Republicans make last push to repeal Obamacare, but it is not clear they have the votes

Eliza Collins | USA TODAY

Show Caption Hide Caption Graham-Cassidy bill is another GOP attempt to repeal Obamacare Republican Senators have taken up another bill to repeal Obamacare. Here's what's in the legislation.

WASHINGTON — Republican senators are making one last push to overhaul Obamacare days before an end-of-September deadline, but it is not clear whether they have the votes to pass a bill.

David Popp, a spokesman for Majority Leader Mitch McConnell, R-Ky., told USA TODAY on Monday that Senate leaders have asked the nonpartisan Congressional Budget Office to produce an expedited analysis of a health care bill from Sens. Lindsey Graham, R-S.C., and Bill Cassidy, R-La. The CBO announced Monday afternoon that it would provide a "preliminary assessment" of the bill by early next week.

The CBO is tasked with reviewing whether legislation will add to the deficit; the Senate must have an analysis from CBO in hand in order to bring the legislation up for a vote.

The Graham-Cassidy bill would keep much of the Obamacare tax structure in place, but it would give the money back to the states in the form of block grants so they can design their own health care systems. The bill would end the Obamacare expansion of Medicaid eligibility in 2020 and replace it with per capita block grants to states to address the needs of low income residents.

Republicans are using a special budgetary procedure that allows health care legislation to pass with just 51 votes, rather than the usual 60. The window to use that procedure ends Sept. 30, and the Senate is not in session this Thursday or Friday.

Republicans need a minimum of 50 of their 52 senators to vote for the bill, since no Democrats are expected to support the legislation.

"I’m pretty confident we’ll get there on the Republican side. People are coming out regularly and saying they’re for it, either privately or publicly," Cassidy told reporters at a briefing in his office Friday. The bill is co-sponsored by Sens. Dean Heller, R-Nev., and Ron Johnson, R-Wis.

“I’m saying right now, we’ve probably got 48, 49 and talking to two or three more," Cassidy said about support for the legislation.

President Trump has indicated support for the Graham-Cassidy bill, saying that “inaction is not an option.”

On Monday, supporters of the bill got some good news when Arizona Gov. Doug Ducey announced he backed the bill. John McCain, Arizona's senior senator, was the final "no" vote that sank Republicans' last attempt to repeal Obamacare. McCain has said he's been consulting with his state's governor on health care.

“With Gov. Ducey’s support, we are gaining the momentum we need to repeal and replace Obamacare," Graham said.

But in remarks to reporters later Monday, McCain said he still wasn't sold.

“The governor came out in favor, which obviously has some impact, but we’ve also not gone through regular order," McCain said at the Capitol. "I want to know what amendments are in order. I want to know why it is that we haven’t had a product in the last nine months.”

McCain has said he voted against the earlier repeal bill because it did not pass his test of going through the normal legislative process.

In addition to Ducey's support, McCain is a close friend of Graham’s, but McCain told reporters that Graham wasn't pressing him on the issue.

Over the weekend, McCain was advocating for the Senate to debate bipartisan legislation being drafted in the Health, Education, Labor and Pensions Committee.

“The way to do this is have a bill, put it through the committee, we have Patty Murray and Lamar Alexander" working on health care, McCain said on CBS' Face the Nation on Sunday. "Bring it to the floor have debate, have amendments."

Alexander, a Tennessee Republican, and Murray, a Washington Democrat, are the chairman and ranking member of the HELP Committee and have been leading a series of hearings on short-term solutions to stabilize the market.

McCain is not the only worry for Republicans on the Graham-Cassidy bill.

Sen. Rand Paul, R-Ky., is against the bill. He said it keeps “90% of Obamacare and redistributes the proceeds” and urged fellow conservatives to oppose the legislation.

In a roundtable with reporters in his office Monday, Paul said: "I'm kind of surprised it has been resurrected because I don't think it's been fully thought through. I mean it's actually more complicated than some people make it out to be."

But Paul acknowledged, "There's a big groundswell of people pushing for this." He said some Republicans are treating Obamacare repeal legislation like a kidney stone and are just focused on passing it to get rid of it — even if it's painful.

Sen. Susan Collins, R-Maine, who did not support the Obamacare repeal bills earlier this year, is another question mark.

"I'm still waiting for the CBO analysis before reaching a final conclusion," Collins told reporters. "But based on my analysis over the weekend, I'm concerned about what the effect would be on coverage, on Medicaid spending in my state, on the fundamental changes in Medicaid that would be made without the Senate holding a single hearing to evaluate them. And also on what the effect would be on premiums particularly for older Americans between 50 and 64."

The Graham-Cassidy bill would also cut federal funding to Planned Parenthood, an issue that Collins has cited as a concern on other bills.

Sen. Rob Portman, R-Ohio, ultimately voted for a narrow Obamacare repeal bill earlier this summer but has been a vocal critic of any cuts to the Medicaid expansion. According to his office, Portman still hasn't decided whether he'd support the Graham-Cassidy plan.

Sen. Lisa Murkowski, R-Alaska, also voted no on the repeal bill that failed in July. Her spokeswoman Karina Petersen said that she is still undecided on the Graham-Cassidy bill.

Sens. Pat Toomey of Pennsylvania and John Kennedy of Louisiana were also among the undecided lawmakers Monday.

The House passed legislation in May that would repeal and replace Obamacare, but that bill is dead. If the Senate is able to pass the Graham-Cassidy bill, the House would have to vote on the bill without changes, because there would be no time for the Senate to consider any House amendments before the Sept. 30 deadline.

House Speaker Paul Ryan, R-Wis., did tweet some positive words about Graham-Cassidy on Friday.

I appreciate Senators Graham and Cassidy continuing to work on a plan to pass the Senate. I’ll take federalism over Obamacare any day. — Paul Ryan (@SpeakerRyan) September 15, 2017

Opponents of an Obamacare repeal were sounding the alarm Monday.

Senate Minority Leader Chuck Schumer, D-N.Y., House Minority Leader Nancy Pelosi, D-Calif., House Budget ranking member John Yarmuth, D-Ky., and Senate Budget ranking member Bernie Sanders, I-Vt., sent a letter to the CBO earlier Monday asking them to do a comprehensive scoring of Graham-Cassidy and not just the bare minimum analysis required to allow for a vote.

"Members of Congress and the American people need to know the full consequences of Graham-Cassidy before any vote," they wrote.

Schumer called Graham-Cassidy "meaner than ever."

"Our health care system again is threatened by a hastily constructed piece of legislation, put together in a backroom by only one party, no CBO score, no committee process, not a single public hearing," Schumer said on the Senate floor Monday.

Also on Monday, 16 patient and provider groups — including the American Diabetes Association and American Heart Association — announced their opposition to the bill.

"Affordable, adequate care is vital to the patients we represent. This legislation fails to provide Americans with what they need to maintain their health," the group wrote.

Contributing: Deborah Barfield Berry and Michael Collins