Republicans' latest bid to roll back the Affordable Care Act appeared to collapse Monday as a third GOP senator came out against the measure and the Congressional Budget Office predicted major coverage losses should it become law.
Sen. Susan Collins (R-Maine), who voted against the last Republican repeal bill, joined Sens. John McCain (R-Ariz.) and Rand Paul (R-Ky.) and issued a stern rebuke of her party's attempt to rush through a sweeping repeal proposal this week with just one public hearing and little independent analysis.
"Part of the problem that we have had has been the lack of hearings, debates and careful consideration and vetting of the healthcare replacement bills," Collins said, renewing calls for Republicans and Democrats to work together on legislation to stabilize health insurance markets and protect consumers from rising costs.
With only 52 Republicans in the Senate and Democrats united in opposition, GOP leaders could afford to lose only two votes.
Collins' announcement followed the release of a preliminary CBO analysis of a bill sponsored by Sens. Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.). The office predicted "the number of people with comprehensive health insurance that covers high-cost medical events would be reduced by millions."
It capped a frenetic day in Washington in which protesters flocked to Capitol Hill and Republican leaders seemed to retreat from their scramble to pass a repeal bill over the objections of nearly every major organization representing patients, physicians, hospitals and others in the healthcare system.
Monday afternoon, Senate Finance Committee Chairman Orrin G. Hatch (R-Utah) said GOP leaders would probably not be able to hold a vote this week as planned.
Even before Collins' announcement Monday, President Trump sounded increasingly downbeat about the bill's chances.
"We're going to lose two or three votes, and that's the end of that," Trump said Monday on Alabama radio's "Rick and Bubba Show," criticizing Republican senators for withholding their support after years of promising to repeal and replace the law. "They pander and they grandstand."
Senate Republicans were rushing to vote before a Sept. 30 deadline, after which they can no longer use a special rule that allows them to advance repeal legislation with only 50 votes instead of the 60 normally required to pass controversial bills in the Senate.
Plans for this week's vote remained uncertain Monday evening amid silence from Senate Majority Leader Mitch McConnell (R-Ky.).
Senate Republican leaders and White House officials had been working furiously to round up votes in recent days.
Trump called Collins on Monday, she told reporters. The president made a similar appeal to Paul over the weekend, Paul said.
Vice President Mike Pence and Health and Human Services Secretary Tom Price also made an effort to woo Collins, the independent Senate veteran.
At the same time, Graham and Cassidy made a series of last-minute changes to their proposal, promising to send more money to Maine, Arizona and Alaska in a clear effort to win over Collins, McCain and Sen. Lisa Murkowski (R-Alaska), who has voiced reservations about the repeal push and voted against the last repeal bill over the summer.
In a bid to win over Paul and other conservatives, Graham and Cassidy also appeared to further weaken consumer protections, giving states more authority to waive requirements under the current law, such as the prohibition on insurers charging sick people more for coverage.
In addition to Paul, Sen. Ted Cruz, speaking in his home state of Texas over the weekend, said that "right now they don't have my vote." He too remained unmoved Monday, but aides said he was trying to get to yes. Cruz said he did not think Sen. Mike Lee (R-Utah) was supporting the bill, either, though Lee's office said Monday that the senator was reviewing the latest version.
By Monday evening, other Republican senators began to voice similar reservations about the rush to pass the Graham-Cassidy proposal as well.
"I have no idea what's in the bill," said Sen. John Kennedy (R-La.) "I think we need to move on from healthcare and do tax reform."
Cassidy and Graham have insisted Americans would not lose vital insurance protections under their bill, including the guarantee that they could get insurance even if they are sick.
"This plan protects those with preexisting conditions and gives states resources and flexibility to lower premiums and increase the number of Americans insured," Cassidy said Monday after releasing his latest proposal.
But the claims were undercut by the nonpartisan CBO, which predicted that most states would struggle with major cuts in funding and that some would roll back insurance protections for sick Americans.
"Some of the choices made by states could reduce enrollees' access to care," warned the budget office, which also noted that premiums would probably increase for some Americans, particularly those who need services like mental health treatment or expensive drugs.
The GOP proposal would not only roll back government programs created by the current law to guarantee Americans' health coverage, but it also would completely restructure the 52-year-old system of federal support for state Medicaid programs that currently cover about 70 million people.
It would also dramatically cut future Medicaid funding that supports coverage for poor children, mothers, seniors and the disabled.
At the same time, the bill would give states broad new authority to remake their healthcare systems and waive many protections in the current law, including the requirement that health plans cover a basic set of benefits.
That prompted rising alarm among consumer advocates and others, who stepped up warnings Monday that the bill would be devastating to sick Americans.
"This bill is an even harsher version of the previous failed proposals that were overwhelmingly rejected by Americans," said Betsy Imholz, special projects director for Consumers Union. "It is not only a repeal of the Affordable Care Act — threatening key consumer protections and coverage requirements that ensure those with preexisting conditions have access to meaningful care — but also a historic undercutting of the Medicaid program."
On Monday, 36 current and former state insurance commissioners, including several Republicans, sent a strongly worded letter to congressional leaders urging them to reject the latest proposal.
"The Cassidy-Graham bill would increase the number of people without health coverage and severely disrupt states' individual insurance markets, with sharp premium increases and insurer exits likely to occur in the short term and over time," the commissioners wrote.
And in yet another blow, analysts at S&P Global Ratings predicted Monday that the Graham-Cassidy proposal would result in the loss of nearly 600,000 jobs over the next decade.
5:05 p.m.: This article was updated with additional reaction and analysis.
3:35 p.m.: This article was updated after Collins said she would oppose the measure.
3:10 p.m.: This article was updated after the CBO report was released.
10:55 a.m.: This article was updated with Trump's comments.