeping repeal bill passed by House Republicans in May, giving them yet another shot at unwinding Obamacare.

That would all have to be done without Democrats, who remain fiercely opposed to the GOP repeal push and voted together Tuesday to try to block the beginning of Senate debate.

The skinny repeal plan risks major disruptions to the nation’s insurance markets, as the lack of any insurance mandate could free Americans to buy health insurance only when they get sick, driving up costs.

But it would leave in place other critical parts of the 2010 law, including hundreds of billions of dollars of federal aid to state Medicaid programs and insurance subsidies that help low- and moderate-income Americans

That assistance is credited with helping extend coverage to more than 20 million previously uninsured Americans.

Also untouched would be landmark rules established by Obamacare that require insurers to cover a basic set of benefits and prohibits health plans from discriminating against Americans with preexisting medical conditions.

It remains unclear whether House Republicans would agree to this more limited repeal plan.

But with centrist and conservative GOP senators in deep disagreement, the skinny repeal may be all McConnell can pass.

The repeal-only plan — which is favored by the most conservative GOP senators — would leave an estimated 32 million more people without health coverage over the next decade, according to the nonpartisan Congressional Budget Office, or CBO.

It is opposed by multiple centrist GOP senators.

The alternative proposed by McConnell that repeals and replaces major parts of the law while also dramatically scaling back federal Medicaid assistance is only slightly less disruptive, CBO analysts have concluded.

The McConnell proposal, which has drawn fire from both centrist and conservative Republicans, would leave 22 million more Americans without insurance by 2026.

That plan would be most devastating to the Medicaid safety net, which currently covers some 70 million poor Americans, including children. Federal Medicaid funding would be reduced by more than a third over the next two decades.

And while CBO concluded the “repeal-and-replace” plan could lower premiums for some consumers, it would likely put health insurance out of reach for older and sicker Americans who could be forced to pay larger deductibles or higher premiums than under the current law.

Still unclear is the effect of yet other GOP proposals that could come up for votes in coming days, including one by Sen. Ted Cruz, R-Texas, to allow health insurers to sell skimpier plans that do not include basic benefits such as prescription drugs, maternity care and mental health and substance abuse services.

The Cruz proposal is widely expected to make health coverage more expensive for sick Americans who need to buy more extensive health coverage and has been panned by health insurers as “unworkable.”

But McConnell elected to proceed with voting Tuesday before CBO had an opportunity to assess the potential impact of Cruz’s proposal. </s> A last-ditch ObamaCare repeal effort by Republicans was all but dead on Monday after Sen. Susan Collins Susan Margaret CollinsThis week: Congress returns for first time since mass shootings Congress faces sprint to avoid another shutdown Democrats make renewed push for election security MORE became the third Republican to oppose the measure.

Collins announced her opposition minutes after the Congressional Budget Office released an analysis predicting that millions would lose insurance under the proposal if it became law.

That was enough for Collins, who had long been seen as an almost certain ‘no’ vote on the measure.

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She joins Sens. John McCain John Sidney McCainTop Arizona GOP official asks supporters to help stop 'gun grabber' Mark Kelly 'dead in his tracks' O'Rourke hits Meghan McCain for saying government taking away guns would cause 'a lot of violence' Sanders cites retiring lawmakers when asked which Republicans he could work with MORE (Ariz.) and Rand Paul Randal (Rand) Howard PaulGraham promises ObamaCare repeal if Trump, Republicans win in 2020 Conservatives buck Trump over worries of 'socialist' drug pricing Rand Paul to 'limit' August activities due to health MORE (Ky.) as GOP “no” votes. Republicans can only afford two defections and still muscle the bill through the Senate.

In a lengthy statement, Collins said the most recent ObamaCare repeal bill, which had been reshaped Sunday in an effort to win her over, “was as deeply flawed as its previous iterations.”

She cited the CBO’s score as one of her reasons for opposing the legislation authored by GOP Sens. Lindsey Graham Lindsey Olin GrahamTrump cancels secret meeting with Taliban leaders, Afghan president after attack Republicans grumble over Trump shifting military funds to wall Hurricane-hit bases among those losing funds to Trump wall MORE (S.C.) and Bill Cassidy William (Bill) Morgan CassidyRepublicans grumble over Trump shifting military funds to wall Push on 'surprise' medical bills hits new roadblocks Iowa professor resigns after saying he's affiliated with antifa MORE (La.), while also criticizing its cuts to Medicaid, its weakening of protections for people with preexisting conditions and predictions by insurers, hospitals and other groups that it would lead to higher premiums and less coverage for people.

Collins also decried a Senate process that she said had been rushed along.

“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,” said Collins, one of three Republicans along with McCain and Sen. Lisa Murkowski Lisa Ann MurkowskiTrump moves to permit new logging in Alaska's Tongass National Forest: report Innovation for the climate through innovative policy Overnight Energy: Green groups sue Trump over Endangered Species Act changes | Bureau of Land Management retirees fight plan to relocate agency | Wildfires in Amazon rainforest burn at record rate MORE (Alaska) to vote “no” on a previous slimmed-down ObamaCare repeal bill in July that appeared to end the debate.

“This is simply not the way we should be approaching an important and complex issue that must be handled thoughtfully and fairly for all Americans.”

It’s not clear whether Senate Majority Leader Mitch McConnell Addison (Mitch) Mitchell McConnellMajority fear mass shooting in their community: poll Top Democrats press Trump on background checks legislation The Hill's Morning Report - Congress returns: What to expect MORE (R-Ky.) will still try to hold a floor vote later this week, something some GOP donors and the White House may want to see just to get senators on the record.

“I think we’re going to need to have a meeting of our conference tomorrow ... so we can kind of see where everybody is before there will be any news,” Sen. John Cornyn John CornynTrump awards Medal of Valor, civilian honors to responders in Dayton and El Paso shootings The Hill's Morning Report - Congress returns: What to expect Cornyn faces toughest race yet in changing Texas MORE (R-Texas) told reporters after a meeting in McConnell’s office on Monday evening.

It’s possible there could be more defections than just the three public GOP “no” votes, as Republicans in the center and on the right have both raised reservations about the measure.

Republicans last week said a vote on the Graham-Cassidy measure was possible, though another public failure on ObamaCare could hurt McConnell’s caucus ahead of next year’s midterm elections.

The push came as Republicans faced a Sept. 30 deadline for passing ObamaCare repeal under special budget reconciliation rules that prevent Democrats from launching a filibuster.

The pressure to take advantage of those rules, plus an opening on the Senate schedule created by a debt-and-spending deal between President Trump and congressional Democrats, created room for the health-care repeal push.

Republicans had also heard an earful from conservative activists disappointed that the GOP had failed to repeal ObamaCare even with the White House and Congress in its control.

Even with the GOP effort seemingly at death’s door after McCain’s announcement of opposition on Friday, emotions were high throughout the day with repeal opponents seeking to build the pressure.

Scores of protesters, many of them in wheelchairs, jammed the GOP’s one-and-only hearing on the bill. Capitol Police had to drag some out of the hearing room.

Trump seems to sense the futility of the GOP effort.

“Looks like Susan Collins and some others who will vote against,” Trump said during an interview on the “Rick & Bubba” radio show on Monday. “We’re going to lose two or three votes and that’s the end of that.”

As criticism mounted over the weekend from health-care groups and senators, the bill’s main sponsors, Sens. Bill Cassidy (R-La.) and Lindsey Graham (R-S.C.) on Monday unveiled a revised version of the bill aimed at winning over Murkowski and Collins.

It kept the bill’s basic structure of repealing ObamaCare and creating block grants to deliver health-care funding to states, but offered additional Medicaid funding to Alaska and Hawaii.

Still, Alaska would receive slightly less federal funding than under ObamaCare even with the changes.

Paul, at a press conference on Monday, called the offer extra money for specific states “unseemly” and doubled down on his opposition.

“This was thrown together in a slipshod way,” Paul said. “Who would say we're going to vote on a trillion dollars worth of grants without even the CBO looking at it or anybody else?”

Cassidy and other proponents acknowledged problems with the process surrounding the bill, but cast their effort as an improvement on ObamaCare that would deliver power to states.

“I don’t defend this process,” Cassidy said at Monday’s hearing, while blaming Democrats for a lack of cooperation throughout the year.

The CBO did not give a specific number of people who would lose coverage in its estimate, but said it would be in the “millions.”

The bill also would reduce deficits by more than $133 billion over 10 years, CBO found, clearing a hurdle in qualifying for special rules to avoid a filibuster.

As the Senate Finance Committee held its hearing Monday, Democrats criticized the effort, saying it was just for show.

Dozens of protesters arrived outside the hearing room as early as 5 a.m., nine hours before the hearing began.

Chants of “No cuts to Medicaid, save our liberty” rang through the halls, and could be heard through the hearing room during the initial testimony. </s> WASHINGTON - The Senate voted Wednesday to defeat a bill that would have repealed Obamacare within two years without any immediate plan to replace the sweeping health care law.

Senators voted 45-55 in favor of the bill, falling six votes short of the 51 needed to pass it. Seven Republicans voted against it: John McCain of Arizona, Dean Heller of Nevada, Susan Collins of Maine, Rob Portman of Ohio, Lamar Alexander of Tennessee, Lisa Murkowski of Alaska and Shelley Moore Capito of West Virginia.

The vote comes on the second day of a 20-hour Senate debate on health care as Republican leaders scramble to win enough votes from their own members to pass something to replace the Affordable Care Act. The Senate began its session Wednesday morning with about 17 hours left in the debate.

Here's a look at where things stand now:

What are they voting on today?

The big vote so far was the failed attempt to pass the amendment by Sen. Rand Paul, R-Ky., to repeal the Affordable Care Act within two years, which would have given lawmakers time to come up with a replacement plan before the law expired. The proposal is the same as one passed by Congress in 2015, which was vetoed by former president Barack Obama. Collins is the only Republican senator who voted against the bill both times.

With a Republican president in the White House, GOP leaders tried again. Paul and other conservatives have led the push for a complete repeal of Obamacare. But there has been a lot of hesitation among Republicans for "repeal" without a plan for "replace."

What have they already voted on?

On Tuesday, senators voted 50-50 to begin debate on a health care bill. Vice President Pence had to come to the Senate chamber to break the tie and allow debate to start.

After that, the biggest news came Tuesday night when senators defeated a Republican bill, on a vote of 43-57, to replace Obamacare. Nine Republican senators voted against the legislation, which was drafted by Senate Republican leaders.

It included a proposal by Sen. Ted Cruz, R-Texas, to allow insurers to sell bare-bones health care plans that don't cover maternity care and other major benefits as long as the companies also sell plans that include a full range of benefits.

The defeated plan also included a proposal by Sen. Rob Portman, R-Ohio, to provide $100 billion in aid to help low-income Americans pay their medical bills after they lose Medicaid coverage as a result of the Senate health care bill.

What are Democrats doing?

The Democrats have been voting against the Republican bills to repeal and replace Obamacare. They also are using procedural tactics to try to slow down the debate process.

For example, Sen. Joe Donnelly, D-Ind., will offer a motion Wednesday to send health care legislation back to the Finance Committee for consideration. On Tuesday, they objected to the usual Senate practice of waiving the reading of the bill, so Senate clerks had to spend several hours reading the leadership replacement bill aloud.

What happens after the 20 hours of debate are over?

A vote-a-rama will begin on dozens of amendments offered by senators of both parties. That is expected to start Thursday.

Do Republican Senate leaders have an endgame?

With the defeat of the comprehensive replacement bill and the "clean" repeal bill, GOP leaders are now looking to pass a "skinny repeal" bill that would make limited changes to Obamacare. It would likely strip out the law's tax on medical devices and its requirements for individuals to buy health insurance and large employers to provide coverage for their workers.

If that plan passes the Senate, it would most likely go to a conference committee of House and Senate negotiators who would try to work out a final compromise.

Democrats say Senate leaders just want to pass anything they can take to this conference committee, where the real bill would be crafted.

"It's becoming clearer that, in the end, the majority leader might push a much scaled-back version of repeal in the hopes of passing something, so-called skinny repeal, just to get to conference," Minority Leader Chuck Schumer, D-N.Y., said in a speech on the Senate floor Wednesday. "But my colleagues, make no mistake about it, skinny repeal is equal to full repeal. It's a Trojan horse designed to get the House and Senate into conference where the hard-right flank of the Republican Caucus, the (House) Freedom Caucus, will demand full repeal or something very close to it."

Why has it been so difficult for the Senate to reach agreement?

Republican leaders have been trying to please the conservative and moderate wings of their party, and they have so far failed to win the support of both groups.

Conservatives generally want a complete repeal of Obamacare's taxes and regulations while moderates worry that ending the law's Medicaid expansion will leave struggling Americans with no way to afford medical coverage.

"Ultimately, we want to get legislation to finally end the failed Obamacare status quo through Congress and to the president’s desk for his signature," Majority Leader Mitch McConnell, R-Ky., said Wednesday in a speech on the Senate floor. "This certainly won’t be easy. Hardly anything in this process has been."
United States Senator Susan Collins says she will vote "no" on the Graham–Cassidy bill joining Senators John McCain and Rand Paul and possibly ending the most recent effort to repeal Obamacare.