President Trump tweets take on GOP holdouts on health legislation

WASHINGTON — Sen. John McCain's opposition to the GOP's last-ditch effort to repeal and replace the Obama health law has dealt a likely fatal blow to the legislation — and perhaps to the Republican Party's years of promises to kill the program.

It was the second time in three months the 81-year-old Arizona Republican had emerged as the destroyer of his party's signature promise to voters.

"John McCain never had any intention of voting for this Bill, which his Governor loves. He campaigned on Repeal & Replace. Let Arizona down!" President Donald Trump said in a series of tweets Saturday that attacked GOP senators who hadn't gotten behind the bill. The measure was co-written by South Carolina Sen. Lindsey Graham, McCain's closest Senate ally, and Sen. Bill Cassidy, R-La.

"McCain let his best friend L.G. down!" President Trump said, adding that the health bill was "great for Arizona."

McCain, who is battling brain cancer in the twilight of a remarkable career, announced Friday that he could not "in good conscience" vote for the legislation.

"I believe we could do better working together, Republicans and Democrats, and have not yet really tried," McCain said. "Nor could I support it without knowing how much it will cost, how it will affect insurance premiums, and how many people will be helped or hurt by it."

His opposition all but ensured a major setback for President Trump and Senate Majority Leader Mitch McConnell, R-Ky. It also appeared likely to deepen rifts between congressional Republicans and a president who has begun making deals with Democrats out of frustration with his own party's failure to turn proposals into laws.

During the election campaign President Trump had pledged to quickly kill the Affordable Care Act — "It will be easy," he contended — and he has publicly chided McConnell for not winning passage before now.

McCain joined Sen. Rand Paul, R-Ky., as two declared GOP "no" votes on the repeal legislation, though President Trump held out hope on Paul.

"I know Rand Paul and I think he may find a way to get there for the good of the Party!" President Trump tweeted.

With Democrats unanimously opposed, two is the exact number of GOP votes McConnell can afford to lose.

But Sen. Susan Collins, R-Maine, said Friday she, too, is leaning against the bill, and Sen. Lisa Murkowski, R-Alaska, was also a possible "no," making it highly unlikely that McConnell can prevail.

President Trump tweeted that health premiums have risen dramatically for Alaskans under the health law, "deductibles high, people angry!"

While President Trump tries to keep up the pressure, the GOP seems destined to fail again on a campaign promise that every Republican agreed on — right up until the party obtained full control of Congress and the White House this year and was actually in position to follow through.

President Trump, at a political rally Friday night in Alabama, he said he would continue the fight to repeal the law. "You can't quit when you have one or two votes short."

Graham, in a statement, said he would "press on," and he reaffirmed his friendship with McCain.

Up until McCain's announcement, McConnell allies were optimistic McCain's relationship with Graham might make the difference.

GOP leaders hoped to bring the legislation to the full Senate this coming week. They face a Sept. 30 deadline, at which point special rules that prevent a Democratic filibuster will expire.

Democrats hailed McCain's announcement and pledged to commit to the bipartisan process he sought. GOP Sen. Lamar Alexander of Tennessee and Democratic Sen. Patty Murray of Washington have been working on a package of limited legislative fixes to the health law's marketplaces.

"John McCain shows the same courage in Congress that he showed when he was a naval aviator," said Senate Minority Leader Chuck Schumer, D-N.Y. "I have assured Sen. McCain that as soon as repeal is off the table, we Democrats are intent on resuming the bipartisan process."

President Trump charged that Schumer "sold John McCain a bill of goods. Sad."

The Graham-Cassidy bill would repeal major pillars of the health law and replace them with block grants to states to design their own programs.

"Large Block Grants to States is a good thing to do. Better control & management," President Trump wrote.

But major medical groups said millions of people would lose insurance coverage and protections. A bipartisan group of governors announced their opposition.

Yet Republican congressional leaders, goaded by GOP voters and the president himself, were determined to give it one last try.

President Trump spent much of August needling McConnell for his failure to pass a repeal bill, and Republican lawmakers back home during Congress' summer recess heard repeatedly from voters angered that after seven years of promises to get rid of the health law, the party had not delivered.

The House passed its own repeal bill back in May, prompting President Trump to convene a Rose Garden celebration, which soon began to look premature.

After the Senate failed in several attempts in July, the legislation looked dead. But Cassidy kept at it with his state-focused approach, and the effort caught new life in recent weeks as the deadline neared. President Trump pushed hard, hungry for a win.

The bill would get rid of unpopular mandates for people to carry insurance or face penalties. It would repeal the financing for Obama's health insurance expansion and create a big pot of money states could tap to set up their own programs, with less federal oversight. It would limit spending for Medicaid, the federal-state program that now covers more than 70 million low-income people. Insurance rules that protect people with pre-existing conditions could be loosened through state waivers.

Over time, the legislation would significantly reduce federal health care dollars now flowing to the states. But McConnell had little margin for error in a Senate split 52-48 between Republicans and Democrats, and could lose only two votes, counting on Pence to break the tie.