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Republicans set the stage for a striking health care showdown

The Graham-Cassidy plan unveiled two weeks ago is dead. There is. however, a new Graham-Cassidy plan.
Image: Bill Cassidy,Lindsey Graham
FILE - In this July 13, 2017, file photo, Sen. Bill Cassidy, R-La., left, and Sen. Lindsey Graham, R-S.C., right, talk while walking to a meeting on Capitol...

If you were one of the many Americans who was involved in the recent effort to derail the Republicans' latest heath care repeal plan, I have some good news and bad news. The good news is, you succeeded: the Graham-Cassidy plan unveiled two weeks ago is dead, unable to secure enough GOP support.

The bad news is, there's a new Graham-Cassidy plan.

As NBC News reported, the new proposal, out this morning, includes "a series of carve-outs for Alaska." The point isn't subtle: Sen. Lisa Murkowski (R-Alaska) has been deeply skeptical of her party's repeal campaign, and Republican leaders are effectively trying to pay her off.

To her credit, the GOP senator has been resistant to these efforts in the past, making clear she's concerned about the national system overall, not just her home state. And if that's still the case, this latest attempt at a Polar Payoff should fall short, since as the Huffington Post's Jonathan Cohn explained, this latest repeal bill is in some ways worse than its predecessor.

Based on initial inspection, the new bill is a lot like the original bill, which would have decimated existing federal health programs, reduced government spending, and left many millions without insurance.But now the legislation, which Politico and Vox first reported, includes a pair of important changes -- an even more aggressive assault on protections for people with pre-existing conditions, as well as some extra money to blunt the impact of funding cuts for a handful of states.

That handful of states includes Alaska and Maine -- home to two Senate GOP skeptics of their party's health care crusade.

That said, even with the carve outs, NBC News obtained an industry analysis that concluded Alaska "would still lose money" under the latest Republican plan because it would end Medicaid expansion, which has benefited much of the country, including Alaska.

So, where does that leave us? Here's where things stand as of this afternoon:

* Sen. John McCain (R-Ariz.) is a "no" and shows no signs of wavering. Sen. Rand Paul (R-Ky.) said last week that he's a "no," but said over the weekend that he could change his mind if the bill's authors agreed to slash state block-grant funding in half, which is plainly unrealistic. This morning, the Kentucky Republican's office said Graham-Cassidy 2.0 still isn't good enough.

* Sen. Susan Collins (R-Maine) hasn't formally announced her position, but she told CNN's Jake Tapper yesterday, "It's very difficult for me to envision a scenario where I would end up voting for this bill."

* Sen. Ted Cruz (R-Texas) shook things up a little yesterday, declaring at an event in Austin, "Right now, [GOP leaders] don't have my vote and I don't think they have Mike Lee's either." I've seen some reports that suggested that means Cruz is also a "no," but I wouldn't go nearly that far. This strikes me as an example of Cruz negotiating in public, looking for enticements. (He did the same thing in July before voting for each of the various repeal bills.)

* Industry stakeholders continue to plead with policymakers to reject the bill. Indeed, in an unheard of move, the nation's largest organizations representing doctors, hospitals, and nurses issued a joint statement denouncing the Republican effort. Soon after, Cleveland Clinic released a similar condemnation. (Cleveland Clinic is one of the largest employers in Republican Sen. Rob Portman's home state of Ohio.)

* The number of Republican governors opposed to their own party's health care proposal reached nine over weekend with a statement from West Virginia's Jim Justice (R). Michigan Gov. Rick Snyder (R) doesn't seem overly impressed, either.

* The first and only Senate hearing on the proposal is poised to begin in about an hour. The hallway outside the Senate Finance Committee hearing room has been packed for hours. Among the witnesses testifying in support of Graham-Cassidy are Lindsey Graham and Bill Cassidy. (I've been to the Dirksen Senate Office Building several dozen times and I don't think I've ever seen quite this many people there.)

* A new national poll from CBS found the clear majority of Americans oppose the Republicans' repeal efforts.

As for what's driving this unnerving zealotry, the New York Times reports that Senate Republicans don't believe they can stop pushing their regressive health care plans -- because the party's donor won't let them.

The deadline is still this Saturday, Sept. 30, at midnight.