Sen. John McCain expressed disappointment Thursday that the latest rewrite of the Senate Republican health-care bill did not adequately shield Arizona's Medicaid system, which would face an estimated $7.1 billion hit by the end of 2026.

Despite McCain's efforts to insert language to soften the blow to the state, the new bill still would eliminate by 2024 federal money for Arizona and other states that expanded Medicaid under the Affordable Care Act.

The Medicaid cuts were one of the original draft's most controversial elements, and its passage is by no means assured in the Senate, where Republicans can't lose more than two votes from their party.

In a written statement, McCain, R-Ariz., vowed to champion amendments that he is authoring in consultation with Republican Gov. Doug Ducey and others from Arizona, provided the bill makes it to the Senate floor.

"Arizona has been nationally recognized for running one of the most efficient and cost-effective Medicaid programs in the country," McCain said. "This legislation should reward states like Arizona that are responsibly managing their health-care services and controlling costs — not penalize them."

Meanwhile, Sen. Jeff Flake, Arizona's junior Republican senator, remains undecided on the legislation, even though he came out in support of Sen. Ted Cruz's "Consumer Freedom Option" amendment, which was incorporated in the new version of the Senate bill.

As summarized in his statement, McCain's goal is to make sure Arizona isn't hurt because it expanded Medicaid as allowed under former President Barack Obama's Affordable Care Act, or "Obamacare," which the new Better Care Reconciliation Act, or "Trumpcare," aims to undo.

McCain wants to give Arizona and the other 30 expansion states more time to adapt their budgets to the loss of federal money and prevent an abrupt loss of coverage for the 14 million Americans nationwide who benefit from the expanded program.

He also wants to alter the Medicaid growth rate in a way that he says would protect Arizona.

McCain further doesn't want to see the state pay a price for having passed Proposition 204, a pre-Obamacare, voter-approved decision in 2000 to boost the number of people eligible for the Arizona Health Care Cost Containment System, the official name of Arizona's Medicaid agency.

McCain doubts bill's viability

McCain on Sunday predicted the Senate's GOP-only health-care bill, which wasdrafted behind closed doors and outside the Senate's usual committee process, likely would soon be "dead." The bill stalled before senators left for their Fourth of July recess because of a lack of support from Republicans, who control the 100-member Senate with a 52-member majority.

President Donald Trump has made health-care legislation a top priority, but public opposition to the Senate bill has been fierce. A USA TODAY/Suffolk University Poll from late last month indicated that only 12 percent of Americans supported the bill's original draft.

McCain made the repeal and replacement of Obamacare a centerpiece of his 2016 re-election campaign, but he said if Republicans can't come terms on a GOP bill, they will have to work with Democrats on a bipartisan compromise.

“Have no doubt: Congress must replace Obamacare, which has hit Arizonans with some of the highest premium increases in the nation and left 14 of Arizona’s 15 counties with only one provider option on the exchanges this year," McCain said in his written statement. "But if we are not able to reach a consensus, the Senate should return to regular order, hold hearings and receive input from senators of both parties, and produce a bill that finally provides Americans with access to affordable and quality health care.”

Flake still undecided

Flake this week announced he is supporting the amendment proposed by Cruz, R-Texas, that would allow insurance companies to offer less-expensive policies as long as they also offer at least one policy that meets the requirements and regulations of the Affordable Care Act.

But Flake's spokesman said in a written statement that he is still looking over the new version of the BCRA and wants to wait for an analysis from the nonpartisan Congressional Budget Office, which is expected by early next week.

"While Senator Flake supports the Consumer Freedom amendment’s approach to restoring Arizonans’ freedom to choose a more affordable health insurance plan that best fits their needs while still guaranteeing federally-subsidized coverage for individuals with pre-existing conditions, it is not indicative of how he will vote on the BCRA," Jason Samuels said.

"Senator Flake’s decision will be based on how the bill balances two principles. The first is that the legislation needs to ensure that those who currently have coverage do not have the rug pulled out from under them. The second is that the Senate must agree on a solution that is fiscally sustainable,” Samuels said.

Nowicki is The Republic's national political reporter. Follow him on Twitter, @dannowicki.

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