A key Republican U.S. senator said Sunday she finds it “very difficult” to imagine herself voting for the party’s latest plan to dismantle nationwide health care policies championed by former Democratic President Barack Obama, a crucial vote that likely would doom the repeal effort this week.

Senator Susan Collins of Maine told CNN she was not ready to declare with certainty that she would vote against the overhaul of the Affordable Care Act, popularly known as Obamacare, and wanted to wait for an assessment of the Republican proposal that the independent Congressional Budget Office is expected to release Monday.

Collins said she wants to see if the new report “reinforces the concerns and reservations” she already has. “Maybe there will be a surprise in there,” she said. “I don’t anticipate that. But I want to wait.”

McCain, Rand Paul opposition

Republican Senators John McCain of Arizona and Rand Paul of Kentucky have already said they would vote against the repeal effort, the latest of dozens of legislative attempts by Republicans to undermine the 2010 law they have opposed, in part because it requires almost all American workers to buy health care insurance policies or pay a fine if they don’t.

A Collins vote against the repeal effort would kill the overhaul effort, as would a “no” vote by Senator Lisa Murkowski of Alaska, who also have voiced reservations about the repeal plan.

In the politically closely divided Senate, Republicans hold a 52-48 advantage over Democrats. With all Democrats opposed to repealing Obamacare, Republicans can afford only two defections, with Vice President Mike Pence poised to vote for the repeal in the event of a 50-50 deadlock.

The latest repeal effort is being advanced by Senators Lindsay Graham of South Carolina and Bill Cassidy of Louisiana. It would send block grants of federal money to the country’s 50 states and allow them to shape independent health care plans for the poorest people in their states, rather than having Washington officials allocate the money, as is now the case.

But Collins has expressed the view that millions of people who now have insurance to pay their health care bills under Obamacare would lose it under the Republican plan. National opinion surveys show that overall a majority of Americans want to keep the current law, although many Republicans do not.

Last-ditch effort

Graham told ABC News that he still thinks there is a possibility of winning the repeal vote and is “moving forward” with efforts to try to change the minds of the last Republican holdouts against the repeal legislation.

Republican Senate leader Mitch McConnell says the Senate will consider the repeal effort this week, just days ahead of a September 30 deadline, as dictated by the Senate’s legislative rules, for completing action.

Even so, it is not clear there will be a vote because McConnell has said he will only call for a vote if he is assured of having enough votes to repeal the law. If the Senate repeals the law, the House of Representatives would then vote on it.

Numerous Democratic critics of the proposal, along with several major health care groups in the country, say that over the coming years the change in the law would cut millions of people from the insurance rolls.

Millions more Americans have been able to secure insurance to help pay their health care bills under Obamacare, but Republicans oppose it because of the mandate to buy insurance coverage and provisions in the law that have led to big increases in the cost of insurance policies for individuals who do not have coverage through their employers as millions of American workers do.

Trump’s comments

U.S. President Donald Trump, anxious for a major legislative victory, has called for the repeal, saying in a Twitter comment last week, “I hope Republican Senators will vote for Graham-Cassidy and fulfill their promise to Repeal & Replace ObamaCare. Money direct to States!”

In a string of comments, Trump has also attacked Paul and McCain for their opposition to the repeal. Trump said Paul ought to vote for the repeal for the good of the Republican party and that McCain had let down voters in home state, where insurance premiums have risen.

“Rand Paul is a friend of mine,” Trump said in one tweet, “but he is such a negative force when it comes to fixing health care. Graham-Cassidy Bill is GREAT! Ends Ocare!,” adding “I know Rand Paul and I think he may find a way to get there for the good of the Party!”

Of McCain, Trump said, “John McCain never had any intention of voting for this Bill, which his Governor loves. He campaigned on Repeal & Replace. Let Arizona down!”

Obama

Obama has only rarely publicly engaged in the day-to-day Washington policy fights since Trump replaced him in January.

But last week Obama attacked Republicans for trying to overturn the health care law.

“The legislation that we passed was full of things that still need to be fixed; it wasn’t perfect, but it was better.” Obama said. “And so, when I see people trying to undue that hard won progress for the 50th or 60th time with bills that would raise costs or reduce coverage or roll back protections for older Americans or people with pre-existing conditions, the cancer survivor, the expecting mom, the child with autism or asthma for whom coverage, once again, would be almost unattainable.

“It is aggravating,” Obama said. “And all of this being done without any demonstrable economic or actuarial or plain common-sense rationale — it frustrates. And it certainly is frustrating to have to mobilize every couple of months to keep our leaders from inflicting real human suffering on our constituents.”

 
…