With strong White House backing, Senate Republicans are mounting a last-ditch effort to reform health care in America, forcing Democrats to mobilize furiously for a battle they thought they had won: preserving the Affordable Care Act, also known as Obamacare.
With a September 30 deadline looming for passing health care legislation, on Tuesday the Senate's Republican leadership endorsed a new proposal that would break up Obamacare and transfer funds to all 50 U.S. states to craft their own health care programs.
"It would repeal the pillars of Obamacare and replace that law's failed approach with a new one, allowing states and governors to actually implement better health care ideas by taking more decision-making power out of Washington," said Majority Leader Mitch McConnell of Kentucky.
The bill, put forward by Republicans Lindsey Graham of South Carolina and Bill Cassidy of Louisiana, took many on Capitol Hill by surprise, given that the Senate voted down previous Republican health care proposals, and a bipartisan bill is being crafted to strengthen Obamacare rather than scrapping the 2010 law.
"We thought that this issue was finished, and it's been revived," Democratic Senator Dick Durbin of Illinois told VOA. "We are taking it very seriously, because this version of the bill, the Graham-Cassidy version, is worse than anything they [Republicans] have brought to the floor before. This would be devastating, and we need to rally our troops again."
In late July, Senator John McCain of Arizona was one of three Republicans who joined with Democrats to defeat an earlier effort to replace Obamacare. With Republicans holding 52 seats in the 100-member body, the party once again can afford only two defections and pass Graham-Cassidy with Vice President Mike Pence casting the tie-breaking vote.
Already, Senator Rand Paul of Kentucky has announced he opposes the bill, blasting it as "Obamacare-lite." Another Republican, Susan Collins of Maine, is voicing deep concerns about the legislation.
"From the initial analysis I've done, it would mean $1 billion less for the state of Maine for Medicaid and other federal health care spending," Collins said on ABC News. "I'm also concerned that the bill does not afford automatic protections to people with pre-existing [health] conditions."
McCain supports ending Obamacare, but remains critical of the truncated process Republicans are using to try to quickly pass legislation on health care, which accounts for one-sixth of the U.S. economy.
"I am not supportive of the [Graham-Cassidy] bill yet," McCain told reporters. "You've heard me time and time again: We need to go through the regular [legislative] order [in the Senate]. You have hearings, you have amendments, you have debate to bring it to the floor, and you have bipartisan support."
The path McCain suggested would take months. The Senate's parliamentarian has ruled that, after September 30, a three-fifths vote would be required to advance health care legislation, giving Republicans fewer than two weeks to pass Graham-Cassidy with a simple majority vote.
"Everybody knows that the opportunity [to end Obamacare] expires at the end of the month," McConnell said.
Only one Senate hearing has been scheduled on the bill, and the nonpartisan Congressional Budget Office has said it will be unable to provide a projection of Graham-Cassidy's impact on the nation's health care coverage by September 30.
"To consider a bill like this without a full CBO score is worse than negligent, it's grossly irresponsible," said the Senate's Democratic leader, Chuck Schumer of New York. "Senators will be voting blind."
Graham insisted the legislation he co-authored is sound.
"I'm trying to take the money and power in Washington and send it back closer to the patient," the South Carolina senator said. "State control of health care will work, because the people in charge will be accountable to you."
White House support
President Donald Trump has been highly critical of Senate Republicans for failing to end Obamacare. Speaking aboard Air Force Two on Tuesday, Vice President Pence said the White House enthusiastically backs Graham-Cassidy.
"I want to make sure that members of the Senate know the president and our entire administration supports Graham-Cassidy," Pence said. "We think the American people need this. Hard facts: Obamacare is collapsing."
In June and July, protesters defending Obamacare swarmed the Capitol almost every week, holding sit-ins at lawmakers' offices and clogging hallways as well as Capitol grounds.
On Tuesday, a woman who identified herself as Jennie was one of only a few dozen demonstrators present for a rally against the Graham-Cassidy bill.
"I'm nervous about this one. I think it surprised a lot of people. It came out of nowhere," Jennie said. "I don't want our health care taken away. My daughter has asthma. She also has scoliosis, which result in needing massive spine surgery. If this [Graham-Cassidy] passes, it will affect all of us."
Democrats said a strong public outcry is urgently needed if the Republican bill is to be defeated.
"Years from now, when your child is denied health care … and you are facing bankruptcy, you'll regret being silent this week," tweeted Senator Chris Murphy of Connecticut.