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| John McCain says he can't vote for Republican plan to replace Obamacare | John McCain says he can't vote for Republican plan to replace Obamacare |
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| Senator John McCain said on Friday that he could not “in good conscience” vote for the latest Republican proposal to replace Obamacare, dealing a potentially fatal blow to its path forward. | Senator John McCain said on Friday that he could not “in good conscience” vote for the latest Republican proposal to replace Obamacare, dealing a potentially fatal blow to its path forward. |
| The senator for Arizona’s move made it increasingly difficult for Republican party leaders to get the votes they need to eliminate the Affordable Care Act in what is being seen as a last-gasp attempt. | |
| Republicans hold a slim 52-seat majority in the Senate. The process Republicans are using to pursue healthcare, known as “reconciliation”, enables them to pass legislation with a simple 51-majority vote. | |
| As a result, Republicans can afford to lose just two senators, a scenario in which vice-president Mike Pence would cast the tie-breaking vote. In addition to McCain, Kentucky senator Rand Paul has said he is firmly against the measure because he does not believe it does enough to repeal the existing healthcare law. | |
| Senator Susan Collins, a Republican from Maine, also said Friday she was “leaning against” the proposal. | Senator Susan Collins, a Republican from Maine, also said Friday she was “leaning against” the proposal. |
| McCain, who would like to repeal the ACA, has taken issue with the fast-track process Republicans are using to rush the bill to the floor and allow them to pass the bill on a party-line vote expires. | McCain, who would like to repeal the ACA, has taken issue with the fast-track process Republicans are using to rush the bill to the floor and allow them to pass the bill on a party-line vote expires. |
| “I cannot in good conscience vote for the Graham-Cassidy proposal,” McCain said in a statement on Friday. “I believe we could do better working together, Republicans and Democrats, and have not yet really tried.” | “I cannot in good conscience vote for the Graham-Cassidy proposal,” McCain said in a statement on Friday. “I believe we could do better working together, Republicans and Democrats, and have not yet really tried.” |
| “Nor could I support it without knowing how much it will cost, how it will effect insurance premiums, and how many people will be helped or hurt by it. Without a full CBO score, which won’t be available by the end of the month, we won’t have reliable answers to any of those questions.” | “Nor could I support it without knowing how much it will cost, how it will effect insurance premiums, and how many people will be helped or hurt by it. Without a full CBO score, which won’t be available by the end of the month, we won’t have reliable answers to any of those questions.” |
| Republican leadership had hoped to hold a vote as early as next week, but McCain’s defection makes the math nearly impossible. | Republican leadership had hoped to hold a vote as early as next week, but McCain’s defection makes the math nearly impossible. |
| Senator Lisa Murkowski of Alaska, who along with Collins and McCain thwarted the most recent attempt by Senate Republicans to repeal the ACA in July, has also expressed deep skepticism over the Graham-Cassidy. | Senator Lisa Murkowski of Alaska, who along with Collins and McCain thwarted the most recent attempt by Senate Republicans to repeal the ACA in July, has also expressed deep skepticism over the Graham-Cassidy. |
| McCain’s decision on Friday was especially notable given his close friendship with Lindsey Graham, the lead co-sponsor of the latest ACA repeal bill. In his statement, McCain alluded to his rapport with Graham to underscore the difficulty he faced in reaching his decision. | McCain’s decision on Friday was especially notable given his close friendship with Lindsey Graham, the lead co-sponsor of the latest ACA repeal bill. In his statement, McCain alluded to his rapport with Graham to underscore the difficulty he faced in reaching his decision. |
| “I take no pleasure in announcing my opposition. Far from it,” McCain said. “The bill’s authors are my dear friends.” | “I take no pleasure in announcing my opposition. Far from it,” McCain said. “The bill’s authors are my dear friends.” |
| The Graham-Cassidy proposal has garnered significant backlash in recent weeks from across the healthcare spectrum. Several leading physicians associations, as well as the lobbying group that represents the insurance industry, have come out against the bill. | The Graham-Cassidy proposal has garnered significant backlash in recent weeks from across the healthcare spectrum. Several leading physicians associations, as well as the lobbying group that represents the insurance industry, have come out against the bill. |
| As crafted, the Graham-Cassidy proposal would eliminate the ACA’s expansion of Medicaid, the federal program that helps provide access to healthcare to low-income individuals. It also guts coverage requirements for preexisting conditions, enabling insurers to charge higher premiums to sick people or to refuse coverage entirely. | As crafted, the Graham-Cassidy proposal would eliminate the ACA’s expansion of Medicaid, the federal program that helps provide access to healthcare to low-income individuals. It also guts coverage requirements for preexisting conditions, enabling insurers to charge higher premiums to sick people or to refuse coverage entirely. |
| The latter was highlighted in recent days by comedian Jimmy Kimmel, who dedicated the opening monologues of his late-night talk show this week to slamming the Republican plan and branding Cassidy a “liar”. | |
| Cassidy had appeared on Kimmel’s show amid healthcare negotiations in May and created the so-called “Jimmy Kimmel test”, under which no family would be denied healthcare because they could not afford it. The issue has been deeply personal for Kimmel, who shared the story of his newborn son requiring surgery for heart problems that qualify as a preexisting condition. | |
| The bill also allows states to opt out of coverage requirements established under the ACA for “essential health benefits”, which include maternity care and prescription drugs. | |
| The goal of the Republican plan, much like other failed iterations, is to give more control to the states. | |
| The Graham-Cassidy proposal would do so by replacing the ACA’s Medicaid expansion and insurance subsidies with a new block grant program for the years 2020 to 2026. (If enacted, the bill would not go into effect until 2020). Federal funding for Medicaid would also be capped. | |
| An analysis released by the Kaiser Family Foundation found that 35 states would lose $160 bn in federal funding under the bill. The Trump administration’s own internal data, which was reported by Axios, showed 31 states poised to lose federal funding, with Murkowski’s state incurring a 38% cut in 2026. |