WASHINGTON — Two more Senate Republicans have declared their opposition to the latest effort to overhaul the nation's health-care system, leaving the measure without sufficient support to pass and potentially ending a months-long effort to make good on a longstanding GOP campaign promise.
Sens. Mike Lee, R-Utah, and Jerry Moran, R-Kan., issued statements declaring that they would not vote for the revamped measure. They joined Sens. Rand Paul, R-Ky., and Susan Collins, R-Maine, who also oppose it. With just 52 seats, Republicans can afford to lose only two votes to pass their proposed rewrite of the Affordable Care Act. All 48 Democrats are expected to vote against it.
"In addition to not repealing all of the Obamacare taxes, it doesn't go far enough in lowering premiums for middle class families; nor does it create enough free space from the most costly Obamacare regulations," Lee said in a statement.
Moran said the bill "fails to repeal the Affordable Care Act or address healthcare's rising costs."
The two conservatives timed the release of their statements and made clear that modest tinkering around the edges of the legislation drafted by Majority Leader Mitch McConnell, R-Ky., would be insufficient to meet their demands.
They joined a pair of other GOP colleagues in calling for a long process of completely redrawing the legislation that would take months and months, short-circuiting McConnell's wish to end the debate this month.
Senate Republican leaders returned to the Capitol on Monday still pledging to press ahead with plans to pass a sweeping overhaul of the nation's health-care system, but the news of Lee and Moran digging in against the bill created the deepest doubts yet as to whether it could pass.
The day had already begun with uncertainty as the health of Sen. John McCain thrust the future of the flagging effort deeper into doubt.
In a speech on the Senate floor, McConnell said that he spoke with McCain, R-Ariz., on Monday morning and that "he'll be back with us soon." The Arizonan is recovering from surgery to remove a blood clot above his left eye that involved opening his skull.
McConnell has delayed action on health care until McCain's return. While McConnell has no way to pass the legislation without his vote, McCain's presence in the Capitol is far from a guarantee that it will succeed.
McCain has voiced worries about the measure and has not committed to voting for it. In addition, Sen. Ron Johnson, R-Wis., hinted Monday that he might vote against advancing the measure to floor debate – departing from his posture last week. Johnson's opposition would bring to three the number of GOP senators opposed to advancing the bill; with 52 Republicans (and Vice President Mike Pence ready to cast a tiebreaking vote), the party can lose only two.
In his speech, McConnell said Republicans intend to put in "continued hard work" to pass their proposed rewrite of much of the Affordable Care Act.
But the likely timetable remained unclear. McCain, 80, is awaiting results of tissue pathology reports "pending within the next several days," the hospital treating him said in a statement over the weekend. He will be away from the Senate for at least the rest of the week. A McCain spokeswoman had no further update on his condition Monday.
Sen. Lindsey Graham, R-S.C., perhaps McCain's closest friend in the Senate, spoke to him by phone as he was walking to the Senate chamber for a vote Monday evening. The two had an animated conversation, and Graham said McCain was "dying to get back."
"They were doing a routine checkup and they found the spot and it looks like everything is going to be A-okay," Graham said. He said McCain's doctors "don't want him to fly for a week, adding, "I think he would walk back if they would let him."
The cause of McCain's blood clot remained unclear on Monday. The most common causes of clots in the head, especially for older people, are falls, car crashes and other incidents that cause traumas, even minor ones, said Elliott Haut, a trauma surgeon at the Johns Hopkins University School of Medicine. By one estimate, 1.7 million people suffer traumatic head injuries each year, with motor vehicle accidents the leading cause and blood clots that affect the brain a common effect.
Traumas can cause blood to leak out of small vessels in two locations in the head: between the brain and a tough, fibrous layer known as the dura, causing "subdural hematomas," and between the dura and the skull, causing "epidural hematomas."
"People die of these every day," Haut said in an interview, emphasizing that he could not speak about McCain's health, because he had no details of the case. Blood clots as small as a half-centimeter are worrisome, he said. Epidural hematomas are less often fatal.
Another possibility is that the clot is related to McCain's history of melanoma, a dangerous form of skin cancer that can spread to other organs, including the brain, and form new tumors. Haut said that is much less likely but not impossible. Diagnosis of a clot in the head requires a CT scan, and it often follows symptoms such as headaches or blurred or changed vision, he said.
Senate Republicans are under self-imposed pressure to complete their work on health care soon. As they have struggled to show progress, McConnell has already said he will keep the chamber in session through the first two weeks of August, postponing the start of the summer recess period to leave time to work on other matters.
Key Republican senators – and the GOP governors they turn to for guidance – have raised concerns about how the bill would affect the most vulnerable people in their states. Private lobbying by the White House and Senate GOP leaders has not mollified them.
Johnson said Monday that last week he was "strongly in favor" of taking a procedural vote allowing the bill to advance to floor debate. But he said he was unhappy with recent comments by McConnell that the bill's deepest Medicaid cuts are far into the future and are unlikely to go into effect anyway.
Johnson said he read the comments in The Washington Post and confirmed them with other senators. He said he planned to talk to McConnell about it Tuesday at the weekly GOP policy lunch. In a statement late Monday, McConnell responded: "I prefer to speak for myself, and my view is that the Medicaid per capita cap with a responsible growth rate that is sustainable for taxpayers is the most important long-term reform in the bill. That is why it has been in each draft we have released."
President Donald Trump planned to huddle with seven Republican senators at the White House Monday evening to talk about health care, including top McConnell allies such as Sens. John Cornyn, Texas, John Thune, S.D., Roy Blunt, Mo., and Lamar Alexander, Tenn.
Democrats are pressuring Republicans to use this week's delay to hold public hearings on the GOP bill. All 48 members of the Democratic caucus – along with the two Republicans – oppose the legislation.
"This will allow members to hear unfiltered and unbiased analysis of how the bill will affect their states and the health and financial security of the constituents they represent," wrote Senate Minority Leader Charles Schumer, D-N.Y., and two other leading Democratic senators in a Monday letter to McConnell and a pair of GOP committee chairmen.
New York Attorney General Eric Schneiderman, a Democrat, threatened Monday to sue the federal government if the health-care bill becomes law. The measure "isn't simply unconscionable and unjust. It's unconstitutional," he claimed on Twitter.
The Schumer letter also asks that GOP leaders not move ahead with the bill until the nonpartisan Congressional Budget Office releases a complete score on it. The CBO had been expected to release its findings as soon as Monday. But that did not happen. A GOP aide, granted anonymity to speak candidly, said a release later this week was possible but not certain.
The CBO has been projecting what the bill would do to insurance coverage levels, premium costs and the federal budget deficit. Having an unfavorable report in the public domain for an extended period of time with an uncertain date for a vote would fuel critics' argument against the bill, making it harder for McConnell to round up votes for it.
A CBO report on an earlier version of the legislation projected that it would result in 22 million fewer Americans with insurance by 2026 than under current law. It predicted that the measure would reduce the budget deficit by $321 billion over the same period. On average, premiums would first rise, then fall under the measure, the CBO projected.
Neither a McConnell spokesman nor the CBO said when the new report would be released or why it was not released Monday.
White House officials have been seeking to cast doubt on the findings from the CBO and other independent analyses of the bill. But some key Republicans have responded to their pitch with skepticism.
Over the weekend, influential Republican governors said they were not sold, even after talking privately with the officials during the National Governors Association's summer meeting.
Several key GOP senators have voiced concerns about the measure's long-term federal spending cuts to Medicaid. Others have said the bill does not go far enough in overhauling the ACA. The opposing pressures have left McConnell in a tough position in which he has struggled to find a solution.
Cornyn told reporters Monday that "we're not going to come up short" on the push for the health-care bill.
Without McCain in the Senate, McConnell can count on at most 49 votes to move ahead on the bill. Along with all of the Democrats, Sens. Rand Paul, R-Ky., and Susan Collins, R-Maine, oppose it. Spokesmen for the two Republicans confirmed they still intend to vote against bringing the bill to the Senate floor.
In the meantime, Senate Republican leaders plan to focus on trying to confirm more Trump administration nominees and some less far-reaching legislative goals. As they do, they will be watching closely for updates on McCain's condition.
"Following a routine annual physical," the Mayo Clinic Hospital in Phoenix said Saturday, McCain "underwent a procedure to remove a blood clot from above his left eye on Friday, July 14." The hospital added that "surgeons successfully removed the 5-cm blood clot during a minimally invasive craniotomy with an eyebrow incision."
Acute subdural hematomas can be fatal half the time and even more often in older people. They can also cause strokes. Unlike clots in the legs and lungs, they must be treated through surgery, rather than blood thinners, Haut said.
In 2009, actress Natasha Richardson died of the effects of an epidural hematoma after declining medical attention following a fall while skiing.
It is not known whether McCain takes blood thinners, but those can make it more likely that blood will escape from vessels after a trauma, Haut said.
Evan Wyloge in Phoenix and Kelsey Snell and Abby Phillip in Washington contributed to this report.