The path toward passing Graham-Cassidy is getting narrower

Key Republican senators voiced doubts over the latest Obamacare repeal bill, narrowing its chances of passage before a looming September 30 deadline.

Maine Sen. Susan Collins told CNN that “it’s very difficult for me to envision a scenario where I would end up voting for this bill.” Texas Sen. Ted Cruz said Sunday morning that “right now, they don’t have my vote.”

Two Republican senators — Rand Paul (KY) and John McCain (AZ) — have already announced they will vote “no” on the Graham-Cassidy health care bill, and show little sign of changing their minds.

This leaves Senate Republicans with no margin of error: A third “no” vote would put them shy of the 50 votes necessary to pass the Obamacare repeal plan. And there are few Republicans campaigning aggressively in the bill’s favor, aside from its sponsors.

Time, meanwhile, is running short: The Senate faces a September 30 deadline for moving the latest repeal bill. After that, the reconciliation rules they plan to use to move Graham-Cassidy expire. If this bill doesn’t pass by the end of the week, then Republicans would likely need to wait until next year to use the reconciliation process again (which allows budget-specific bills to pass with just 50 votes, rather than the 60 required to break a filibuster).

Senate Republicans have seen their previous attempts at Obamacare repeal fall short by a small number of votes. They now risk the same fate with Graham-Cassidy, a bill that cuts federal health spending by an estimated $215 billion and targets the largest cuts to states that expanded Medicaid.

Graham-Cassidy’s defunding of the Medicaid expansion, coupled with its redistribution of Affordable Care Act funds, hasn’t won over key senators. More moderate Republicans worry that the Medicaid cuts would hurt their low-income residents, while conservative legislators argue Graham-Cassidy doesn’t do enough to repeal Obamacare.

Collins, appearing Sunday morning on CNN, said that she feared what the Medicaid cuts would do to her home state of Maine:

I’m concerned about the impact on the Medicaid program, which has been on the books for more than 50 years and provides health care to our most vulnerable citizens, including disabled children and low-income seniors. I’m concerned about the impact on costs and coverage. We already have a problem under the Affordable Care Act with the cost of premiums and deductibles. And, finally, I’m very concerned about the erosion of protections for people with preexisting conditions, like asthma, arthritis, cancer, diabetes, and what it would mean to them.

One analysis estimates that Maine would lose $1 billion in federal funding over the next decade if Graham-Cassidy became law.

Cruz also expressed reservations about the bill but likely has completely different objections. Texas would actually gain $35 billion over the next decade if Graham-Cassidy passes because it has not expanded Medicaid. But he said at a Texas Tribune Festival event Sunday, “Right now, they don’t have my vote and I don’t think they have Mike Lee’s vote either.”

Cruz didn’t expand on why he or Lee, a Republican senator from Utah, currently opposes Graham-Cassidy. But the two are some of the most conservative senators, and are likely to share Sen. Paul’s concerns that the bill doesn’t do enough to roll back the Affordable Care Act. It keeps many of the law’s taxes intact, for example, rather than rolling them back wholesale.

As Republican senators were criticizing Graham-Cassidy, major health groups issued a harsh rebuke of the proposal. In a rare joint letter, the hospital industry, the insurance industry, and major doctor groups said they “cannot support this proposal” and predicted it would “have real consequences on consumers and patients by further destabilizing the individual market, cutting Medicaid, [and] pulling back on protections for pre-existing conditions.”

Still, the bill’s sponsors remain optimistic. There will be a hearing on the bill Monday afternoon in the Senate Finance Committee and Sen. Cassidy has promised a new version of the bill in the morning.

The bill’s namesakes, Sens. Lindsey Graham (R-SC) and Bill Cassidy (R-LA), will participate in a CNN debate that evening, defending their bill against Sens. Bernie Sanders (I-VT) and Amy Klobuchar (D-MN). And they continue to argue that key senators — like Lisa Murkowski of Alaska, who has also been critical of the plan — remain winnable. It appears they will continue to pursue their bill right up to the September 30 deadline.