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More like McCan't

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Dylan Scott covers health care for Vox. He has reported on health policy for more than 10 years, writing for Governing magazine, Talking Points Memo and STAT before joining Vox in 2017.

This is the web version of VoxCare, a daily newsletter from Vox on the latest twists and turns in America’s health care debate. Like what you’re reading? Sign up to get VoxCare in your inbox here.

Sen. John McCain (R-AZ) announced Friday he would oppose the latest Obamacare repeal bill, a potential death blow to the GOP’s last hope of undoing much of the 2010 health care law.

McCain said in a statement he “cannot in good conscience” support the bill from Sens. Lindsey Graham (R-SC) and Bill Cassidy (R-LA), which would turn much of Obamacare’s funding into a block grant for the states starting in 2020.

The Arizona senator said, much as did when he voted down Obamacare repeal in late July, that Republicans should instead work with Democrats on a health care bill and that any legislation should go through the regular order of committee hearings and markups.

“I believe we could do better working together, Republicans and Democrats, and have not yet really tried,” McCain said. “Nor can I support it without knowing how much it will cost, how it will effect [sic] insurance premiums, and how many people will be helped or hurt by it.”

McCain’s vote was crucial to killing the last GOP attempt to repeal Obamacare in late July. Now his opposition could spell doom for Graham-Cassidy, which outside estimates have projected would lead to 21 million fewer Americans having health coverage versus Obamacare.

Fifty of the 52 Senate Republicans must support any repeal plan for it to pass the Senate, and the legislation appears to be short. Two other votes, in addition to McCain, look almost certainly gone. They would sink the bill:

  • Sen. Rand Paul (R-KY) has consistently said he opposes the plan, arguing that it keeps too much of Obamacare for his support. "I won't vote for Obamacare Lite that keeps 90% of the taxes & spending just so some people can claim credit for something that didn't happen," Paul tweeted Friday morning.
  • Sen. Susan Collins (R-ME) has not taken a definitive position, but she has raised concerns about how the bill affects people with preexisting conditions and its Medicaid cuts. "The premiums would be so high they would be unaffordable," Collins told the Portland Press-Herald Friday of the changes in the bill to protections for people preexisting conditions. She is widely considered a “no” vote.

There are a few other senators, most notably Sen. Lisa Murkowski (R-AK), who have not yet said whether they support or oppose the bill, but whose support is thought to be in doubt.

Yesterday I walked through the ways Graham-Cassidy doesn't meet Murkowski's standards for health reform. We also got a new analysis, done at the request of the Alaska health department, showing the state facing a 65 percent cut in federal funding by 2026 under Graham-Cassidy compared to Obamacare. It's hard to believe Murkowski, who has opposed every Obamacare repeal bill so far, will decide this is the one to back.

McCain’s opposition comes with the clock ticking down for Senate Republicans to repeal Obamacare. The special privileges they are using to pass a bill with only 51 votes and avoid a Democratic filibuster expire on September 30. After that, they would need to start the process over by passing a budget resolution.

So Obamacare repeal now hinges on the unlikely flip of either Paul or Collins, plus sweeping up the other skittish senators like Murkowski and West Virginia's Shelley Moore Capito. It seems near-impossible (though it won't truly be over until October 1).

Senate leaders had said that they intended to bring Graham-Cassidy up for a vote next week, though it’s not clear if they would still hold the vote knowing that the bill would fail.

Chart of the Day

Kaiser Family Foundation

Why do Republicans keep trying to repeal Obamacare? Because their base wants them to. A new Kaiser Family Foundation poll out this morning sheds some light on why Republicans remain incredibly persistent in their efforts to overturn the Affordable Care Act. Twice as many Republican voters want to see their legislators work to repeal Obamacare as want them to improve the way the health care law is working. Read more here.

Kliff’s Notes

With research help from Caitlin Davis

Today's top news

  • "McCain to vote no on ObamaCare repeal": ““I cannot in good conscience vote for the Graham-Cassidy proposal. I believe we could do better working together, Republicans and Democrats, and have not yet really tried," he said in a statement, referring to the legislation spearheaded by GOP Sens. Lindsey Graham (S.C) and Bill Cassidy (La.).” —Jordain Carney, the Hill
  • "Susan Collins leaning 'no' on Graham-Cassidy Obamacare bill": “Sen. Susan Collins, R-Maine, is leaning against supporting the Republicans' latest Obamacare overhaul bill due in part to it stripping protections for people with pre-existing conditions, according to a published report.” —Robert King, Washington Examiner
  • "CVS Health Moves to Limit Access to Opioid Painkillers": “CVS Health Corp., which administers drug benefits for employers, insurers and some state Medicaid programs, said it would limit opioid prescriptions to seven days or less for certain patients with acute pain who haven’t previously taken an opioid painkiller. That will be a big change, given that many CVS-covered patients with acute pain receive opioid prescriptions for 20 days or more.” —Jeanne Whalen, Wall Street Journal

Analysis and longer reads

  • "Obamacare’s assassins put the squeeze on Alaska": “Senators Lindsey Graham and Bill Cassidy, the co-sponsors of the titular repeal bill, appear to have turned to bribery. The purported effort to buy Murkowski’s vote has surfaced in news reports in various forms.” —Abigail Tracy, Vanity Fair
  • "Advocates Say Seniors With Obamacare Need More Time To Switch To Medicare": “A lifetime of late enrollment penalties typically await people who don't sign up for Medicare Part B, which covers doctor visits and other outpatient services, when they first become eligible at age 65. That includes people who mistakenly thought that because they had insurance through the ACA marketplaces, they didn't need to enroll in Medicare.” —Susan Jaffe, Kaiser Health News
  • "Rural hospitals see Graham-Cassidy as latest threat to survival": “Leaders of cash-strapped rural hospitals worry that the latest proposal to repeal and replace the Affordable Care Act could destroy them. With higher rates of Medicaid patients than their urban counterparts, rural hospitals would be disproportionately hurt by an end of the Medicaid expansion proposed in the so-called Graham-Cassidy Senate bill, said Maggie Elehwany, vice president of government affairs at the National Rural Health Association.” —Dave Barkholz, Modern Healthcare