A bill to repeal the Affordable Care Act suffered another blow on Sunday when Sen. Susan Collins (R-Maine) reiterated her criticism of the proposal and said she was likely to vote no.
Collins declined to declare a firm position on the proposal, saying that she wanted to wait until the Congressional Budget Office weighs in with some kind of formal analysis.
But Collins warned that the bill would likely deprive millions of people of insurance coverage and gut protections for people with pre-existing conditions. The senator added that it would take a “surprise” from the CBO, predicting very different results, to get her on board.
Such a surprise would be highly unlikely, since the CBO has already said that, because of the GOP’s rush to vote on the bill, it will not be able to produce a full estimate of coverage effects in time. The estimate due tomorrow is likely to focus only on the bill’s impact on the federal deficit.
Meanwhile, multiple private and independent analysts have all produced their own estimates. All have predicted devastating effects on insurance coverage and weaker protections for people with pre-existing conditions ― as Collins acknowledged.
“I actually expect the CBO will reinforce those studies … or that the CBO is going to say they simply don’t have time to do a thorough analysis,” Collins said. “Maybe there will be a surprise in there, but I don’t anticipate that.”
Collins’ position on the bill is hardly a shock. She is the least conservative member of the Republican caucus and has voted against every repeal bill to come up for a vote so far.
But her vote remains pivotal, because the GOP has only 52 seats in the upper chamber and two other GOP senators, John McCain from Arizona and Rand Paul from Kentucky, have already declared their opposition. A no from Collins would leave Republicans at least one short of 50, the minimum they need to pass the bill under special parliamentary authority that expires on Sept. 30.
The sponsors of the legislation, Sens. Bill Cassidy (R-La.) and Lindsey Graham (R-S.C.), have said they are not giving up yet ― promising to modify it in ways that could win over some of the skeptics. “We’re moving forward,” Graham said Sunday during an appearance on ABC News “This Week.”
Administration officials made similar vows on Sunday. Marc Short, White House director of legislative affairs, said on NBC’s “Meet the Press” that a vote this week remained likely.
But Collins, McCain, and Paul have laid down consistent markers about what they want and it’s difficult to see how mere tweaks could satisfy them ― especially since they seem concerned with the hurried process to pass the bill as well as the substance itself.
And those three aren’t the only likely no votes at this point. Sen. Lisa Murkowski (R-Alaska) has not declared yet her position on the bill. But she was the third senator to vote no in late July, when a previous repeal bill failed in a dramatic floor vote.
She has been openly critical of this latest effort and has said she does not want a “special deal” for Alaska. Her governor has also been openly critical of the proposal.
The Graham-Cassidy bill would cut Medicaid, replace the Affordable Care Act’s coverage funding with smaller grants to the states, and allow states to waive regulations that protect people with pre-existing conditions.
The number of people without health insurance would be 21 million higher by 2026, according to the most recent and authoritative analysis of the plan, which comes from the University of Southern California-Brookings Schaeffer Initiative for Health Policy. The authors noted that their estimate might be conservative, and that one decade later, by 2036, the number would be up to 32 million because the Graham-Cassidy bill’s new funding cuts off at that point.
Opposition to the bill has been loud and included not just progressives but also a broad coalition of organizations involved in health care. On Saturday, six prominent groups representing doctors, hospitals, and insurers ― including both the American Medical Association and America’s Health Insurance Plans ― issued a rare joint letter condemning the Graham-Cassidy bill.
Cassidy and Graham have insisted all those experts and organizations are wrong about the bill ― that states could provide care more efficiently, and that their bill contains sufficient protections for people with serious medical problems.
Collins on Sunday sided with the experts and groups that know health care. “I’m concerned about the impact on the Medicaid program, which has been on the books for more than 50 years and provides coverage to our most vulnerable citizens,” Collins said.
Collins went on to acknowledge that many people already face high premiums or deductibles under the Affordable Care Act. But Collins, who served previously as Maine’s chief insurance regulator, said she worried that the Graham-Cassidy bill could make the problem worse ― and cause “erosions” of protections for people with pre-existing conditions.
Collins noted that a bipartisan effort to shore up the Affordable Care Act’s marketplaces had been underway, in the Senate’s health, education, labor and pensions committee. The committee’s chairman, Sen. Lamar Alexander (R-Tenn.), called off that effort last week. Collins said she hopes that it can start up again.