The Senate Republican health care bill teetered on the brink of collapse by Tuesday morning as the Congressional Budget Office delivered a brutal assessment of its potential effects on coverage.
Sen. Susan Collins of Maine, a key moderate vote in the Republican conference, tweeted on Monday night that given its potential effects, she would not vote for the legislation — or even a motion to move it forward on the floor.
"I want to work w/ my GOP & Dem colleagues to fix the flaws in ACA. CBO analysis shows Senate bill won't do it. I will vote no on mtp," Collins tweeted Monday.
Other members of the GOP Senate conference also appear to be on the fence about voting for the legislation, many of them wavering after an analysis from the CBO showed the BCRA would reduce the number of insured Americans by 22 million in 2026 compared to the current baseline.
Sen. Ron Johnson of Wisconsin, one of four conservatives who came out against the legislation when it was released last week, also said he had "a hard time believing I'll have enough information for me to support a motion to proceed this week" on Monday.
A spokesperson for Sen. Mike Lee, another conservative hold out, told The New York Times on Monday that the senator would not for the legislation in its current form.
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Collins and Johnson joined Sens. Dean Heller and Rand Paul, who previously announced their opposition to a motion-to-proceed vote for the bill, named the Better Care Reconciliation Act (BCRA). Any more than two votes by GOP members against the motion would defeat it.
Heller is up for reelection in Nevada in 2018, a state that Hillary Clinton won and that has a popular GOP governor who opposes the BCRA for its cuts to Medicaid. He announced his intention to vote against the legislation last Friday.
In Paul, GOP leaders have the opposite problem, as the Kentucky senator believes the BCRA does not go far enough in its repeal of Obamacare.
On Monday, moderate Sen. Lisa Murkowski of Alaska said she had not gotten to a "yes" vote yet and wanted to learn more about the bill's potential effects on her state.
"I don't have enough data in terms of the impact to my state to be able to vote in the affirmative," Murkowski told CNN's Dana Bash.
Sen. Bill Cassidy of Louisiana also wavered after seeing the CNN score.
"It makes me more concerned," Cassidy told CNN. "I've been uncommitted and I remain uncommitted, I mean just deadline uncommitted. But, it certainly makes me more concerned and makes me want to explore this more."
Republican leadership targeted a late Tuesday or early Wednesday vote on the motion to proceed in order to get a final vote by the end of the week. This plan would have finished off the process before the week-long July 4 congressional recess.
Senate GOP leadership had not given up hope as of Monday night, hoping to alleviate members concerns and at the very least clear the motion to proceed.
"We're trying to accommodate their concerns without losing other support," Senate Majority Whip John Cornyn told reporters, adding the conference was in a "good place."
The White House is also attempting to exert its influence on the process, with Vice President Mike Pence dining with conservative members of the caucus including Lee, who signed a letter opposing the bill on Thursday.
President Donald Trump, meanwhile, called Cruz, Johnson, Paul, and Sen. Shelley Moore Capito of West Virginia to ask for their support on the bill White House press secretary Sean Spicer said.
But Trump has wavered himself over the past several weeks. In an interview that aired Sunday, he appeared to confirm to Fox News that he called the House's version of the healthcare bill "mean." His comments have been a constant point of attack for Democrats over the past week.
The mix of members opposing the motion leaves leadership in a precarious position. If they attempt to move the bill to the right by cutting more funding or repealing regulations to appease conservatives like Lee, Paul, and Johnson, they could further alienate Collins and Heller, as well as Murkowski and Capito.
Move the bill to center with more generous funding, a smaller deficit reduction, and a slower phaseout for Obamacare's Medicaid expansion, and Lee, Johnson, Paul, and Cruz could block the vote.
But as many long-time political observers pointed out on Monday, if there's anyone who could broker some sort of deal to placate both wings of the party, it's Senate Majority Leader Mitch McConnell.
A deal is "unlikely before the end of this week, when the July 4 break begins; it's not even certain a motion to proceed can pass today or tomorrow," said Greg Valliere, the chief strategist at Horizon Investments. "But McConnell now has an option — he can yank the bill this week, delaying a final vote until late July, giving him time for wheeling and dealing with individual members."
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