McCain decision leaves GOP, ObamaCare and repeal at crossroads

Sen. John McCainJohn Sidney McCainGOP rushes to cut ties to Moore GOP strategist: 'There needs to be a repudiation' of Roy Moore by Republicans World leaders reach agreement on trade deal without United States: report MORE’s (R-Ariz.) announcement that he will oppose the latest GOP ObamaCare repeal bill has left both parties wondering about the health care law’s future.

Some Republicans are still pushing for repeal, given the tiny chance that they could still scrounge up enough votes before Sept. 30, the deadline for using budgetary rules that prevent a filibuster on the measure.

Vice President Pence said Friday that he and President Trump are “undeterred” in their effort to repeal the law, while Democrats say that they are on guard and will keep up the pressure.

But it seems more likely that the debate could be moving into a new stage.

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Democrats are pushing for bipartisan talks in the Senate Health Committee, which Republicans shut down earlier this week.

McCain cited those talks in opposing the new bill, and Trump has given more nods toward working with Democrats in recent weeks. The president also wants to turn to tax reform, which is taking up an increasing amount of his workload.

A key issue in the bipartisan talks would be addressing payments known as cost-sharing reductions that help insurers provide coverage to low- and middle-income people.

Trump has threatened to cancel those payments in an effort to make ObamaCare “implode.” And he still could.

The bipartisan Senate talks were aimed at providing congressional approval for those funds to cement their legality and prevent Trump from canceling them. Insurers say that step would be critical in giving them certainty and preventing premium increases.

Sen. Lamar AlexanderAndrew (Lamar) Lamar AlexanderObamaCare becomes political weapon for Democrats Senate passes resolution requiring mandatory sexual harassment training Sen. Warren sold out the DNC MORE (R-Tenn.), chairman of the Health Committee and the lead Republican negotiator, has not yet commented after McCain’s announcement.

It is highly unlikely that an end to the ObamaCare repeal effort would usher in an era of bipartisanship on health care.

House conservatives and liberal Democrats in the House and Senate have very different ideas on how to move forward on health care, something underlined by a CNN debate scheduled for Monday. Its participants include Sen. Bernie SandersBernard (Bernie) SandersWorld leaders reach agreement on trade deal without United States: report Sanders on Brazile revelations: DNC needs ‘far more transparency’ Sen. Warren sold out the DNC MORE (I-Vt.), whose single-payer system is gaining steam with Democrats, and the authors of the latest GOP ObamaCare repeal bill, Sens. Bill CassidyWilliam (Bill) Morgan CassidyOvernight Health Care: Trump officials to allow work requirements for Medicaid GOP senator: CBO moving the goalposts on ObamaCare mandate CNN to air sexual harassment Town Hall featuring Gretchen Carlson, Anita Hill MORE (La.) and Lindsey GrahamLindsey Olin GrahamCNN to air sexual harassment Town Hall featuring Gretchen Carlson, Anita Hill Trump wrestles with handling American enemy combatants Flake: Trump's call for DOJ to probe Democrats 'not normal' MORE (S.C.).

Without any bipartisan action or a final long-shot repeal attempt, ObamaCare, which has extended coverage to roughly 20 million people, will remain on the books.

Despite worries that there would be counties next year without any insurance options, insurers have stepped in to fill every area. Standard & Poors found in July that ObamaCare markets are “stabilizing.”

Democrats believe there are plenty of risks to the law, however, as long as Trump is in the White House.

They accuse the president of threatening to “sabotage” the law — both with his threats on the insurer payments and a 90 percent cut to funds used to advertise and enroll people in the insurance exchanges.

Within hours of McCain’s statement on Friday, Democrats were pointing to an announcement that the administration would be taking healthcare.gov offline from 12 a.m. to 12 p.m. every Sunday during the enrollment period.

“More sabotage of our health care system,” Matt House, a spokesman for Senate Democratic Leader Charles SchumerCharles (Chuck) Ellis SchumerTrump is right: The visa lotto has got to go Schumer predicts bipartisan support for passing DACA fix this year No room for amnesty in our government spending bill MORE (N.Y.), wrote on Twitter.

A spokesman for the Centers for Medicare and Medicaid Services said the downtime is part of regularly scheduled “maintenance outages” that happen every year. “This year is no different,” the spokesman said.

Frederick Isasi, executive director of Families USA, a leading pro-ObamaCare group, said that repeal is still a “very, very real threat for millions and millions of Americans.”

But beyond that threat, he warned: “It's a real concern that the administration is trying to sabotage the ability of Americans to get high-quality affordable coverage.”

He warned that if enrollment efforts fall off, fewer healthy people will be enrolled in ObamaCare, which will harm the long-term sustainability of the exchanges.

McCain’s opposition is a major blow to the seven-year effort to repeal the law.

It almost certainly dooms the current legislation, given opposition to the bill from Sen. Rand PaulRandal (Rand) Howard PaulGOP senator asks to be taken off Moore fundraising appeals Red state lawmakers find blue state piggy bank Prosecutors tell Paul to expect federal charges against attacker: report MORE (R-Ky.), and Sen. Susan CollinsSusan Margaret CollinsBipartisan group of lawmakers aim to reform US sugar program A bipartisan bridge opens between the House and Senate Gaming the odds of any GOP tax bill getting signed into law MORE (R-Maine) said in a statement that she is leaning against it. Collins is seen as a long-shot to vote for repeal, and Republicans can only afford two defections.

It’s also possible there are other GOP senators who do not want to back the bill.

It’s of course still possible Republicans could make another effort at repeal either before or after Sept. 30.

Sen. Orrin HatchOrrin Grant HatchRead Senate GOP's tax bill Senate panel to start tax bill markup on Monday Senate set for clash with House on tax bill MORE (R-Utah) has even floated the idea of pairing ObamaCare repeal with tax reform under a new budget resolution that would again allow Republicans to avoid a Democratic filibuster.

Yet such a plan would put tax reform at risk, something that seems unlikely at this stage.

Rep. Mark Meadows (R-N.C.), chairman of the conservative House Freedom Caucus, sounded a note of disappointment but did not criticize McCain after his announcement.

“Certainly today's news is not a positive sign for people yearning for lower insurance premiums but to criticize Senator McCain would be to allow my disappointment to manifest itself in a manner that won't produce a different outcome,” Meadows said. “Amendments and a floor vote should still be allowed.”

Scott Wong contributed.