In a surprising reversal, Republicans resuscitated efforts to repeal and replace the Affordable Care Act, moving a bill to the brink of passage days before a key deadline.
The bill, introduced by GOP Senators Lindsey Graham of South Carolina and Bill Cassidy of Louisiana, would reshape the U.S. health care system. It would end the Medicaid expansion and state insurance marketplaces created by Obamacare, and instead give states pools of money to use as they see fit. The legislation would allow states to sell cheaper plans with skimpier coverage as well as waive minimum-coverage requirements, and would end mandates for people to buy insurance and employers to provide it to workers. "State control of health care will work," Graham said. "The people in charge will be accountable to you."
Health care experts, patient advocates and hospital associations came out against the plan, warning it could lead to higher premiums and millions of people losing insurance coverage. The Senate skirted the typical hearing process for the bill, and the nonpartisan Congressional Budget Office said it won't have enough time to estimate the act's long-term effects before the GOP hopes to vote.
Even so, Republicans are edging closer to passing it. The GOP's previous effort to repeal Obamacare failed by a single vote. The party can afford two defections, and only one Republican Senator has so far committed to opposing the new plan. "I'm for a complete repeal," Senator Rand Paul of Kentucky tells TIME, dismissing the Graham-Cassidy legislation as "Obamacare lite." Several other GOP Senators remain on the fence, including some who supported earlier efforts.
The party is racing against the clock--intentionally so. The Senate has until Sept. 30 to vote under the budget process known as reconciliation, which requires just 50 votes for passage. (In the event of a tie, GOP Vice President Mike Pence would cast the deciding vote.) Outside that window, the bill would need 60 votes to overcome a filibuster. Republican leaders plan to rush it to the floor.
Democrats mobilized against the legislation, urging supporters to flood the Capitol with phone calls and emails. Opponents--from the AARP to comedian Jimmy Kimmel--spoke out against the last-ditch effort by a GOP Congress clamoring for a victory and hoping to fulfill a longtime promise to undo President Obama's signature law. "If you spent seven years raising literally hundreds of millions of dollars from donors on the promise that you would repeal the Affordable Care Act, then you'd feel a certain monkey on your back," says Andy Slavitt, who ran the Centers for Medicare and Medicaid Services under Obama. "But this is extreme."