WASHINGTON — The floundering Republican attempt to undo the Affordable Care Act met hardening resistance from key GOP senators Sunday that left it on the verge of collapsing, even as advocates vowed to keep pushing for a vote this week.
With Senate GOP leaders just one “no” vote away from defeat, Sen. Susan Collins, R-Maine, said in a TV interview that it was “very difficult” to envision voting for the bill written by Sens. Bill Cassidy, R-La., and Lindsey Graham, R-S.C., Sen. Ted Cruz, R-Texas, said he and a colleague were not ready to back the measure. And Sen. Rand Paul, R-Ky., who has come out against it, showed no signs of backing down in his own TV appearance.
As Graham and Cassidy pledged to keep trying to pass their bill, the White House and the office of Senate Majority Leader Mitch McConnell gave differing accounts of the path ahead. White House legislative affairs director Marc Short predicted a Wednesday vote while a McConnell spokesman declined to publicly embrace that timeline.
The fresh discord over a signature Republican promise added turbulence to the start of a critical week for President Donald Trump and McConnell, R-Ky. In addition to health care, they are both watching Tuesday’s special election primary runoff in Alabama, a high-stakes intra-party fight that could set the tone for the midterm elections. GOP leaders are also expected to unveil their most detailed blueprint yet of the tax reform plan they hope to pass by the end of the year.
Speaking on CNN’s “State of the Union,” Collins cited concerns about how the Cassidy-Graham legislation would affect Medicaid recipients and people with preexisting medical conditions, among other things.
“It is very difficult for me to envision a scenario where I would end up voting for this bill,” Collins said. “I have a number of serious reservations about it.”
Two Republican senators — Paul and John McCain of Arizona — have already said they would vote against Cassidy-Graham. A third would be enough to defeat the bill, since no Democrats are expected to support it. Republicans hold a 52-48 advantage in the Senate.
The bill has been roundly rejected by influential national groups representing physicians, hospitals and insurers. On Saturday, six such organizations including the American Medical Association and American Hospital Association issued a joint statement urging the Senate to reject it.
Collins voted against a July repeal bill and is a key swing vote in the current dynamic. Last week, she said she was leaning against Cassidy-Graham. Privately, many Republicans have predicted that she will ultimately come out against the bill.
The senator said she had a lengthy chat with Vice President Mike Pence on Saturday. But that was not enough to sway her. Collins said she wants to see the limited forthcoming analysis of the legislation from the nonpartisan Congressional Budget Office this week before she makes a final decision.
“Even over the weekend, I was receiving emails suggesting that the sponsors of the bill are still changing the formula,” she said. “So it may be difficult for the CBO to do the kind of in-depth analysis that it usually does, but that’s what I would like to see before making a formal decision.”
The CBO has said that it will not be able to provide an assessment of how Cassidy-Graham would affect insurance premiums or the number of people with medical coverage “for at least several weeks.” But Trump and McConnell are trying to bring the bill to a vote by the end of this week take advantage of a procedural rule allowing the plan to pass with just 51 votes.
But it was far from clear Sunday that they could get even close to that number.
Addressing Cassidy-Graham at the Texas Tribune Festival in Austin, Cruz said, “right now, they don’t have my vote. And I don’t think they have Mike Lee’s either,” referring to the Republican senator from Utah.
Cruz said that he and Lee met with Graham and Cassidy last week to propose changes to the measure that would get them to yes, but their changes were not included.
Graham and Cassidy appeared on ABC’s “This Week with George Stephanopoulos,” where they defended their plan and vowed to keep up their efforts to shepherd it to passage.
“We’re moving forward. And we’ll see what happens next week. I’m very excited about it,” Graham said. The South Carolina Republican mentioned Collins and Paul as he made his pitch.
“Rand Paul objects to the taxes,” he said. “But when you look at the bill, Rand, we save a lot of money over time for Medicaid. We put a cap on Obamacare growth.”
On NBC’s “Meet the Press,” Paul showed no signs that he was preparing to switch his position.
“I’m just not for this block-granting concept,” he said. At the core of the Cassidy-Graham plan is a maneuver to turn funding for the ACA into block grants for states. It would also dramatically cut Medicaid spending over time.
Also on “Meet the Press,” Short said, “We’re planning to have the vote this week,” adding, “we think it’ll probably be Wednesday.”
McConnell’s office said last week that he intended to bring Cassidy-Graham to the floor this week but has provided no further details. Asked Sunday whether McConnell agrees with Short’s timeline, McConnell spokesman Don Stewart said McConnell had not announced a vote schedule.
The Republican leader is also keeping a close eye this week on the Senate race in Alabama, where Republican Sen. Luther Strange is trying to get past insurgent primary challenger Roy Moore, a former judge. Trump and McConnell both back Strange, but supporters and associates of Trump, including former chief strategist Stephen Bannon and Housing and Urban Development Secretary Ben Carson, have voiced support for Moore.
If Moore defeats Strange, it will be a blow to both McConnell and Trump, who have rallied their powerful political operations behind Strange. Some Republicans also believe it will embolden other conservative insurgents to challenge Republican senators in 2018.
Also this week, the “Big Six” negotiators from the White House, Senate and House are expected to unveil more details of their tax reform plan, which like the health care talks, could be spark messy disagreements among Republicans that could complicate their next big legislative target.
Some of the elements of the plan have already started taking shape. Republicans are targeting a corporate rate of 20 percent in their overhaul, according to three people familiar with the emerging blueprint — a number that represents a substantial cut from the current 35 percent rate but falls short of the 15 percent Trump has advocated.
But for Senate Republicans, the first order of business this week is resolving the health-care push — one way or the other. Even the bill’s champions have already started pondering the prospect of failure.
Asked on “This Week” what he will tell people if he comes up short, Graham responded: “That I did everything I could to get money and power out of Washington to give you better health care closer to where you live and I’m not going to stop fighting.”
The Washington Post’s Carol Morello contributed to this report.