A last-ditch Republican push to roll back the Affordable Care Act appeared to pick up momentum Monday even as opposition from leading patient advocates and healthcare organizations mounted, setting the stage for another potentially dramatic Senate vote on the future of the 2010 law, often called Obamacare.
Prospects for the new repeal legislation — sponsored by Sens. Bill Cassidy (R-La.) and Lindsey Graham (R-S.C.) — remain uncertain, but the proposal won an important endorsement Monday from a key Republican governor, Arizona's Doug Ducey.
That raised the possibility that the state's senior senator, John McCain, who cast the crucial vote in July to kill the last repeal push, could back the new bill. McCain has said he would be influenced by Ducey's position, but has also called for a less partisan, less rushed approach to healthcare legislation.
On Monday afternoon, the Republican senator said he remained undecided. "I'm not supportive of the bill yet," he told reporters, explaining that he would prefer healthcare legislation go through the normal committee process.
Supporters of the Graham-Cassidy measure aim to bring it to the Senate floor next week, just days ahead of the expiration of special rules that could allow it to pass with 50 votes, rather than the 60 that major measures typically require.
That has prompted leading patient and medical groups to intensify warnings that the Graham-Cassidy proposal could devastate coverage for tens of millions of vulnerable Americans.
The bill would go far beyond repealing key parts of President Obama's signature healthcare law. It would fundamentally change how states and the federal government divide the cost of providing healthcare.
At the same time, the measure would give states broad new authority to completely overhaul their healthcare systems and change or eliminate consumer protections.
It would also redistribute tens of billions in federal aid, taking it away from states such as California, Illinois and New York that have expansive safety nets and giving more to states that do not, including many Republican-majority states in the South, according to independent analyses.
The nonpartisan Congressional Budget Office said Monday that it would not be able to produce a full analysis of the bill for "at least several weeks" although it would offer a "preliminary assessment" of some aspects next week.
On Monday, a coalition of 16 patient groups condemned the proposal.
"This legislation fails to provide Americans with what they need to maintain their health," the groups said in a statement, echoing similar criticism leveled last week by the AARP, physician groups and the country's safety net hospitals.
The patient groups — which include the American Diabetes Assn., American Heart Assn., American Lung Assn., March of Dimes and National Multiple Sclerosis Society — warned the bill "would roll back important essential health benefit protections and potentially open the door to annual and lifetime caps on coverage, endangering access to critical care for millions of Americans."
Last week, six leading physician groups, including the American Academy of Family Physicians, American College of Physicians and American Academy of Pediatrics, said in a letter to congressional leaders that the new GOP proposal "fails to protect the health care coverage and consumer protections available under current law."
None of the country's leading patient or healthcare groups has backed the legislation.
The bill's authors say it would lead to better care and lower costs.
"Instead of a Washington-knows-best approach like Obamacare, our legislation empowers those closest to the healthcare needs of their communities to provide solutions," Graham said last week.
"Our bill takes money and power out of Washington and gives it back to patients and states."
The legislation has appeared to face long odds, in part because of the short time left before the special rules, known as budget reconciliation, expire on Sept. 30.
It's also unclear whether GOP congressional leaders have the appetite to restart a contentious debate over health legislation that could imperil insurance protections for millions of Americans.
As of Monday afternoon, it still appeared Republicans were at least a vote or two shy. No Democratic senators are expected to vote for the bill, so Republican leaders can afford to lose only two of their members.
Conservative Sen. Rand Paul (R-Ky.) has rejected the Graham-Cassidy proposal because it retains much of the spending in the current law. Sens. Susan Collins (R-Maine) and Lisa Murkowski (R-Alaska), who voted against repeal legislation over the summer, have voiced reservations about provisions that would restrict federal money for Planned Parenthood.
Meanwhile, leading Republicans and Democrats in the Senate Health Committee are working on a bipartisan effort to stabilize insurance markets created by the law. Collins and Murkowski and numerous patient advocates and healthcare groups have supported that effort.
But the White House has supported the repeal push. And Cassidy has said in recent days that he is close to the 50 votes needed to advance the bill.
The Graham-Cassidy proposal would eliminate federal assistance that allowed 31 states to expand Medicaid coverage to poor, working-age adults, a population not traditionally covered by the safety net health insurance program.
The Medicaid expansion, which began in 2014, is credited with helping drive a historic decline in the number of Americans who lack health coverage.
The bill would also eliminate tax subsidies that the current law makes available to moderate-income consumers who shop for coverage on state insurance marketplaces.
Starting in 2020, the bill would cap future federal Medicaid aid to states, while giving states more authority to limit enrollment and benefits in the program.
After that, federal healthcare aid to states would transition to a complex new formula that would in effect redistribute federal funding among states.
The bill appears to allow states to once again allow health insurers to charge sick Americans more for coverage, in effect gutting the current law's ban on discrimination against people with preexisting medical conditions.
The Graham-Cassidy bill would also repeal mandates that require Americans to buy health coverage and require large employers to provide health benefits. And it would loosen restrictions on health savings accounts, allowing Americans to make broader use of the tax-free accounts to pay health insurance premiums as well as medical bills.
Taken altogether, the bill would represent a complete overhaul of federal financing for healthcare, affecting health coverage for nearly 100 million Americans.
The full impact of such major changes would normally be analyzed and debated through lengthy committee hearings.
That has not happened. On Monday, the Senate Homeland Security and Governmental Affairs Committee, which does not usually review healthcare bills but is headed by Sen. Ron Johnson (R-Wis.), a cosponsor of the Graham-Cassidy bill, announced a hearing on one aspect of the bill, scheduled for Sept. 26.
1:18 p.m.: This article was updated with a comment from Sen. John McCain.