Republican plan to defeat Obamacare looks doomed as Susan Collins says no to bill

The latest Republican bill to repeal Obamacare appears doomed to fail after a key senator came out strongly against it within minutes of an analysis which said the plan would strip health insurance from “millions” of Americans.

Moments after the nonpartisan Congressional Budget Office released a partial analysis of the Republicans’ plan, Maine Senator Susan Collins announced she would not vote for the bill, and called it “deeply flawed”.

The CBO said it was unable to provide its customary detailed estimate because it lacked time to examine the legislation, but said “millions fewer” people would have insurance because of large cuts to Medicaid (a health insurance program for the poor), lower subsidies for individuals who buy insurance, and a lack of penalties for people who prefer to go without insurance.

Collins said the bill would have a “substantially negative impact on the number of people covered by insurance”.

The estimate, which says the bill would cut the US budget deficit by $133bn, comes as Senate Republicans hoped to push through a health reform bill this week.

However, it appears Republicans, with their narrow 52-48 Senate majority, have already lost too many votes to pass the legislation. No Democrats plan to vote for the bill, which means at least 50 Republican senators would be needed for the bill to pass with the aid of the casting vote of Mike Pence, the vice-president.

Collins joined Rand Paul of Kentucky and John McCain of Arizona in pledging to vote against the bill, leaving only 49 votes.

Late on Monday, Donald Trump stepped back into the fray with a renewed attack on McCain, in a sarcastic tweet that contained clips of previous comments in which the senator had promised to repeal and replace Obamacare. “My oh my has he changed – complete turn from years of talk!” Trump said.

The president’s vilification of McCain provoked some of the liveliest exchanges at a town hall debate on the bill held by CNN on Monday night. Lindsey Graham, a senator for South Carolina, rallied to the side of his close friend, despite McCain’s opposition to the proposals he has co-authored.

He told CNN’s audience: “John, if you’re listening … nobody respects you more than I do. So to any American who has a problem with John McCain’s vote, all I can tell you is that John McCain was willing to die for this country and he can vote any way he wants to and it doesn’t matter to me.”

Bernie Sanders described Trump’s latest attack as “beyond my imagination. I cannot understand how someone like Donald Trump could attack an American hero, one of the most decent people in the United States senate.”

The CBO’s findings, although less specific than usual, still revealed that “millions” of Americans would have reduced health insurance. In particular, Medicaid funding would be significantly shrunk, and the Republican bill would shift funds from blue states, which chose to accept federal funding to insure the poor, to Republican states which refused to do the same.

The exact number of people could “vary widely” depending on how states implement the legislation, but the CBO said the “direction of the effect is clear”. The biggest effects would begin in 2020.

“In the short time available, rather than provide the point estimates that are typical in such analyses,” the agency was able to analyze the bill’s effect on “health insurance coverage and market stability”. Analysts said they would need “several weeks” to give a fuller analysis of the bill.

Senate Republicans are offering new deals to key lawmakers in the hope of forcing through a repeal of the Affordable Care Act that would slash the government’s spending on healthcare for poor and disabled Americans.

The Senate must vote on a bill before a Saturday deadline if Republicans are to pass it with a simple majority, but critics, led by McCain, are concerned that the usual due process has been ignored.

The bill had only one public hearing, at a Senate committee on Monday afternoon, and its cost and consequences will be subject to only a “preliminary analysis” from the non-partisan Congressional Budget Office.

“Right now, there is a frenzy of special deals being considered, [and] elbow-twisting behind the scenes to bring swing votes from off the fence,” Senator Ron Wyden, the ranking Democrat on the Senate finance committee, told NPR on Monday. “The fight is far from over.”

Donald Trump and Senate Republicans are trying to hurry the bill through Congress to meet both a seven-year GOP campaign pledge and to free up cash for future tax reform.

In order to do that without a single Democratic vote, Republicans want to pass the bill using a process called “reconciliation”. That allows Republicans to pass bills that affect taxes and spending using just 51 votes. Senate Republicans have 52 Senate seats plus the tie-breaking power of the vice-president, Mike Pence.

But the reconciliation process is time-bound, tied to a budget resolution Congress passed earlier this year. The deadline to pass a health reform bill with only 51 votes is 30 September.

Senator Lisa Murkowski of Alaska has not revealed her position. Nevertheless, pressure from the Alaska governor, Bill Walker, to vote “no” has been steadfast. Walker said any change to Medicaid would “likely result in drastic cuts” in his state.

At a hearing on the bill in the Senate, the Republican senator Orrin Hatch of Utah made his opening statement over the screams of disabled protesters, whom he asked police to remove from the room. Protesters yelled: “No cuts to Medicaid! Save our liberty!”

Hatch said: “If the hearing if going to devolve into a side-show or a forum simply for putting partisan points on the board, there’s no reason for us to be here.”

Nevertheless, White House officials said they were optimistic about the bill’s chances, even if one senior Republican official told the Guardian that passing the bill was “nearly impossible”.

Sarah Huckabee Sanders, the White House press secretary, told reporters at a press briefing: “We know we can’t live with the Obamacare status quo. It’s a complete disaster.”

Meanwhile, the White House had undertaken a “repeal by 1,000 cuts”, Wyden said, referring to a number of administration actions that make it more difficult for Americans to sign up for health insurance if they don’t get it from their employers.

This week, the administration announced that websites for people to buy health insurance through the ACA would not operate on the weekends. The administration has also cut funding for advertising ACA exchanges, has shortened the time Americans have to sign up, and has cut the budget for people who help Americans sign up for health insurance (a complex and time-consuming process).

Over the weekend, Republicans rebalanced proposed federal funding to states, including specifically to states that are home to senators who could act as swing votes. According to Politico, Alaska, Arizona and Kentucky, would all receive more federal funds.

The bill and the process have proved wildly unpopular with the American public. Just 20% of Americans support the measure, according to a CBS poll released Monday. Most Republicans don’t support the bill.

The Graham-Cassidy bill, named for its Republican sponsors, would make huge cuts to Medicaid, a government health insurance program for the poor that insures 70 million people, and would remove most roadblocks for deregulating health insurance in the US.

That could leave millions of Americans uninsured, and in the financially perilous position of paying out-of-pocket for care in the world’s most expensive health system. Though several independent groups have analyzed the bill, the Congressional Budget Office is considered the most authoritative. Its “preliminary analysis” is expected Monday afternoon.

Sabrina Siddiqui contributed to this report