- Sen. Susan Collins of Maine became the third Republican to publicly oppose the Graham-Cassidy bill, likely dooming the Obamacare repeal effort.
- Collins revealed her decision right after the Congressional Budget Office released a preliminary analysis of the Graham-Cassidy bill, which said millions of people would lose health insurance.
- The Senate has until Saturday to pass the bill under special rules being used for the bill.
Sen. Susan Collins, R-Maine, revealed Monday that she will vote against the Graham-Cassidy bill that would repeal and replace major parts of Obamacare, likely dooming Republican efforts to get rid of that health-care law.
Earlier Monday, President Donald Trump said the failure by his fellow Republicans in Congress to pass Obamacare repeal as long promised was "disgusting," and that he expected Collins to kill the latest effort by opposing the bill.
GOP leaders need 50 of their 52-member majority in the Senate to vote for the bill to win passage before a deadline Saturday.
Collins' move came minutes after the Congressional Budget Office in a preliminary analysis said that if the bill becomes law the number of people with health insurance that covers "high-cost medical events would be reduced by millions."
And it came hours after the release of a new version of Graham-Cassidy that was tweaked to direct more federal funds to Collins' home state of Maine, as well as to the states of several other Republican holdouts to the bill.
In announcing her opposition, Collins cited the CBO report, among other factors.
"The CBO's analysis on the earlier version of the bill, incomplete though it is due to time constraints, confirms that this bill will have a substantially negative impact on the number of people covered by insurance," Collins said.
Collins also cited the rushed effort to pass Graham-Cassidy, the risks that the bill poses to Medicaid, and the danger of the legislation undercutting Obamacare protections for people with pre-existing health conditions.
"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," Collins said.
"Today, we find out that there is now a fourth version of the Graham-Cassidy proposal, which is as deeply flawed as the previous iterations. The fact that a new version of this bill was released the very week we are supposed to vote compounds the problem."
Earlier Monday, S&P Global Ratings issued two reports that estimated Graham-Cassidy would lead to job losses of nearly 600,000 people, and cost $240 billion in lost economic activity over the next decade, as well as threatening the fiscal outlooks of state and local governments.
The CBO report issued Monday analyzed, in preliminary fashion, the effect of an earlier version of Graham-Cassidy. Another version of the bill was rolled out Monday.
CBO, in its report on the bill, said the number of newly uninsured "could vary widely depending on how states implemented" Graham-Cassidy.
"The decrease in the number of insured people would be particularly large starting in 2020," the non-partisan CBO said in its new report.
That year is when Graham-Cassidy would begin making major changes in how the federal government funds Medicaid and provides assistance to people buying health coverage in the individual plan market.
CBO pointedly noted that the report does not offer specific estimates on exactly how many people are expected to become uninsured.
Nor does the preliminary report estimate how Graham-Cassidy would affect individual market insurance premiums or its total expected impact on the federal budget deficit.
CBO said it would need "at least several weeks to provide" such specific projections.
Past reports by the CBO on recent Republican bills to repeal Obamacare estimated that up to 21 million people or more would become uninsured by 2026 if those bills became law, as compared with the Affordable Care Act remaining intact.
The report was rushed at the behest of Senate Majority Leader Mitch McConnell, R-Ky., in an effort to pass Graham-Cassidy before a deadline this Saturday.
The deadline is the result of the Republicans using a process known as budget reconciliation to allow passage of a repeal effort with just 50 votes, as opposed to the 60 votes traditionally needed with other legislation to avoid being blocked by a filibuster. The Senate parliamentarian ruled Sept. 1 that the reconciliation authorization expires this Saturday.
Despite the lower vote hurdle, McConnell for months has been unable to cobble together the 50 Republican senators he needs to pass a repeal bill, assuming a tie-breaking vote from Vice President Mike Pence, himself a Republican.
Last week, McCain said he would oppose the bill. On Monday, Paul restated his opposition to a new version of the bill.
While Paul had voted for an Obamacare replacement bill in July, McCain had dramatically voted against it, sending it down to defeat.
Murkowski has yet to declare her position on Graham-Cassidy.
Read Collins' full statement opposing Graham-Cassidy, below:
Health care is a deeply personal, complex issue that affects every single one of us and one-sixth of the American economy. 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. Today, we find out that there is now a fourth version of the Graham-Cassidy proposal, which is as deeply flawed as the previous iterations. The fact that a new version of this bill was released the very week we are supposed to vote compounds the problem.
I have three major concerns with both the proposal that we were discussing last week and the newest version that was put together this weekend:
First, both proposals make sweeping changes and cuts in the Medicaid program. Expert projections show that more than $1 trillion would be taken out of the Medicaid program between the years 2020 and 2036. This would have a devastating impact to a program that has been on the books for 50 years and provides health care to our most vulnerable citizens, including disabled children and low-income seniors.
Second, both bills open the door for states to weaken protections for people with pre-existing conditions, such as asthma, cancer, heart disease, arthritis, and diabetes. Some states could allow higher premiums for individuals with pre-existing conditions, potentially making their insurance unaffordable. States could also limit specific categories of benefits for Affordable Care Act policies, such as eliminating coverage for mental health or substance abuse treatment.
Third, physicians, patient advocates, insurers, and hospitals agree that both versions of this legislation would lead to higher premiums and reduced coverage for tens of millions of Americans.
The CBO's analysis on the earlier version of the bill, incomplete though it is due to time constraints, confirms that this bill will have a substantially negative impact on the number of people covered by insurance.
There has been some discussion that the new version of the bill includes additional money for my home state of Maine. The fact is, Maine still loses money under whichever version of the Graham-Cassidy bill we consider because the bills use what could be described as a "give with one hand, take with the other" distribution model. Huge Medicaid cuts down the road more than offset any short-term influx of money. But even more important, if Senators can adjust a funding formula over a weekend to help a single state, they could just as easily adjust that formula in the future to hurt that state. This is simply not the way that we should be approaching an important and complex issue that must be handled thoughtfully and fairly for all Americans.
The Affordable Care Act has many flaws that need to be addressed. The current state of health insurance, where premiums are skyrocketing, choices are limited, and small businesses are struggling, needs fixing. My focus will remain on remedying these problems.