McCain to vote against health care bill, likely dooming GOP effort

Sen. John McCain’s surprise announcement that he will oppose the Graham-Cassidy health care bill likely derailed the latest bid by congressional Republicans to repeal and replace the Affordable Care Act, or Obamacare. (Photo by Keerthi Vedantam/Cronkite News)

WASHINGTON – Sen. John McCain said Friday that he cannot “in good conscience” vote for the latest plan to replace Obamacare, a surprise announcement that may have killed the bill for Senate leaders who can only afford to lose two GOP votes.

The Arizona Republican joins Sen. Rand Paul, R-Kentucky, in coming out against the so-called Graham-Cassidy bill that supporters say would return control to the states – but critics say would force 32 million Americans off health care and cut billions in aid to states, including Arizona.

McCain, who was a key vote against a similar bill that died in July, had complained earlier this week about complex health care measures being pushed through without the “regular order” of debate and amendment.

He repeated those concerns in a statement Friday, saying the bill was being rushed through to meet a Sept. 30 deadline that would let the Senate pass the bill with a simple majority of 51 senators instead of the 60 required to stop a filibuster.

“I cannot in good conscience vote for the Graham-Cassidy proposal. I believe we could do better working together, Republicans
and Democrats, and have not yet really tried,” his statement said.

While he said he might have supported a bill that went through the normal process, he could not support this bill “without knowing how much it will cost, how it will affect insurance premiums, and how many people will be helped or hurt by it.” Answers to those questions will not be available until the Congressional Budget Office reviews the bill, he said, which is not expected to happen before the end of the month.

Gov. Doug Ducey, who supports Graham-Cassidy, repeated that support Friday in a statement that called the bill “far superior to anything Washington, D.C., has proposed on healthcare policy in recent memory, because it shifts dollars and decisions back to the states.”

Ducey ended his statement by noting that “51 votes are still possible.” Analysts agreed that while it’s still possible to get enough votes to pass a bill, it is increasingly unlikely.

All 48 Senate Democrats are expected to vote against the bill, and “no” votes by McCain and Paul would result in a 50-50 tie that would be broken by Vice President Mike Pence to push the bill over the top. But analysts note that Republican Sens. Lisa Murkowski of Alaska and Susan Collins of Maine, who joined McCain to shoot down the last GOP health care bill in July, are far from sure “yes” votes this time around.

“McCain’s decision probably kills the bill because it’s hard to see Collins supporting it,” Jennifer Duffy, senior editor of the Cook Political Report, said in an email Friday. “These votes on health care have been some of the most consequential of his career.”

Kyle Kondik, managing editor for Sabato’s Crystal Ball at the University of Virginia’s Center for Politics, said Senate Republicans have been “foiled left and right” in their attempts to make good on a promise to repeal the Affordable Care Act, or Obamacare.

Despite this latest setback, he said there is still a chance Republicans could deliver on that promise.

“I wouldn’t want to say the Republican effort to change the ACA is dead,” Kondik said, noting that with the vast majority of Republicans in agreement on the issue, “some other iteration could pass.”

The latest iteration, sponsored by Republican Sens. Lindsey Graham of South Carolina and Bill Cassidy of Louisiana, among others, would reverse a number of elements in Obamacare. It would eliminate requirements that individuals buy health insurance, and employers provide it; remove subsidies that helped poor people pay for their coverage; reallocate Medicaid funds to states in the form of block grants; and drop the federal prohibition against denying coverage based on pre-existing medical conditions, letting states to decide that issue.

Republicans like Ducey and Flake said that returning control to the states will solve the top-down control of Obamacare that they said led to skyrocketing premiums and falling numbers of companies willing to offer insurance.

Flake said he has “the utmost respect” for McCain, but disagreed with him on Graham-Cassidy, which he called “the best shot I’ve seen for a repeal and replace bill to get signed into law.”

“Graham-Cassidy will give Arizona the flexibility it needs to innovate and lower premiums while maintaining protections to ensure access to quality, affordable care for individuals with preexisting conditions,” Flake said in a statement Friday.

But Democrats and health care advocates immediately attacked the bill – for being rushed through the Senate as well as for its elements that they said would leave up to 32 million people without health care.

While no CBO report is available, other analysts have said the proposal would result in hundreds of billions in health-care funding cuts to states, the hardest hit of which would be states that expanded Medicaid coverage – like Arizona – under Obamacare.

The Center on Budget and Policy Priorities estimated that Arizona could lose $6.9 billion by 2027 under Graham-Cassidy; another consultant, Avalere, put Arizona’s estimated losses at $19 billion by 2027.

While Republican response to McCain’s announcement was muted Friday, Obamacare supporters were quick to praise the senator for his decision.

“Graham-Cassidy is bad on process as Sen. McCain has rightly noted,” Brad Woodhouse, campaign director for Protect Our Care in Arizona, said in a statement. “But it would be a dumpster fire for the American health care system.”

Woodhouse said it is time to “allow bipartisan efforts to stabilize our health care system to move forward.”

The bill is scheduled to have its first hearing Monday in the Senate Finance Committee.