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Senate Republicans’ last-ditch effort to repeal and replace the Affordable Care Act is gaining steam, but several complications could prove insurmountable.
The bill proposed by and named after Sens. Lindsey Graham, Bill Cassidy, Dean Heller, and Ron Johnson would send most federal funding for healthcare programs like Medicaid to individual states in the form of a lump sum.
Republicans are facing an end-of-September deadline to pass healthcare-related legislation through the budget-reconciliation process, which allows them to move measures with a simple-majority vote. Recent developments have increased the chance that Republicans are close to 50 “yes” votes. (Republicans hold 52 seats in the Senate.)
Cassidy told reporters Friday that 48 or 49 GOP members supported the bill, putting it right on the threshold. Sen. John McCain, one of the holdouts on the previous, failed Republican effort to repeal the ACA, also known as Obamacare, said he would consider voting for the bill.
Separately, Senate Majority Leader Mitch McConnell instructed the nonpartisan Congressional Budget Office to speed up its scoring of the legislation, a move that indicates he is putting some weight behind the effort.
However, Republicans face a deadline to use 2017 budget-reconciliation rules, which allow a bill to pass the Senate with a simple-majority vote, bypassing a filibuster, if it would lower the deficit. The Senate parliamentarian, an official of sorts for the chamber’s rules, said the budget-reconciliation rules attached to the fiscal 2017 budget would expire at the end of the month.
Aside from the tight calendar, proponents of the legislation are facing some friendly opposition.
Republican Sen. Rand Paul of Kentucky said on Friday that he would not vote for the bill.
“I can’t support a bill that keeps 90% of Obamacare in place,” Paul tweeted. “#GrahamCassidy is not repeal or replace, it is more Obamacare Lite.”
And the bill contains many of the same Medicaid funding issues that led moderate Republican Sens. Susan Collins and Lisa Murkowski in July to reject bills to repeal and replace Obamacare. Republican leaders could afford to lose only two votes to pass that legislation.