WASHINGTON — Just when the effort to repeal the Affordable Care Act appeared to be dead, a last-ditch push to obliterate the law could be nearing a showdown vote in the Senate, and a handful of Republicans insist they are closing in on the votes.
The leaders of the latest repeal effort, Senators Lindsey Graham of South Carolina and Bill Cassidy of Louisiana, say their drive is gaining momentum. But it is still a long shot.
Under their bill, millions could lose coverage, Medicaid would see the same magnitude of cuts that earlier repeal bills extracted, and insurers in some states could charge higher premiums to people with preexisting conditions.
Senator Rand Paul, Republican of Kentucky, has said he will not vote for the measure because it leaves too much of the Affordable Care Act in place.
And Senator John McCain, the Arizona Republican who cast the deciding vote that killed the repeal effort in July, expressed misgivings that the Senate would again try to pass a bill that had not been examined by committees with expertise — and with no Democratic support.
“Why did Obamacare fail? Obamacare was rammed through with Democrats’ votes only,” he said on CBS’s “Face the Nation” on Sunday. “That’s not the way to do it. We’ve got to go back. If I could just say again, the way to do this is have a bill, put it through committee.”
Senators Susan Collins of Maine and Lisa Murkowski of Alaska, Republicans who opposed previous repeal efforts, have not said where they stand. But the new bill contains the same provisions they opposed this summer: deep cuts to Medicaid and temporary elimination of funding to Planned Parenthood.
If the Senate does not vote by the end of next week, it will become nearly impossible to repeal the law because the drive to kill the Affordable Care Act will lose the procedural protections that allow it to pass the Senate with a simple majority, rather than the 60 votes that would otherwise be needed.
The House passed a repeal bill in early May, 217 to 213. But the seven-year Republican push to undo President Barack Obama’s signature health care law appeared to reach a dead end in July, when multiple versions of repeal legislation failed to gain even a simple majority in the Senate.
Refusing to accept defeat, Graham and Cassidy have come up with yet another bill. The Senate majority leader, Mitch McConnell, Republican of Kentucky, has told them he will find time for it on the Senate floor if they can muster 50 votes, which would ensure passage with Vice President Mike Pence on hand to break a tie.
McConnell is pressing the Congressional Budget Office for a quick analysis of the Graham-Cassidy bill.
But on Monday the Democratic leaders, Senator Chuck Schumer of New York and Representative Nancy Pelosi of California, asked for detailed answers to this question: “How many people will lose health insurance under the Graham-Cassidy bill?
Other questions: How much will premiums and out-of-pocket health costs increase, particularly for older Americans? How much will Medicaid be cut? And how would the bill affect people with preexisting conditions?
The Graham-Cassidy bill has two major elements. The new element is a block grant. Graham and Cassidy would give each state a fixed amount of federal money for health care and health insurance each year from 2020 to 2026. The allotments would total $1.2 trillion — slightly less than what the government is expected to spend under the ACA on Medicaid expansion, premium tax credits, and subsidies to reimburse insurers for reducing low-income consumers’ out-of-pocket costs.
States would have new discretion over how to use the money, and they could receive federal block grant funds without putting up state money.
In addition, the Graham-Cassidy bill would make deep cuts in Medicaid. It would end the expansion of eligibility under the Affordable Care Act, which has extended coverage to 13 million people. And it would put the program on a budget, ending the open-ended entitlement that now exists. States would receive a per-beneficiary allotment of federal money.