Sen. Lindsey Graham’s quest to fulfill his party’s promise to repeal and replace the Affordable Care Act appeared all but doomed on Friday after his close friend, Sen. John McCain, said he’d oppose the effort.
The sudden shift in momentum was jarring. Graham, R-S.C., had left Washington on Wednesday, confident he and his allies would find enough support to pass his bill to radically transform the American health care system.
President Donald Trump was committed to helping. Senate Majority Leader Mitch McConnell said he intended to schedule a vote. The powerful Senate Finance Committee scheduled a Monday hearing. Graham and his partner in the legislative effort, Louisiana Sen. Bill Cassidy, were set to appear on CNN in prime time Monday evening to defend their bill against two Senate progressives, Vermont Independent Bernie Sanders and Minnesota Democrat Amy Klobuchar.
Friday, though, Graham found his bid suddenly, stunningly, on the brink of collapse.
McCain, R-Ariz., announced he could not “in good conscience” vote for Graham’s bill, which would send Obamacare money back to the states as block grants. McCain was concerned about a process that had not allowed for hearings, amendments or a full analysis by the nonpartisan Congressional Budget Office.
His statement came after Sen. Susan Collins, R-Maine, said Friday morning that she was “leaning towards” a no vote, according to the Portland Press-Herald. Sen. Rand Paul, R-Ky., has said all week he’s a no. He objects to how the plan maintains the current law’s taxes on the wealthy.
Since Republicans control 52 of the Senate’s 100 seats, and no Democrat is expected to back Graham’s bill, a loss of three GOP votes imperils the legislation. Graham faced a deadline of Sept. 30 to move his bill, the day the ability to cut off debate with 51 votes ends. After that, it will take 60 votes to stop a filibuster.
McCain was regarded as one of the holdouts. He, Collins and Sen. Lisa Murkowski, R-Alaska, had opposed an Obamacare “skinny repeal” effort this summer, dooming that effort.
GOP leaders this week were reportedly trying to woo Murkowski on the Graham bill by offering her state the option to essentially continue to operate under the Obamacare framework. If those reports were correct, it didn’t immediately appear the bid was enough to convince Murkowski to go along.
Norman Ornstein, a resident scholar at the American Enterprise Institute and a longtime expert on Congress, said the only path to victory he could see at this point was in making concessions to Paul to move the bill further to the right.
“But I don’t quite see how they do that over the weekend,” Ornstein said. “And if they make any of those changes, I don’t see how Murkowski can vote for this.”
Graham’s bill, also sponsored by Republican Sens. Bill Cassidy of Louisiana, Dean Heller of Nevada and Ron Johnson of Wisconsin, was widely panned by the health care community. Advocates warned there were few promises that individuals with preexisting conditions would be protected and little guarantee Medicaid would not suffer devastating cuts.
Even staunch Senate Republicans such as Chuck Grassley of Iowa readily acknowledged there were reasons to oppose the measure, but insisted it was necessary to forge ahead as a way to keep the party’s seven-year-old pledge to replace the Democratic-authored health care law.
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The concession that Republicans were prepared to support a flawed bill in a bid to appease the party’s base has not proven widely popular, not even among some Republican governors.
The vote would not be an easy one for plenty of Republicans.
Heller, who is facing challengers from both parties in 2018, has struggled to situate himself in the health care debate, ultimately deciding to sign on to the Graham bill so he can look like a leader on health care.
However, Nevada GOP Gov. Brian Sandoval recently undermined Heller’s comments that the measure would be good for the state. The most desirable option for Heller at this point might be for the bill to simply disappear.
“He has dug himself a huge hole,” said Jon Ralston, veteran state political analyst and editor of the Nevada Independent news outlet. “But he’s been the only one holding the shovel.”
Ornstein predicted that if Graham’s bill became law, it would likely “haunt” the veteran legislator who until this point has had a reputation as a bridge-builder and a dealmaker.
“He’s smart enough to look at what bills do and their implications, and what reality is, and what data tell us,” said Ornstein. “We’ve seen this in Lindsey in a very courageous way on immigration and climate change. He looks at reality and goes there, even if it doesn’t please many in the party.
“He’s been the bridge on important issues that are really important for the country, understanding for the good of the country you have to step on the orthodoxy a bit and find some common ground across lines. He’s kept to his principles,” Ornstein continued. “Why Lindsey would join in this and lend his name to this, I can’t explain it.”
Michael Tanner, a senior fellow at the libertarian Cato Institute, predicted the GOP would pay a political price if the bill dies.
“It’s been seven years,” he told McClatchy. “Republicans never actually knew what they wanted in a bill. And this bill was symptomatic of it.”
On Friday afternoon, Graham released a statement saying his friendship with McCain, who was recently diagnosed with an aggressive form of brain cancer, remained strong.
“My friendship with John McCain is not based on how he votes but respect for how he’s lived his life and the person he is,” Graham said.
While he could not say with certainly whether his bill still had a lifeline, Graham made it clear he didn’t plan on giving up the fight.
“Obamacare is collapsing in Arizona, South Carolina, and across the nation – driving up premiums and reducing choices,” Graham said. “I feel an obligation to fix this disaster and intend to push forward for state-centric health care versus Washington-knows-best health care.
“I’m excited about the solutions we have found,” he continued. “We press on.”
Emma Duman @emma_dumain