Congress Health Overhaul

Sen. John McCain, R-Ariz., speaks to reporters at the Capitol as the Republican-controlled Senate unable to fulfill their political promise to repeal and replace "Obamacare" because of opposition and wavering within the GOP ranks, on Capitol Hill in Washington, Thursday, July 27, 2017. (AP Photo/Cliff Owen) ORG XMIT: DCCO117

Cliff Owen

WASHINGTON — U.S. Sen. John McCain of Arizona announced his opposition to a last-ditch Republican effort to replace Obamacare Friday afternoon, leaving the effort on life-support.

“I cannot in good conscience vote for the Graham-Cassidy proposal," McCain said of the plan, spearheaded by Louisiana's Sen. Bill Cassidy and Sen. Lindsey Graham of South Carolina. "I believe we could do better working together, Republicans and Democrats, and have not yet really tried."

McCain's announcement deeply imperils Cassidy and Graham's proposed health care overhaul, which they've billed as Republicans' final opportunity to fulfill promises to repeal the Affordable Care Act, commonly known as Obamacare.

But it doesn't yet doom the Cassidy-Graham plan to certain failure. Republicans have until Sept. 30 to pass the bill with a simple-majority vote under a process known as reconciliation. With Democrats and independents unified in opposition, Cassidy and Graham can only afford to lose two Republican colleagues and still pass their plan.

McCain joins Kentucky's Rand Paul in opposing the bill, which Paul has labeled "Obamacare-lite" and has blasted for not going far enough to gut the ACA.

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Sen. Susan Collins, R-Maine, has said she's "leaning" toward voting no on Cassidy-Graham, according to the Portland Press-Herald newspaper in Maine. Yet Collins — who with McCain and Alaska Sen. Lisa Murkowski broke ranks to defeat the Republicans' previous attempt to replace the Affordable Care Act in July — hasn't definitively pledged to vote against it.

Opposition from Collins, or from one of a handful of other undecided Republicans, would send the Cassidy-Graham plan down in defeat.

Murkowski has repeatedly told reporters she needs to study the bill more closely and is weighing analyses by a number of different groups that show the potential impact on her state, which because of its massive geographic size and sparse population faces unique costs and challenges in delivering health care.

Sens. Rob Portman, R-Ohio, Shelley Moore Capito, R-West Virginia, and Cory Gardner, R-Colorado, have also not indicated publicly which way they'll vote. All represent swing states that expanded Medicaid and most analyses of the proposals show all three states losing out on funding under Cassidy-Graham.

At the heart of the Cassidy-Graham plan is a formula that would take the federal dollars currently pouring into the Affordable Care Act's individual health insurance subsidies and Medicaid expansion and bundle them into flexible block grants instead. It would also phase in a population-based cap on federal funding for traditional Medicaid as well.

The Congressional Budget Office is expected to release an initial, partial analysis of the Cassidy-Graham proposal this week. But the report won't consider the bill's effects on the total number of people covered by health insurance, nor will it analyze its impact on the federal deficit. The CBO has said those estimates will take several more weeks.

But estimates and analyses of the bill by a number of other groups — including the federal Centers for Medicare and Medicaid (CMS) — indicate that states that expanded Medicaid under the Affordable Care Act as well as those with high rates of enrollment on the law's health insurance exchanges will see federal health care funding cut under Cassidy-Graham.

Louisiana, which expanded Medicaid in 2016 following the election of Democratic Gov. John Bel Edwards, is among those widely projected to lose federal funding, though figures on exactly how much differ. Edwards and Dr. Rebekah Gee, secretary of the state Department of Health, have come out against the plan.

The Centers for Medicare and Medicaid estimated Louisiana would lose $2.4 billion in federal funding in 2026, not including cuts from the proposed law's caps on traditional Medicaid funding, while Avalere Health, a consulting group, estimated in a study funded by the Democrat-aligned Center for American Progress that the state could lose as much as $8 billion over the next decade.

Cassidy has argued that the bill's rollback of a required 10 percent state match on Medicaid expansion dollars and increased funding for hospitals serving low-income areas would offset those cuts, though the state and several outside analysts have disputed that.

Rumors have swirled around Capitol Hill that Cassidy and Graham — along with co-sponsors Sens. Dean Heller, R-Nevada, and Ron Johnson, R-Wisconsin — had been preparing potential alterations to the bill's formula to send more money to Alaska or exempt the state from some of its provisions in a bid to win over Murkowski.

CMS estimated Alaska would see a 38 percent drop in federal funding for Medicaid expansion and insurance subsidies by 2026. An analysis commissioned by the Alaska Department of Health and Social Services put the cut at 65 percent.

In a statement, Cassidy said he was "disappointed that Sen. John McCain is not voting to repeal and replace Obamacare.

"But, as long as there are families being penalized because they can’t afford insurance costing $30,000 to $40,000 a year, I will continue to work for those families," Cassidy added.

The astronomical premium figures appeared to refer to costs incurred by Lafayette-based conservative radio talk-show host Moon Griffon, whom Cassidy has repeatedly highlighted while talking about health care. Griffon, according to Cassidy, pays $40,000 in premiums to cover his family, including a child with special need.

A spokesman for Cassidy didn't immediately respond to emails and phone messages Friday asking whether the senator still saw a path to Senate passage without McCain's backing.

The Cassidy-Graham proposal is currently slated for a hearing late Monday morning before the Senate's finance committee. It wasn't immediately clear if the committee's chairman, Sen. Orrin Hatch, R-Utah, would press ahead with the hearing.

Senate Majority Leader Mitch McConnell indicated earlier in the week that he intends to bring the Cassidy-Graham plan up for a vote in the Senate sometime this week. It's also unclear if McConnell would press forward with a vote now that the plan's passage appears to be in jeopardy.

"I’m excited about solutions we have found in Graham-Cassidy-Heller-Johnson," Graham tweeted Friday afternoon, after McCain's announcement. "We press on."

Follow Bryn Stole on Twitter, @BrynStole.