Bill Cassidy, Rick Santorum

Sen. Bill Cassidy, R-La., second from right, accompanied by Former Pennsylvania Sen. Rick Santorum, right, testifies during a Senate Finance Committee hearing to consider the Graham-Cassidy healthcare proposal, on Capitol Hill, Monday, Sept. 25, 2017, in Washington. (AP Photo/Andrew Harnik) ORG XMIT: DCAH140

Andrew Harnik

WASHINGTON — Admitting the votes simply weren’t there to pass the latest Republican effort to repeal the Affordable Care Act, U.S. Senate leaders on Tuesday officially pulled the plug on the last-minute effort, spearhead by Sens. Bill Cassidy, of Louisiana, and Lindsey Graham, of South Carolina.

Opposition from three key Republican Senate colleagues — John McCain, of Arizona; Rand Paul, of Kentucky; and Susan Collins, of Maine — doomed Cassidy and Graham’s bill to almost certain failure despite years of Republican campaign promises to gut the 2010 health care law, also known as "Obamacare."

But Cassidy remained largely undeterred by the setback. He pledged to continue working on a conservative alternative to the health care law and, like Graham, his co-author, expressed optimism their concept could be revived in coming months. Leadership made the decision not to hold a vote just days before a Saturday deadline to pass the bill on a party-line, simple-majority vote through a process known as reconciliation.

“We made the decision that, if we don’t have the votes, we’ll postpone that vote,” Cassidy said at the Senate Republican leadership’s weekly news conference.

Cassidy went on to rattle off a series of statistics about climbing insurance premiums, citing the stiff price tags for some families’ health policies as a central failing of the Affordable Care Act.

"Am I disappointed? Absolutely,” Cassidy said.

Opponents of the bill, however, celebrated its defeat without a vote. Democrats, activists and a range of organizations representing stakeholders in the health care system — including doctors’ groups, insurance companies and hospital associations — had come out against it.

The bill would’ve repackaged much of the funding for insurance subsidies and expanded Medicaid coverage under the Affordable Care Act into flexible block grants for states. But those block grants would’ve been accompanied by cuts in funding for the states that did expand Medicaid — something Cassidy and Graham pitched as equity but opponents panned as cynical, given that Republican leaders in those states blocked expansion.

It also would’ve phased in a cap on federal spending on the traditional Medicaid program, which covers low-income and disabled Americans and is currently structured as an open-ended entitlement, meaning federal dollars increase when more patients enroll in the program. Under Cassidy-Graham, future growth in funding instead would’ve been capped by a per-capita formula.

The nonpartisan Congressional Budget Office said millions would lose health insurance coverage under the plan, though the CBO added that its analysts didn’t have sufficient time to more thoroughly vet the bill, the first version of which was publicly released less than two weeks ago.

Louisiana would’ve seen its federal health care funding drop significantly under the formula, though analyses by outside groups varied in their assessment of just how much. Centers for Medicare and Medicaid, an arm of President Donald Trump's administration, pegged the total reduction at $2.4 billion, a figure that didn't factor in the impact of caps on traditional Medicaid funding.

Cassidy and Graham have argued repeatedly that the current rate of growth in federal Medicaid spending is wildly unsustainable, with Cassidy labeling the program as a “black hole” for tax dollars in an address at the Baton Rouge Press Club in August. The caps, they argued, were necessary to put the program on more solid fiscal footing.

Patient groups, however, raised the alarm about what a number of critics and health-policy experts deemed the most fundamentally radical Republican health care proposal yet. Protests briefly postponed a committee hearing for the Cassidy-Graham plan on Monday, its lone public vetting, and about a dozen more protesters were arrested by Capitol police Tuesday after they staged a “die-in” to block underground corridors connecting a Senate office building with the U.S. Capitol.

Graham refused to declare the bill dead on Tuesday, instead predicting it would eventually be passed by the Senate. Both he and Cassidy said the rushed timeframe — which allowed little time to debate the bill’s merits or analyze its effects, much less substantially amend it — was its undoing.

“There are 50 votes for the substance (of Cassidy-Graham), just not 50 votes for the process,” Graham said, referring to the number of Republican senators needed to pass the bill. "Obamacare is not working. But we’ve had a hard time articulating what we’re for — until now. Now we have something that makes sense.”

“We’re coming back to this after taxes,” Graham added, referring to a tax-code overhaul that now moves to the top spot on Capitol Hill Republicans’ list of priorities. The reconciliation process, under which Republicans can push through legislation with a 50-vote simple majority instead of the chamber’s usual 60-vote threshold, only comes around at distinct points on the legislative calendar. Senate Majority Leader Mitch McConnell, R-Kentucky, has said they plan to use the next process, at the end of the year, to push through tax cuts.

It remained “premature” to discuss when exactly Republicans might revisit health care, Cassidy said. And the Louisiana senator added that he also didn’t yet know how he might revise his proposal to shore up votes.

In the meantime, Senate Democrats urged their Republican colleagues to return to bipartisan talks aimed at shoring up the health care law's individual insurance exchanges, which have seen rising premiums and a dwindling number of insurers offering plans. Talks led by Sens. Lamar Alexander, R-Tennessee, and Patty Murray, D-Washington, appeared to collapse last week amid the last-minute Republican push to pass Cassidy-Graham.

Cassidy said he wasn’t playing a direct role in those talks but didn’t rule out voting for potential fixes, either, though he added that he thought they’d likely come up short on votes as well. But he also suggested he had little interest in propping up the Affordable Care Act’s marketplaces with an infusion of money.

"I think we need to work to lower premiums — but I think we need to do more than just throw money at the status quo,” Cassidy said. "Throwing money at the status quo doesn’t solve the problems.”

Follow Bryn Stole on Twitter, @BrynStole.