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Adam Fondren, Deseret News
Stacy Stanford from the Utah Health Policy speaks to the rallies during the rally against the Graham-Cassidy health care plan in front of the Wallace Bennett Federal Building in Salt Lake City, Monday, Sept. 25, 2017.

SALT LAKE CITY — As the latest attempt to repeal and replace the Affordable Care Act appeared to crumble Monday with a lack of necessary votes, Sen. Mike Lee's office said the legislative effort "moves in the wrong direction."

"Sen. Lee has not made a final decision on the bill, but the latest version moves in the wrong direction by giving more power to federal bureaucrats and less regulatory relief for states," the senator's spokesman, Conn Carroll, said in an email.

When asked for a timeline on the Utah Republican reaching a conclusion about the Graham-Cassidy bill, Carroll replied: "I do not think it is likely there will be a decision today."

The legislation being mulled was proposed by Republican Sens. Lindsay Graham of South Carolina and Bill Cassidy from Louisiana.

Amid universal opposition from Democrats, Republicans in the Senate could only afford to lose two GOP votes and still get the bill passed. Sen. Rand Paul, R-Ky., and Sen. John McCain, R-Ariz., said in recent days they cannot support the measure. Monday evening, Sen. Susan Collins, R-Maine, confirmed she opposes it.

Barring a reversal from one of those three, the bill would fail to pass even if Lee voted for it.

The measure, as constituted Monday, would end former President Barack Obama's Medicaid expansion and subsidies for consumers, and ship the money — $1.2 trillion through 2026 — to states to use on health services as block grants with few constraints.

Desperate to win over reluctant senators, GOP leaders revised the measure several times, adding money late Sunday for Alaska, Arizona, Maine, Kentucky and Texas in a clear pitch for Republican holdouts. They also gave states the ability — without federal permission — to permit insurers to charge people with serious illnesses higher premiums and to sell low-premium policies with big coverage gaps and high deductibles.

The Senate must vote this week for Republicans to have any chance of prevailing on a repeal bill with their slim 52-48 control of the chamber. On Sunday, rules allowing the measure to pass by a simple majority expire, and future legislation would need 60 votes to pass.

Hatch's hearing

Also Monday, protesters disrupted a Senate Finance Committee hearing on the Graham-Cassidy bill in Washington, just as Sen. Orrin Hatch, R-Utah, opened the meeting.

“No cuts to Medicaid. Save our liberty,” demonstrators chanted.

“If you want a hearing, you better shut up,” Hatch said, banging his gavel.

Capitol police arrested several people, removing one man from his wheelchair and carrying him out of the room as committee members watched. After several minutes, Hatch recessed the hearing and walked out. He returned about 15 minutes later to restart the meeting.

“Look, a lot of us are on your side. Let’s have some order. If you can’t be in order, then get the heck out of here,” Hatch said, as protesters' chants echoed from the hallway.

In his opening statement, Hatch asked his colleagues to respectfully discuss the issue without theatrics.

“When we talk about health care policy, we’re not just talking about a theoretical concept or legislation that impacts a single isolated industry,” he said. “This topic has a significant impact on the lives of every person in this country in ways that can make or break both their health and their livelihoods.”

Hatch has spoken favorably of the Graham-Cassidy measure and has consistently thrown his weight behind multiple pieces of legislation this year designed to roll back the Affordable Care Act.

Activists: 'Zombie' legislation

At a protest Monday afternoon outside the Wallace F. Bennett Federal Building in downtown Salt Lake, about 75 protesters gathered to deride Graham-Cassidy as "zombie" legislation.

"We thought we were safe, we thought this was over, but this is the repeal that just won't die," said Stacy Stanford, health policy advocate with the Utah Health Policy Project, a health care policy think tank and Affordable Care Act enrollment organization. "So here we are."

Several protesters came dressed for a zombie theme, painting their faces and carrying signs in the shape of gravestones. "Lost my Medicaid," one cutout headstone read.

"These are not our values" in Utah, Stanford said of the legislation's provisions. "We protect our neighbors, we serve our families and we cannot support a bill that puts lives at risk."

Molly Scoville of Salt Lake City told the gathered crowd about her struggles to find affordable insurance on the private market before the Affordable Care Act, thanks to her narcolepsy and depression, both of which she said were labeled as pre-existing conditions.

"I couldn't afford a monthly premium on two incomes," Scoville said.

Scoville said she is upset to see the threat of things returning to the way they used to be, when people with pre-existing conditions had no access to reasonably affordable health insurance.

Psarah Johnson, Disabled Rights Action Committee member, said at the rally that the fight for health care coverage, with regard to those who have pre-existing conditions, is most accurately viewed as a fight for civil rights for those who have chronic illnesses or conditions or who are disabled.

"Health care is a basic civil right, period," Johnson said.

CBO report

Collins' announcement of her opposition to the Graham-Cassidy measure came shortly after the nonpartisan Congressional Budget Office released a report saying that "the number of people with comprehensive health insurance that covers high-cost medical events would be reduced by millions" compared to current law.

The report didn't cite a more specific figure, stating, "the number could vary widely depending on how states implemented the legislation." But it listed reasons why the number of insured Americans would inevitably decrease as compared to under the Affordable Care Act.

"First, enrollment in Medicaid would be substantially lower because of large reductions in federal funding for that program. Second, enrollment in nongroup coverage would be lower because of reductions in subsidies for it. Third, enrollment in all types of health insurance would be lower because penalties for not having insurance would be repealed," the report states.

The report also concluded that the legislation would cut the federal budget deficit by at least $133 billion by 2026. More specific information about how many people might lose insurance was not available because Congressional Budget Office analysts would need several more weeks than they were given to reliably estimate those numbers, the report said.

Herbert backs bill

Gov. Gary Herbert has been a vocal supporter of the Graham-Cassidy measure.

"Many of the negative analyses of Graham-Cassidy assume that the status quo of the Affordable Care Act, along with its endless mandatory spending, is sustainable indefinitely. That is simply not true. Obamacare is collapsing," the governor said in a statement to the Deseret News.

Herbert went on to praise the measure for the autonomy it grants to states.

"It is not perfect. But it is a far more equitable way of providing for the most vulnerable among us," Herbert said. "And, seriously, does anyone really believe that bureaucrats in Washington, D.C., care more for the least among us than do the state and local representatives in the respective statehouses?"

Rep. Jim Dunnigan, R-Taylorsville, who co-chairs the state Legislature's Health Reform Task Force, said "Utah would welcome the opportunity to have both the responsibility and the flexibility" promoted by Graham-Cassidy.

"We can act much quicker, certainly we're closer to the people in Utah than Washington, D.C., folks are, and I think we could figure it out. ... We have some terrific talent and resources in our state, some people very (skilled) in the health care (policy) arena," Dunnigan told the Deseret News.

Utah Health Policy Project spokesman Jason Stevenson said he understands why state leaders are intrigued by the prospect of high flexibility. But that flexibility amounts to "a lot more responsibility and a lot less funding," he said.

"I don't know if states understand the maturity of those decisions they'll have to be making," Stevenson said.

Contributing: Dennis Romboy; The Associated Press