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FRIDAY, Sept. 22, 2017 (HealthDay News) -- Sen. John McCain dealt a body blow to the latest effort to replace Obamacare on Friday by announcing that he can't vote for the Graham-Cassidy health care bill as it stands.
"I believe we could do better working together, Republicans and Democrats, and have not yet really tried," McCain (R-Ariz.) said in a statement. "Nor could I support it without knowing how much it will cost, how it will affect insurance premiums, and how many people will be helped or hurt by it."
"Without a full CBO [Congressional Budget Office] score, which won't be available by the end of the month, we won't have reliable answers to any of those questions," McCain noted.
Meanwhile, Sen. Susan Collins (R-Maine) said Friday that she is leaning toward voting no on the bill, while Sen. Rand Paul (R-Ky.) has already voiced his opposition to the latest proposal.
If all three vote no, the bill will almost certainly be doomed, the Associated Press reported. Republicans have until Sept. 30 to pass a health care bill with a simple majority. After that, they will need 60 votes, considered a near impossibility.
But one expert said the bill's fate still hangs in the balance.
McCain's "no" vote leaves very little margin for error. With Alaska's Lisa Murkowski still undecided, it's unclear whether the measure will garner the simple majority needed to pass the Senate. In the event of a 50-50 vote, Vice President Mike Pence would cast the deciding vote.
"Some people are certainly saying it's the death knell of this bill, but I'm not assuming that," said Matt Salo, executive director of the National Association of Medicaid Directors, in Washington, D.C. The organization opposes the bill.
"I think it is more significantly uphill to get there, but it's definitely not impossible to get there," he added.
Salo does not rule out the possibility that Sen. Paul would vote with his party in the end. "I can certainly see him saying, 'Ugh, alright, yeah, I don't like it, but it's better than nothing.'"
The Graham-Cassidy bill, the latest effort by Senate Republicans to roll back key provisions of the Affordable Care Act (also known as "Obamacare"), first surfaced earlier this month. The bill was sponsored by Senators Lindsey Graham of South Carolina, Bill Cassidy of Louisiana, Dean Heller of Nevada and Ron Johnson of Wisconsin.
Seen as a last-ditch attempt by the GOP to fulfill its vow to replace the health reform law, the bill would give states more decision-making authority on how to allocate health care dollars.
Instead of funding Obamacare's Medicaid expansion, premium tax-credits and cost-sharing reductions, the bill would redistribute that money to states in the form of block grants.
The Graham-Cassidy bill would also repeal the individual and employer mandates. The individual mandate requires most Americans to have insurance coverage or pay a fine.
Medical groups and consumer advocates have criticized the new GOP measure, saying it would sharply boost the number of uninsured Americans and undermine key consumer health protections.
Dr. Jack Ende, president of the American College of Physicians (ACP), has said the proposal fails to meet ACP criteria to ensure that patient health is improved -- not harmed -- by changes to current law.
Ende said Congress should consider policies that encourage state innovation "without rolling back current coverage, benefits and other consumer protection."
Betsy Imholz, special project director at Consumers Union, has called the legislative effort "a distraction from the productive bipartisan efforts underway in the Senate to pass real solutions to stabilize and strengthen the insurance markets."
Obamacare's open enrollment period for coverage in 2018 kicks off on Nov. 1 amid continued uncertainty over the future of funding provided to insurers to reduce out-of-pocket costs to low-income consumers.
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SOURCES: Matt Salo, executive director, National Association of Medicaid Directors, Washington, D.C; Sept. 13, 2017, legislative summary, Graham-Cassidy-Heller-Johnson; Associated Press