The latest Republican Congressional attempt to repeal and replace the Affordable Care Act (ACA) has foundered, as three Republican senators announced they will join Democratic senators in opposing the “Graham-Cassidy” repeal plan.

Very broadly, Graham-Cassidy would, among other things:

• Eliminate the penalties and mandates that individuals buy insurance and certain employers offer insurance;
• Replace insurance premium subsidies and funding for Medicaid expansion with block grants to the states (with greatly reduced federal contributions);
• Give states wide latitude in determining the parameters of insurance coverage and premiums; and
• Revise the tax treatment of certain medical expenses.

Senate GOP leaders intended to bring Graham-Cassidy to the floor for a vote this week – before special “budget reconciliation” rules that allow passage on a simple majority vote expire at the end of this month.  On September 25, 2017, the Congressional Budget Office released a preliminary estimate of the impact Graham-Cassidy would have on health insurance coverage and federal spending.  The CBO projects that the bill would cut Medicaid by $1 trillion and result in millions of individuals losing insurance coverage.  These projections prompted Senator Susan Collins (R-ME) to declare her opposition to the bill (joining Republican Senators John McCain and Rand Paul).  Congressional leaders have now shelved the vote in light of the dim prospects for passage.