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McCain decision leaves GOP, ObamaCare and repeal at crossroads

Sen. John McCainJohn Sidney McCainEx-McSally aide pleads guilty to stealing over 0K in campaign funds DOJ: Arizona recount could violate civil rights laws Cheney fight stokes cries of GOP double standard for women 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 AlexanderLamar AlexanderThe Republicans' deep dive into nativism Senate GOP faces retirement brain drain The Hill's Morning Report - Presented by the National Shooting Sports Foundation - CDC news on gatherings a step toward normality 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 SandersBernie SandersThe Memo: Outrage rises among liberals over Israel On The Money: Biden says workers can't turn down job and get benefits | Treasury launches state and local aid | Businesses jump into vax push Symone Sanders 'hurt' at being passed over for press secretary: report MORE (I-Vt.), whose single-payer system is gaining steam with Democrats, and the authors of the latest GOP ObamaCare repeal bill, Sens. Bill CassidyBill CassidyUtah county GOP censures Romney over Trump impeachment vote Amazon blocks 10B listings in crackdown on counterfeits Cassidy on pipeline cyberattack: Congress must equip businesses with defenses against incursions MORE (La.) and Lindsey GrahamLindsey Olin GrahamHouse conservatives take aim at Schumer-led bipartisan China bill There will be no new immigration law under Biden, unless he changes course McConnell safe in power, despite Trump's wrath 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 Chuck SchumerChuck SchumerHouse conservatives take aim at Schumer-led bipartisan China bill There will be no new immigration law under Biden, unless he changes course This week: Congressional leaders to meet with Biden amid GOP reckoning 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 PaulTim Scott sparks buzz in crowded field of White House hopefuls Sherrod Brown calls Rand Paul 'kind of a lunatic' for not wearing mask Overnight Health Care: WHO-backed Covax gets a boost from Moderna MORE (R-Ky.), and Sen. Susan CollinsSusan Margaret CollinsTop female GOP senator compares Cheney ousting to 'cancel culture' Utah county GOP censures Romney over Trump impeachment vote House conservatives take aim at Schumer-led bipartisan China bill 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 HatchBottom line The Republicans' deep dive into nativism Press: Forget bipartisanship — it's dead! 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.