The Republican effort to repeal Obamacare is once again on life support.
Lawmakers return to Washington on Monday with the GOP just one more "no" vote away from having their latest effort to overhaul the Affordable Care Act scuttled.
So far, two Republicans -- Sens. John McCain of Arizona and Rand Paul of Kentucky -- have publicly come out against the latest bill to overhaul Obamacare. That number could grow as soon as Monday when Maine Republican Sen. Susan Collins -- who said on CNN Sunday that she couldn't envision a scenario in which she would support the bill -- expects a partial score from the non-partisan Congressional Budget Office. Leaders are also closely watching Alaska Sen. Lisa Murkowski, who has been mulling over her decision at home over the weekend.
On Sunday evening, the GOP released its latest version of the health care bill, which aimed to convince members who are still undecided to support the bill. The changes aim to increase funding for states like Alaska, but there's no proof that the bill will bring the undecided senators onboard now.
In one new provision particularly beneficial to Alaska, the state would receive a 25% boost in federal matching funds for Medicaid due to its defined high-level of poverty.
But despite the new version, there are still plenty of obstacles ahead. An aide to Paul said that the Kentucky Republican opposed the new version of the bill as well, citing how his requested changes were not included in Sunday's version.
Texas Sen. Ted Cruz made headlines on Sunday when he said at the Texas Tribune Festival that the legislation as written did not currently have his support, though his answer did not definitively rule out backing the bill and added that he wants "to be a yes."
The next 24 hours are critical for the future of Graham-Cassidy, the latest Republican plan to overhaul Obamacare from South Carolina Sen. Lindsey Graham and Louisiana Sen. Bill Cassidy. On Monday, the GOP has scheduled a hearing on their bill in the Senate's Finance Committee and leadership will have to make a decision soon about whether or not the bill will come to the Senate floor for a vote even though the latest version of the bill wasn't unveiled until Sunday.
A partisan health care bill must be voted on by the end of the week, when the vehicle that Republicans are using to move their plan is expected to expire.
Over the weekend, the administration and the bill's sponsors continued to lobby on-the-fence members, with aides telling CNN that the effort wouldn't end until Republicans saw that third and final "no."
"Whatever sports metaphor you want to use about how it would take a miracle, it's that," a source acknowledged, noting that even a "Hail Mary" pass might be too generous to describe the odds at the moment.
The odds are stacked against the bill with outside groups also coming out in droves to oppose it.
A bipartisan group of governors sent a letter to congressional leaders last week warning that Graham-Cassidy would gravely hurt patients in their states. A long list of industry groups and leaders, including those representing insurance companies and health professionals, have also come out against the proposal.
Still, the stakes are incredibly high for members and Republican leaders who have tried to forge ahead with the bill. Gutting Obamacare was the GOP's promise for seven years, and facing a second defeat would only expose the party to more criticism from its donors and base. The party is now split between supporting a bill that appears unpopular with stakeholders and hasn't had even two full weeks to be vetted or moving ahead in an effort to pass anything it can.
Republican Sen. Chuck Grassley of Iowa made headlines last week when he openly acknowledged that fulfilling the GOP's years-long campaign promise was just as important as the policy ramifications of the bill.
"You know, I could maybe give you 10 reasons why this bill shouldn't be considered," the Iowa Republican said according to a report from The Des Moines Register. "But Republicans campaigned on this so often that you have a responsibility to carry out what you said in the campaign. That's pretty much as much of a reason as the substance of the bill."
Former Pennsylvania Sen. Rick Santorum, who has been working with Cassidy and Graham on the legislation, told CNN that not taking action now will leave Republicans stuck with the blame on any future problems that arise in the health care system.
"It's either fix it and do it the right way or own the debacle that's coming," Santorum, a Republican, said. "This may be Obamacare but they're going to blame Trump if it doesn't work."
The fact that the Senate vote in July failed by just one -- McCain's third "no" vote -- has also made it difficult for some Republicans to move on.
Another political reality at play: Republicans, including President Donald Trump and his top aides, are desperate for a legislative victory.
Trump and his top advisers have spent much of this year moving from one controversy to the next, all as the investigation into the Trump campaign's possible collusion with Russia has loomed over the White House.
Getting anything done on repealing Obamacare would mark an important win in a year that has lacked good news for the President.
"For the White House, the desire to have a significant legislative accomplishment remains a big and important goal," said Lanhee Chen, former chief policy adviser to Republican presidential nominee Mitt Romney. "And the fact that they were so close suggests that they could get across the finish line, so the reality and possibility of success is there."
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