Sen. Susan Collins (R-ME) announced Monday that she will vote against the Graham-Cassidy bill to repeal and replace the Affordable Care Act following the release of the Congressional Budget Office (CBO) score, seemingly killing the latest attempt by Republicans to repeal and replace Obamacare.

The CBO didn’t have sufficient time to conduct a full analysis but said “millions” of Americans would lose their health care.

Senator Collins opposes Graham-Cassidy health care bills https://t.co/nW6MFUvYVg pic.twitter.com/0DSxDJNMPp — Sen. Susan Collins (@SenatorCollins) September 25, 2017

Collins’ announcement means Senate Republicans do not have the votes for the bill, which was spearheaded by Sens. Lindsey Graham (R-SC) and Bill Cassidy (R-LA). The measure would have block granted health care funding the states and capped Medicaid, ultimately leaving millions without insurance and cutting trillions in funding over the next two decades.


Two Republican senators, Sens. Rand Paul (R-KY) and John McCain (R-AZ) previously announced they would vote against the bill, and Republicans could only lose two votes to pass the measure via reconciliation, which requires a simple majority. A hearing on the Graham-Cassidy bill was still underway when Collins announced her opposition, and there is a CNN town hall debate on health care slated for late Monday evening.

Where GOP stands on Graham-Cassidy Murkowski: 🤔

Cruz: 🤔

Lee: 🤔 McCain: ❌

Collins: ❌

Paul: ❌ 3 GOPers saying ❌ stops bill. — Dan Diamond (@ddiamond) September 25, 2017

The only definitive statement the CBO made about the Graham-Cassidy bill was that it saves as much money as the American Health Care Act, the GOP health care bill that passed in the House in May. Beyond that, given the short time available, the CBO was unable to provide a complete analysis of the bill.

CBO drew from older ACA repeal bills to make its projections, but even that was limited because the bill would have states create their own marketplace.


The Graham-Cassidy measure would repeal the ACA subsidies and Medicaid expansion, ultimately block granting health care funding to the states. States — with waiver authority — could roll back essential health benefits and allow insurers to raise premiums for sick patients or those with pre-existing conditions. Additionally, the bill would make cuts to the Medicaid overall, which provides care to low-income adults, children, elderly, and disabled.

“All told, federal spending on Medicaid would be reduced by about $1 trillion over the 2017–2026 period under this legislation, and the program would cover millions fewer enrollees,” the CBO report said.

Several outside analyses found that the Graham-Cassidy bill would result in 32 million people would lose their health insurance over the next two decades. Monday’s CBO score did not go into specifics, but said “the direction of the effect is clear.”

“The number of people with comprehensive health insurance that covers high-cost medical events would be reduced by millions compared with the baseline projections for each year during the decade, CBO and JCT estimate,” the report said. “That number could vary widely depending on how states implemented the legislation, although the direction of the effect is clear.”

Collins’ announcement likely means a number of other Republican senators will come out in opposition to the bill, though that does not mean attempts to repeal and replace the ACA will end. Republicans in Congress have until Saturday to pass a measure with a simple majority.

After Saturday, any bill would need 60 votes for cloture, and Republicans have just 52 seats in the Senate, but the GOP can bring reconciliation back next year and do this all again.