From left, Sen. Bill Cassidy (R-La.), Sen. Dean Heller (R-Nev.,)...

From left, Sen. Bill Cassidy (R-La.), Sen. Dean Heller (R-Nev.,) Sen. Lindsey Graham (R-S.C.), and Sen. Ron Johnson (R-Wis.), hold a news conference on Capitol Hill in Washington, Sept. 13, 2017, to unveil legislation to reform health care. Credit: AP / Andrew Harnik

Two months after suffering the year’s most humiliating legislative defeat, Senate Republican leaders are quietly making one final effort to dismantle Obamacare and achieve one of the GOP’s most coveted political goals.

While success would give Republicans a political triumph, it could produce the same sharp reduction in health care coverage for millions of Americans that Democrats and their allies in the health care industry have fought all year, though it delays the biggest cuts until 2026.

The measure, proposed by Sens. Lindsey Graham of South Carolina and Bill Cassidy of Louisiana, would penalize large northern states with the most successful health care programs and eliminate protection for people with pre-existing conditions, just like the House-passed bill President Donald Trump called “mean.”

Supporters are scrambling to get enough support and a ruling on its financial impact from the Congressional Budget Office to permit a vote before Sept. 30, when legislative authority expires to act with only GOP votes. In essence, the measure would transfer most of the federal government’s responsibility and funds for health care coverage to the states and significantly reduce and alter the way the funds are allocated.

Like prior proposals, it needs at least 50 of the 52 Republican senators, a prospect that remains uncertain. Sponsors claim they have 48 or 49 votes, though no one is too sure. Sen. Rand Paul of Kentucky said he opposes it, and Sen. Susan Collins of Maine is considered a likely foe.

That could leave the outcome to the other two Republicans who torpedoed the last GOP effort in July, Sens. John McCain of Arizona and Lisa Murkowski of Alaska, though both of their states fare poorly under the plan. On CBS’ Face the Nation Sunday, McCain praised the rival effort by GOP Sen. Lamar Alexander of Tennessee and Democratic Sen. Patty Murray of Washington to bolster Obamacare, using the regular legislative process. But he also told NBC News he may “reluctantly” back Graham-Cassidy.

Earlier, several top Republican leaders, including Majority Whip John Cornyn of Texas and Sen. Orrin Hatch of Utah, expressed doubt the Graham-Cassidy measure can pass. But the White House is apparently encouraging the renewed effort.

If it succeeds, Republicans would not only dismantle President Barack Obama’s most significant domestic achievement but transform the defeat that damaged both Trump and the GOP into an unexpected partisan political windfall - at least in the short term.

If they fail, Alexander, Murray and a bipartisan coalition of House members hope to craft and pass legislation that would bolster Obamacare by providing the subsidies insurance companies need to avoid massive cost increases for the less than 10 percent of Americans who are affected.

If the Senate passes the Cassidy-Graham measure, House leaders might try to muscle it through their chamber. But its cutbacks could pose political risks to Republican supporters. The bill leaves to the states the future guarantees of insurance covering pre-existing conditions, which not all states would support, and reduces overall funds for health care, while shifting money from states that expanded Medicaid coverage to those which didn’t.

According to opponents, it would cut total funds for health care by about one-third over the next 10 years and eliminate all added funding after 2026. It would end the Medicaid expansion, which gave 11 million Americans coverage. And it would end the federal subsidies that help poorer people pay insurance costs, substituting a different system with less money.

It would penalize blue states like California, Massachusetts and New York that took advantage of the Affordable Care Act’s provision to expand Medicaid coverage and reward predominantly Republican governed ones like Texas and Oklahoma, which have refused for seven years to expand it.

The latest GOP effort has received relatively little attention, overshadowed by last week’s introduction by Sen. Bernie Sanders and 15 Democrats of legislation to extend Medicare coverage to all Americans. That enabled Republicans to renew their warnings that failure to kill Obamacare now could lead to Democrats enacting national health insurance.

That is likely an exaggeration. The Sanders proposal, which fails to specify how it would be financed, has no chance of being adopted for any foreseeable time, and some of its co-sponsors actually favor more modest expansions.

The irony of the renewed Republican effort - and the Trump administration’s year-long battle to undermine Obamacare - is that most Americans are not directly affected by the legislation, because they get health insurance through private employers, the government or Medicare.

But it has become a symbol of the ineptitude of the newly elected president and the GOP-controlled Congress, making the prospect of a last-minute success all the sweeter.

Carl P. Leubsdorf is the former Washington bureau chief of The Dallas Morning News and a frequent contributor.

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