THE PROGNOSIS

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Sen. Bill Cassidy (R-La.) officially lost his bid to pass an Obamacare overhaul late Monday as a third Republican senator announced her defection from his bill and brought the Senate’s desperate, 11th hour effort to repeal the Affordable Care Act to a grinding halt – again.

That senator was the very lawmaker who had co-sponsored a health-care bill with Cassidy earlier this year: Maine’s Susan Collins. And it is also the one whose state would have gotten more funding under a new version of Cassidy-Graham, which Senate Republicans and President Trump hoped to vote on this week. Now, that's very unlikely to happen.  

Cassidy told me earlier in the day that if Collins just looked at his bill – which he’d tweaked over the weekend resulting in $1 billion more federal health-care dollars for her state – she could be convinced to support it. Maybe Collins could even help implement the measure if she decides to run for Maine’s governor in 2018, he suggested.

“Imagine what a smart governor who knew health insurance so well as Susan does could do with that money to benefit lower-income Mainers,” Cassidy said during an interview in his Capitol Hill office.

Everyone thought the Republican quest for an ACA overhaul was dead in July after the Senate spectacularly failed to pass three different health-care bills. Cassidy, eager to carve out a name for himself in health care, appeared close to resurrecting the debate with his proposal to block grant much of the ACA’s spending and turn it over to the states.

“Two years ago people thought I was Don Quixote. A month ago people thought things were dead. Two weeks ago, people smiled - and now folks say, ‘Wow, they may still pull it off,’” Cassidy told me.

“If you keep your head down and keep plugging, good things happen,” the Louisiana Republican added.

But to really secure the support of dueling camps of Republicans – the moderates (like Collins) worried about steep spending cuts and the conservatives troubled over Obamacare regulations – Cassidy and his co-sponsor, Sen. Lindsey Graham (R-S.C.), had to convince 50 of them the bill was both good policy and good politics.

But they haven't. And so the Obamacare repeal-and-replace effort seems once again dead just a few days before the expiration of the budget reconciliation bill in which it was supposed to be housed.

Senate Republicans will meet today for their weekly lunch, where they'll decide whether to even go ahead with a planned vote Wednesday on the measure. Senate Majority Whip John Cornyn (R-Tex.) didn't rule out the possibility despite clear evidence it doesn't have sufficient support to pass, The Post's Sean Sullivan, Juliet Eilperin and Kelsey Snell report.

“There are a lot of people who want to vote 'yes' and be recorded as voting 'yes',” Cornyn said. “I think there is some advantage to showing you’re trying and doing the best you can.”

Cassidy has at least one thing going for him: He's carved out a health-care name for himself. The Louisiana Republican, who worked as a gastroenterologist before joining the House in 2008, has centered much of his political career around ditching the 2010 ACA – even more than most Republicans. Health care is where he wants to make his mark.

Cassidy has introduced multiple bills to replace the ACA over the three years he’s spent in the Senate. There was his 2015 “Patient Freedom Act” prompted by the prospect of the Supreme Court blocking much of the ACA’s subsidies. The next year it was a measure with former senator Jeff Sessions that Cassidy dubbed the “world’s greatest health-care bill ever.” 

And earlier this year, Cassidy teamed up with Collins on a bill that would have allowed states to keep or reject the ACA as they saw fit.

The painful reality for Cassidy is that even after revisions he and Graham announced yesterday, which redistributed federal block grant funding for states to better equalize their allotments, wasn't enough. Collins wasn’t convinced the measure would be good for her state, even after a call from the president yesterday afternoon. Maine would still have lost federal funding overall via cuts to the regular Medicaid program, Collins noted as she announced her intention to vote against the measure.

“I told him that I would go back and look at the numbers one more time, but I was straightforward with him that I was not likely to be a yes vote,” she said, adding that the process had been too hasty. “Last night, a whole new bill came out, which to me epitomizes the problem.”

Collins' full statement, per my colleague Sean Sullivan:

USA Today's Paul Singer:

Andy Slavitt, head of the Centers for Medicare and Medicaid Services under Obama, noted that Collins announced her opposition shortly after the Congressional Budget Office released a preliminary estimate of the bill's cuts to federal health-care spending.

Here's what Finance Committee Chairman Sen. Orrin G. Hatch (R-Utah) had told reporters just minutes earlier:

The last two weeks have been a wild ride for Cassidy, culminating in a dramatic Senate hearing yesterday. Shortly before he testified before the Finance Committee, protesters chanted so loudly Hatch was forced to temporarily pause proceedings as police officers arrested and removed several of them. Hundreds of activists lined up outside the committee room earlier that morning, forming a massive, snaking line through the Hart Senate Office Building, my colleague Dave Weigel reported.

Here's a video:

From Sean: 

The Post's Elise Viebeck:

HuffPost's Matt Fuller:

“Does my wife worry more about me now? She does,” Cassidytold me in the interview, saying he wishes there would be more “civility” in how people express their opinions. He and his bill have been sharply criticized by many health-care advocates, Democrats and, most recently, talk-show host Jimmy Kimmel.

Kimmel reamed Cassidy over the course of several nights last week, saying his health-care plan seriously violates the “Jimmy Kimmel test” the senator coined in April, referring to the importance of making insurance accessible and affordable for people with serious medical conditions.

Cassidy used the phrase to explain his health reform goals in an appearance on Kimmel’s show, shortly after the host had announced that his infant son had been diagnosed with a heart ailment that required surgery.

What’s it like getting regularly slammed by Kimmel, an entertainer millions of Americans listen to?

“I don’t want to say I haven’t noticed it, because of course you notice,” Cassidy said. “But is that what I’ve been focused on? Not at all.”

Cassidy said he respects Kimmel’s “passion” but wishes the host would have given him a chance to explain.

“I do wish he would have allowed me to present the side that may have been different from Charles Schumer,” Cassidy said, referring to the Democratic Senate leader who is vehemently opposed to his bill.

Kimmel tweeted thanks yesterday to Collins for defecting on Cassidy's bill:

Cassidy had another prime-time TV moment last night on CNN, when he and Graham debated two Democrats -- single-payer advocate Bernie Sanders (I-Vt.) and Amy Klobucher (D-Minn.) -- on health-care. When the debate was announced last week, the Cassidy-Graham bill looked very much alive. But when it began last night, the legislation was headed for the ash heap, turning the debate into a lower-stakes argument about the best way to deliver health care in the future.

“It’s okay to fall short,” Graham said near the start of the debate, all but conceding defeat. 

"Halfway through the debate, Sanders went in for the kill," reports my colleague Dave Weigel, who watched the whole thing. "Graham had taken his umpteenth swing at 'bureaucrats,' telling viewers that 'Bernie’s solution is more government, not less,' warning that the Vermont senator would pour millions of people into Medicare when the system could not handle them."

“It is easy to beat up on big, bad federal government,” Sanders said. “Guys, do you know what the most popular health insurance program in America is? It’s not the private insurance industry. It is …”

Graham decided not to dodge.

“Medicare,” he said.

“Medicare, yeah!” Sanders said.

“Which is falling apart,” Graham said.

Klobuchar and Sanders stayed united to rip apart Cassidy-Graham, quoting from CBO studies and medical industry statements to portray the Republican bill as radical and unworkable.

“It’s not giving people a choice. It’s cutting Medicare by a trillion dollars,” Sanders said.

TRUMP TEMPERATURE

--What was President Trump up to yesterday as the health-care effort was splintering yet again on Capitol Hill? Well, he spent about 15 minutes of his day in a radio interview where he took aim at Sen. John McCain (R-Ariz.) for opposing Cassidy-Graham (McCain and Sen. Rand Paul (R-Ky.) had already announced their opposition to it last week, before Collins became the third to defect yesterday). He called McCain's opposition “a tremendous slap in the face to the Republican Party."

“You can call it what you want, but that’s the only reason we don’t have it, because of John McCain,” Trump said, referring to the previous repeal bill McCain's vote sank in July.

The president’s comments came during a call into the “Rick & Bubba Show,” a syndicated radio program based in Alabama that airs across the South. The hosts bill themselves as the “two sexiest fat men alive."

Trump also referred to an Alabama Republican Senate candidate by the wrong name — and later said that wasn’t a good sign for the candidate. And he dinged top Senate Republican Mitch McConnell (R-Ky.) saying: "Mitch is not, polling-wise, the popular guy in this country."

Trump tweeted another criticism of McCain early this morning:

AHH, OOF and OUCH

AHH: So what did the CBO say yesterday about Cassidy-Graham? It would cause "millions" of Americans to lose insurance by 2026 while lessening the federal deficit by at least $133 billion, The Post's Amy Goldstein reports. According to the partial analysis, the precise increase in people without health coverage “could vary widely,” because the legislation would give each state great latitude to design its own health-care policies.

But “the direction of the effect is clear,” the report said, because of the “large reductions” in federal Medicaid funding, a decrease in government subsidies for people who buy coverage on their own, and the repeal of penalties for people who flout insurance requirements under the ACA.

OOF: S&P also released an analysis of the effects of Cassidy-Graham, concluding that it would hurt the economy and reduce coverage levels. The S&P Global Ratings report found the bill could cost about 580,000 jobs and $240 billion in lost economic activity by 2027 while limiting the gross domestic product growth to about 2 percent a year over the next decade, The Hill reports.

AHH: Meanwhile, McCain is fighting an aggressive disease. The senator told CBS's 60 Minutes that his brain cancer prognosis is "very poor."

"They said that it's very serious, that the prognosis is very, very serious," said McCain, who is undergoing treatment for a fast-growing brain tumor known as glioblastoma. "Some say 3 percent, some say 14 percent. You know, it's a very poor prognosis."

"So I just said, 'I understand. Now we're gonna do what we can, get the best doctors we can find and do the best we can,'" he added. "And, at the same time, celebrate, with gratitude, a life well-lived....I want, when I leave, that the ceremony is at the Naval Academy, And we just have a couple of people that stand up and say, 'This guy, he served his country.'"

--You might think McCain's health situation would prompt fellow Republicans (who aren't Trump) to withhold their criticisms of his voting decisions. Not so for Rep. Louie Gohmert (R-Tex.), who suggested yesterday on Fox News that McCain should be "recalled" because his cancer treatment may be hurting his ability to do his job in Congress.

"You know, nothing inhibits recovery from cancer like stress. I think Arizona could help him and us. Recall him. Let him, you know, fight successfully this terrible cancer. And let's get somebody in here that will keep the word he gave last year," Gohmert said on "Fox and Friends."

HEALTH ON THE HILL

--If Senate Republicans struck you as impulsive and haphazard as they started hopping on the Cassidy-Graham train over the last two weeks, you’re not alone. Here are seven ways the latest health-care effort has defied legislative norms, my colleague Elise reports.

1. The bill was released less than two weeks ago.

2. The bill had only one legislative hearing.

3. Cassidy specializes in health policy, but not Graham.

4. The CBO didn't provide a complete score.

5. Cassidy and Graham introduced a new version of the bill yesterday.

6. That version didn't get a complete score from the CBO either.

7. To pass a bill without Democratic votes, Republicans would need to act by Saturday.

REPRODUCTIVE WARS

--The House will vote next month on a bill prohibiting abortions about halfway through pregnancy, legislation it has passed before but not in the present Congress. This morning, Majority Leader Kevin McCarthy (R-Calif.) will announce a vote on the bill, dubbed the "Pain-Capable Unborn Child Protection Act" because it is based on the idea that a fetus could feel pain five months into pregnancy. McCarthy will be joined by leaders of several antiabortion groups, members of Congress -- and five-year-old Micah Pickering, who was born at 20 weeks gestation (officially considered 22 weeks of pregnancy).

The House last approved such a measure in May 2015 -- Senate Republicans tried to advance the bill several months later but were blocked by Democrats.The measure has been a top priority of abortion opponents, who argue that scientific advances are enabling premature babies to survive earlier and earlier. Abortion rights supporters argue that such bans -- which 20 states have passed -- violate the Supreme Court's Roe v. Wade standard that women have the right to an abortion before the fetus would be viable.

A few other good reads from The Post and beyond:

INDUSTRY RX
The FDA action was part of an international effort to target the illicit sale of prescription drugs.
Laurie McGinley
A report by the HHS Office of Inspector General found deterrents in reporting problems with human research.
Joe Davidson | Columnist
STATE SCAN
The voice mails could have cleared up the ugly fight between the governor and nursing home officials.
Kyle Swenson
DAYBOOK

Today

  • The Brookings Institution will hold an event on “The Medicare Physician Fee Schedule and Alternative Payment Models."

Coming Up

  • The House Financial Services Subcommittee on Housing and Insurance will hold a hearing on “examining insurance for nonprofit” on Thursday.

  • The American Enterprise Institute holds an event on “Innovative rethinking of health care delivery and competition” on Friday.

  • The National Press Club will have a headliners luncheon with FDA Commissioner Dr. Scott Gottlieb on Friday.

SUGAR RUSH

Puerto Rico's hospitals struggle after Hurricane Maria:

Sen. Orrin Hatch (R-Utah) to protesters: "If you want a hearing, you better shut up": 

Watch Seth Meyers take on President Trump's attack of protesting athletes: 

Stephen Colbert weighs in on Puerto Rico and North Korea: