As Republicans try (again) to repeal and replace the Affordable Care Act, a small group of Republican senators are in the spotlight.

The bill, spearheaded by Sens. Lindsay Graham (R-SC) and Bill Cassidy (R-LA), would block grant health care funding to the states and repeal a number of taxes in place under Obamacare. The grants would steadily decline over time, and all states would suffer under cuts of up to $4 trillion over the next two decades. An estimated 32 million people will lose their health insurance by 2026 if the bill is signed into law.

Republicans in Congress are attempting to pass the Graham-Cassidy repeal and replace bill, which is also sponsored by Sens. Dean Heller (R-NV) and Ron Johnson (R-WI), through the reconciliation process ending September 30.

Passing the bill via reconciliation means the bill only needs a simple majority to get through. Republicans currently hold 52 seats in the Senate, and Vice President Mike Pence can break the tie if the measure gets an even 50 yes votes, meaning Republicans can safely lose just two members.


Senate Majority Leader Mitch McConnell (R-KY) has said he intends to bring the bill to the floor for a vote next week, but the question remains: Does he have the votes?

The answer will likely come down to nine Republican senators, some of whom have voted against previous repeal and replace plans and others who have raised concerns about the bill.

As of Friday afternoon, both Sens. Rand Paul (R-KY) and John McCain (R-AZ) have said they will vote against the bill. This list will be updated should that change.

Sen. Rand Paul (R-KY)

Status: Says he’ll vote no, but some people don’t trust him.

This new "gang" bill is another Grahamnesty, this time for Obamacare. Conservatives have seen this before. — Senator Rand Paul (@RandPaul) September 20, 2017

Paul has been a loud, public “no” on Graham-Cassidy, calling the bill “Obamacare lite” and saying that he will vote against the bill because it doesn’t go far enough to repeal the Affordable Care Act.


Trump lashed out at Paul on Twitter Wednesday, tweeting, “Rand Paul is a friend of mine but he is such a negative force when it comes to fixing healthcare. Graham-Cassidy Bill is GREAT! Ends Ocare!”

Rand Paul is a friend of mine but he is such a negative force when it comes to fixing healthcare. Graham-Cassidy Bill is GREAT! Ends Ocare! — Donald J. Trump (@realDonaldTrump) September 20, 2017

Paul doubled down after Trump’s comment, tweeting, “#GrahamCassidy is amnesty for Obamacare. It keeps it, it does not repeal it. I will keep working with the President for real repeal.”

#GrahamCassidy is amnesty for Obamacare. It keeps it, it does not repeal it. I will keep working with the President for real repeal. — Senator Rand Paul (@RandPaul) September 20, 2017

Some Congressional watchers have raised questions about whether Paul could go back on his vote, though. Paul both advocated and voted for the last version of repeal and replace — “skinny repeal” — which ultimately would’ve left more of the ACA in place than Graham-Cassidy would.


For now, at least, Paul is the only senator to publicly declare his intention to vote against the bill. Asked by a reporter if he felt pressure from his colleagues to vote for the bill, Paul said, “Uh, no. I feel very comfortable.”

I asked Rand if he was feeling pressure from colleagues to back Graham-Cassidy. "Uh, no. I feel very comfortable" https://t.co/Jr0Mm9yIDu — Burgess Everett (@burgessev) September 20, 2017

Sen. John McCain (R-AZ)

Status: Says he’ll vote no, because he wants regular order (not because he doesn’t like the bill).

Two months ago, McCain sunk what seemed, at the time, to be the GOP’s last chance to repeal and replace the ACA, voting down the bill with a dramatic late-night thumbs down. At the time, McCain said he voted down the bill not because of its substance but rather because he wants any legislation to go through regular order.

On Monday, McCain said he “might” vote for Graham-Cassidy if Arizona Gov. Doug Ducey (R) liked the bill, and later that day, Ducey announced his support for the plan.

Despite Ducey’s endorsement, McCain has continued to call for regular order.

On Wednesday, McCain said he was still looking at the bill.

Q: Any update on your stance on Graham-Cassidy?

McCain: "Nope." Q: So you're still looking at it?

McCain: "Yup." *Subway car pulls away* — Frank Thorp V (@frankthorp) September 20, 2017

McCain is NOT ready to back this bill: "I want the regular order" — Burgess Everett (@burgessev) September 20, 2017

In a thinly-veiled attempt to woo McCain, Republicans have scheduled hearings on the bill for early next week, but McCain told reporters that two last-minute hearings are not, believe it or not, regular order, and he isn’t buying it.

John McCain also thinks holding two hearings on a bill—one of them in a committee that doesn't have jurisdiction—isn't regular order, btw — Haley Byrd (@byrdinator) September 19, 2017

But perhaps the most interesting factor when considering McCain’s vote is that Graham is McCain’s best friend. Their friendship is widely considered to be the thing that could change McCain’s mind, despite the fact that there has been no semblance of regular order.

On Friday, McCain released a statement saying he could not, in good conscience, vote for Graham-Cassidy, making him the second public no for the bill.

McCain’s statement makes it clear: He will vote no not because he doesn’t like the bill, but rather because he wants regular order. If the process could be construed to look enough like regular order, McCain could get back on board.

As of Friday afternoon, however, McCain’s vote leaves Republicans with just a single vote to play with.

Sen. Lisa Murkowski (R-AK)

Status: Undecided

Murkowski, along with McCain, was one of three Republicans who voted against skinny repeal, and Republicans have been working hard to woo her on Graham-Cassidy, carving out extra funding just for Alaska.

But the bill would still have disastrous effects for the state, and after a meeting with Graham and Cassidy Thursday, Murkowski told reporters she was still not ready to vote for the bill.

Colleague Jason Donner rpts Murkowski just finished mtg Graham/Cassidy in Sullivan's office. Ready to back health care bill? "Nope, I'm not" — Chad Pergram (@ChadPergram) September 20, 2017

Several analyses of the bill have cited that the effects would hit Alaska hard, which Murkowski has said is her main concern. “My issues are still how they derive the formula and how that works with the numbers for Alaska,” she said.

Sen. Dan Sullivan (R-AK)

Status: Undecided

The other senator from Alaska is also publicly undecided on the bill, telling reporters, “I’ll answer… as I dig more into the bill.”

Notably, Alaska Gov. Bill Walker, an Independent, has come out against the bill, citing concerns about Medicaid cuts.

This is big: Alaska's Governor Walker is concerned about Graham-Cassidy. He opposes Medicaid cuts to states.https://t.co/naZghxApTB — Topher Spiro (@TopherSpiro) September 19, 2017

Sen. Susan Collins (R-ME)

Status: Undecided

Collins, along with Murkowski and McCain, sunk skinny repeal in July, and she has been one of the only reliable Republican votes against the recent repeal and replace efforts. Collins has often said her concerns about the various bills have to do with the way they would affect Medicaid.

On Wednesday, Collins said Graham-Cassidy “changes..the Medicaid program for the first time in 50 years without ..vetting to see exactly what the consequences will be.”

Collins says Graham/Cassidy "changes..the Medicaid pgm for the 1st time in 50 yrs w/o..vetting to see exactly what the consequences will be — Chad Pergram (@ChadPergram) September 20, 2017

She also told CNN Wednesday that she is “disappointed” that the Republican-only Graham-Cassidy has surged ahead of any bipartisan health care plan.

On Friday, Collins told the Press Herald that she is has been reading the bill and that it would allow insurers to charge sky-high rates to people with pre-existing conditions.

Big: GOP Senator Susan Collins confirms Graham-Cassidy would gut protections for pre-existing conditions:https://t.co/WXsJ1cIx5E pic.twitter.com/N5ayEFsEj1 — Greg Sargent (@ThePlumLineGS) September 22, 2017

“I’m reading the fine print on Graham-Cassidy,” she said. “The premiums would be so high they would be unaffordable.”

Sen. Shelley Moore Capito (R-WV)

Status: Undecided

Capito voted against an earlier repeal plan, repeal and delay, saying she “didn’t come to D.C. to hurt people.” Later, Capito voted for skinny repeal, but she has been noncommittal on Graham-Cassidy.

FINALLY found Shelley Moore Capito to ask her about Cassidy-Graham. She was noncommittal, said decision would come down to numbers for WV. — Dylan Scott (@dylanlscott) September 14, 2017

Her decision, she said, would come down to the numbers for West Virginia.

Sen. Cory Gardner (R-CO)

Status: Undecided, but he’s done this every time and voted yes.

Gardner, like Capito, has said he doesn’t have the numbers for Colorado and needs to look at the data more before making a decision — but as Denver Post correspondent Mark Matthews noted, Gardner has made similar noncommittal comments before every repeal and (maybe) replace attempt and voted for every one of them.

FWIW @SenCoryGardner took a similar tact during healthcare debate this summer before supporting every major GOP proposal. #copolitics — Mark K Matthews (@mkmatthews) September 20, 2017

Sen. Rob Portman (R-OH)

Status: Undecided, but positive.

Portman has often been cited as a potential detractor from the GOP’s repeal efforts, but he has yet to follow through. He has not officially said whether he will vote for Graham-Cassidy, but has been positive, spinning the bill as giving states the ability to expand Medicaid (though, considering the massive federal funding cuts, that’s unlikely).

So it seems like you can put Portman in the camp of Cassidy/Heller-like senators who just want to get to yes no matter the bill's content. pic.twitter.com/CD5xsqmi5b — Taniel (@Taniel) September 19, 2017

Ohio Gov. John Kasich (R) has been staunchly against the bill and other Republican plans that would cap and cut Medicaid.

Sen. Jerry Moran (R-KS)

Status: “Still talking”

A spokesperson for Moran has said the Kansas senator is “still talking” to Kansans about the bill. A number of other senators have made similar comments, but Moran is perhaps notable because Moran, along with Sen. Mike Lee (R-UT), sunk an earlier version of repeal and replace.