Sen. Bill Cassidy (R-La.) testifies during a Finance Committee hearing on the Graham-Cassidy health-care proposal Monday. (Saul Loeb/AFP/Getty Images)

Sen. Johnny Isakson (R-Ga.) quickly realized that Monday’s hearing on the Republican effort to revamp the health industry had devolved into a farcical, partisan shouting match. So he began his round of questioning by ignoring the subject at hand.

Isakson asked a Democratic colleague on the Senate Finance Committee if he had recently co-sponsored a bill, with a Republican, to battle rare childhood diseases. “Yes, I did,” Sen. Robert P. Casey Jr. (D-Pa.) replied, “and that senator is a good man.”

Isakson said he mentioned his work with Casey to show that the Senate still had some ability to function. “We do a lot of things together as Republicans and Democrats that we don’t tell the public about, so I thought they ought to leave the hearing with one piece of good news,” Isakson said.

That exchange summed up how some veteran senators felt about the process behind the consideration of the Cassidy-Graham bill that aimed to repeal the Affordable Care Act and replace it with block grants to states: It was bad news, start to finish, with little chance of success — and little in the way of true legislative scrutiny.

Senators like to refer to their chamber as the world’s greatest deliberative body. But Monday’s five-hour meeting, the only hearing to review the Republican drive to repeal the ACA held by either of two Senate committees with jurisdiction over health policy, didn’t live up to the standard.

Sen. Ron Wyden (D-Ore.), the ranking Democrat on the Senate Finance Committee, said on Sept. 25 that “the American people do not want” the Cassidy-Graham health-care bill. (Reuters)

This latest repeal effort, led by Sens. Bill Cassidy (R-La.) and Lindsey O. Graham (R-S.C.), is at least the fourth legislative draft the Senate has considered in the past four months. Yet the Senate has barely followed anything resembling a normal process as it considers a bill that would overhaul an industry that represents one-sixth of the national economy.

At least partly as a result of that, the Cassidy-Graham legislation was left for dead before the Finance Committee hearing had even ended.

“Everybody knows that’s going to fail,” Sen. Orrin G. Hatch (R-Utah), the committee chairman, told reporters Monday afternoon during a break. Hatch had done the math and knew more than two Republicans would oppose the measure, the bare minimum they could afford lose to pass it on a party-line vote.

“You don’t have one Democrat vote for it,” Hatch said, “so it’s going to fail.”

A few minutes later, Sen. Susan Collins (R-Maine) officially became the third Republican opposed to the legislation, sealing its fate if Majority Leader Mitch McConnell (R-Ky.) sticks to his plan to call up the legislation later this week.

The process of making legislative sausage on Capitol Hill has never been pretty, but the effort to repeal the ACA has stretched the limits of congressional norms — and given lawmakers hesitant to support the controversial GOP health-care proposal an excuse to back away.

It’s hard to see how Republicans’ Obamacare repeal passes now
To have a realistic chance at passing, the vote needs to occur before the end of the fiscal year on Sept. 30.

The main reason for having Monday’s hearing was an effort to placate the “regular order” demands of Sen. John McCain (R-Ariz.), who has called for a normal process of hearings, committee markups and a full-throated debate on the Senate floor.

Instead, during the summer, McConnell negotiated several drafts inside his Capitol suite just off the Senate floor with a few key senators and his senior staff. McCain famously flashed a thumbs down in an overnight roll call in late July, providing the decisive vote against that version of the bill.

By early September, Graham and Cassidy resumed pushing their version of ACA repeal, knowing they had only until the end of the month to use special budget privileges to pass their bill on a simple majority. Many mistakenly believed that Graham’s close friendship with McCain would sway him to reconsider. While McCain continued to demand regular order, some — particularly Graham — heard what they wanted to hear, that maybe he was reconsidering.

So Republican leaders threw together Monday’s hearing, hoping McCain would see a single meeting as a sufficient nod to how things are supposed to work in the Senate. “This was done to window-dress that it was regular order,” said Sen. Bill Nelson (D-Fla.), a member of the Finance Committee.

On Friday, McCain preemptively ended the need for the hearing, announcing that he was a hard no against the Cassidy-Graham bill.

He called for a resumption of negotiations that began earlier this month in the health committee, where Sen. Lamar Alexander (R-Tenn.) led several hearings looking at ways to stabilize the private insurance markets.

That panel’s work was set aside when Cassidy and Graham seemed to pick up momentum on their bill to repeal the ACA.

“We were making great progress,” Collins, a member of Alexander’s committee, told reporters Monday after announcing her opposition to the Cassidy-Graham bill.

Now, the question is whether Alexander and his Democratic counterpart, Sen. Patty Murray (D-Wash.), will resume those negotiations. Conservatives, already disappointed by the Republican inability to repeal a law they have vowed to impale, view the Alexander-Murray effort as akin to bailing out the insurance industry.

Through it all, McConnell has been silent about what comes next. He never responded to McCain’s announcement Friday, and Monday, when the Senate reconvened, he rose in the chamber to reiterate his longtime opposition to the law he derisively calls Obamacare.

McConnell then spoke of the legislation as if it were already defeated, thanking the committee staff who had been involved in the process through its many phases.

“I’d like to thank them all for their dedicated work,” McConnell said.

He then moved on to a discussion about labor-law disputes.

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