WASHINGTON -- Sen. John McCain declared his opposition Friday to the GOP's last-ditch effort to repeal and replace the Patient Protection and Affordable Care Act, just three months after the Arizona Republican helped scuttle another effort by his party to repeal the health law and fulfill a signature promise to voters.
"I believe we could do better working together, Republicans and Democrats, and have not yet really tried," the 81-year-old McCain said of the bill, co-written by Lindsey Graham of South Carolina, his best friend in the Senate, and Bill Cassidy of Louisiana. "Nor could I support it without knowing how much it will cost, how it will affect insurance premiums, and how many people will be helped or hurt by it."
McCain, who is battling brain cancer, said he could not "in good conscience" vote for the legislation. That all but ensured a major setback for President Donald Trump and Senate Majority Leader Mitch McConnell, and appeared likely to deepen rifts between congressional Republicans and a president who has begun making deals with Democrats out of frustration with his own party's failure to turn proposals into laws.
During the election campaign Trump had pledged to quickly kill President Barack Obama's health care program -- "It will be easy," he contended -- and he has publicly chided McConnell for not winning passage before now.
With McCain's decision, there are now two declared GOP no votes on the repeal legislation, the other being Rand Paul of Kentucky. With Democrats unanimously opposed, that's the exact number McConnell can afford to lose. But Sen. Susan Collins, R-Maine, said Friday that she, too, is leaning against the bill, and Lisa Murkowski of Alaska was also a possible no, making it highly unlikely that the legislation can prevail.
For months, McCain has lamented a Senate legislative process that avoided hearings or formal bill-drafting procedures and excluded Democrats. On Friday, he said those tactics were intolerable.
"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. "If we do so, our success could be as short-lived as theirs when the political winds shift, as they regularly do."
Trump, speaking at a rally Friday night in Alabama, called McCain's opposition "sad" and "a horrible, horrible thing" for the Republican Party. But he said he would continue the fight to repeal the health law even if it meant going back again and again.
"It's a little tougher without McCain's vote, I'll be honest. But we've got some time. We're going to go back," he said, adding, "You can't quit when you have one or two votes short."
Vice President Mike Pence said the fight wasn't over. "This is not going to be easy. Some have gone so far as to announce their opposition already," he said. "President Trump and I are undeterred."
Graham, too, vowed to "press on." He also reaffirmed his friendship with McCain.
"My friendship with John McCain is not based on how he votes," Graham wrote on Twitter, "but respect for how he's lived his life and the person he is."
"Of course, I'm disappointed," Cassidy said in an interview, "but that doesn't mean that I'm going to stop working for those folks who can't afford their premiums."
Other Republicans were less optimistic.
"It's a loss for Republicans," said Rep. Mark Walker, R-N.C., chairman of the conservative Republican Study Committee. "I think we're all going to be held accountable to some degree. What that means in next year's elections, I don't know. But this is going to bite for a while."
At a town-hall meeting in liberal Iowa City, which began an hour after McCain announced his opposition to the bill, Sen. Joni Ernst, R-Iowa, told a crowd stacked with Affordable Care Act supporters that the GOP's repeal push was likely over for the year.
"I'll be honest," Ernst said. "It seems unlikely that we'll be voting on this."
Up until McCain's announcement Friday, McConnell allies still thought there was a chance McCain's relationship with Graham would make the difference.
GOP leaders hoped to take the legislation to the Senate floor next week, and Graham vowed to do so even with the two "no" votes. They face a Sept. 30 deadline, at which point special rules that prevent a Democratic filibuster will expire.
Democrats hailed McCain's announcement and pledged to commit to the bipartisan process he sought. Sen. Lamar Alexander, R-Tenn., and Sen. Patty Murray, D-Wash., have been working on a package of limited legislative fixes to the Affordable Care Act marketplaces.
"John McCain shows the same courage in Congress that he showed when he was a naval aviator," said Senate Minority Leader Charles Schumer, D-N.Y. "I have assured Sen. McCain that as soon as repeal is off the table, we Democrats are intent on resuming the bipartisan process."
The Graham-Cassidy bill would repeal major pillars of Obama's law, replacing them with block grants to states to design their own programs. Major medical groups are opposed, saying millions of people would lose insurance coverage and protections, and a bipartisan group of governors also has announced opposition.
Yet Republican congressional leaders, goaded by GOP voters and the president himself, were determined to give it one last try.
Trump spent much of August needling McConnell for his failure to pass a repeal bill, and Republican lawmakers back home during Congress' summer recess heard repeatedly from voters angered that after seven years of promises to get rid of the 2010 health care law, the party had not delivered.
The House passed its own repeal bill in May, prompting Trump to convene a Rose Garden celebration that soon began to look premature. After the Senate failed in several attempts in July, the legislation looked dead. But Cassidy kept at it with his state-focused approach, and the effort caught new life in recent weeks as the deadline neared. Trump, too, pushed hard, hungry for a win.
Trump tweeted Friday morning that "Rand Paul, or whoever votes against Hcare Bill, will forever (future political campaigns) be known as 'the Republican who saved ObamaCare.'"
Paul -- who objects to the legislation on the grounds that it does not fully repeal the Affordable Care Act -- responded in a series of tweets saying he "won't be bribed or bullied" into changing his mind.
Gov. Asa Hutchinson of Arkansas issued a statement Friday defending his support for the Cassidy-Graham health care bill, which independent analysts said would reduce the amount of federal funds going to Arkansas and other states that expanded their Medicaid programs while providing more money to states, such as Texas and Mississippi, that did not expand Medicaid.
Hutchinson's statement didn't address the redistribution of funding but noted that the overall amount provided under the proposal's block grants would be 95 percent of what the Affordable Care Act is expected to provide nationwide in Medicaid expansion funds and subsidies for private insurance.
"Graham-Cassidy puts federal spending on a budget -- a realistic, manageable and achievable budget," Hutchinson said. "This sort of discipline is long overdue in Washington, and the states must be a partner in making our health care programs more sustainable."
On the other side, late-night TV host Jimmy Kimmel, whose son was born with a heart defect, got considerable attention when he criticized the new repeal effort at length on his show. In a tweet Friday, he thanked McCain "for being a hero again and again and now AGAIN."
The bill would get rid of mandates for people to carry insurance or face penalties. It would repeal the financing for Obama's health insurance expansion and create a pool of money states could tap to set up their own programs, with less federal oversight. It also would limit spending for Medicaid, the federal-state program that now covers more than 70 million low-income people. Insurance rules that protect people with pre-existing conditions could be loosened through state waivers.
An analysis published Friday by the Brookings Institution and the University of California Schaeffer Center for Health Policy and Economics projected that roughly 15 million Americans would lose coverage over the next two years if the Graham-Cassidy bill is enacted.
Information for this article was contributed by Erica Werner, Alan Fram and Ricardo Alonso-Zaldivar of The Associated Press; by Thomas Kaplan and Robert Pear of The New York Times; by Sean Sullivan, Juliet Eilperin and Kelsey Snell of The Washington Post; and by Andy Davis of the Arkansas Democrat-Gazette.
A Section on 09/23/2017
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