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Shifts on ACA repeal put new pressure on push for bipartisan fix

Sen. John McCain is back in the spotlight on health care. Photo: J. Scott Applewhite/AP

The uncertainty surrounding Senate Republicans' latest repeal-and-replace bill is putting more pressure on Democrats to reach a deal to stabilize the Affordable Care Act.

Sens. Lamar Alexander and Patty Murray have been working on a plan to tweak the ACA through a mix of looser regulations and more reliable funding. And Alexander's hand in those talks may be getting stronger as a side effect of the momentum behind a repeal bill sponsored by Sens. Lindsey Graham and Bill Cassidy.

Why: Sens. Lisa Murkowski and John McCain are publicly rooting for the stabilization effort to succeed, and Graham-Cassidy can't pass without at least one of them.

  • Murkowski has actively participated in the four hearings the Health, Education, Labor and Pensions Committee has held on stabilization, often staying longer than most other members.
  • On Sunday, McCain mentioned this effort by name on Face the Nation, saying Republicans shouldn't "ram" their proposal through.

The problem: While Democrats say the negotiations are going well and weekend talks were "productive," per a Democratic aide, Republicans disagree. "There's no deal, and one doesn't look imminent. If there's no deal, I assume that means Republicans are going to flock to the only thing that's on the table," a senior GOP aide told me.

Yes, but: McCain and Murkowski could vote against Cassidy-Graham-Heller-Johnson regardless. Both their states stand to lose under the bill, according to an early analysis by the left-leaning Center on Budget and Policy Priorities. But it seems that if what they've been calling for all along is within reach, it gives them a lot more of an excuse to vote against a GOP-only bill.

Who we're watching: Murray. If she can strike a deal with Alexander — which hinges on giving states more flexibility through innovation waivers — it could deeply influence McCain and Murkowski's decision.