Sen. John McCain likely killed the Senate’s final effort this year to repeal Obamacare.

The longtime Arizona Republican, whose dramatic 11th-hour decision in July spelled doom for the so-called “skinny repeal” of the Affordable Care Act, released a statement Friday saying he could not support the latest repeal effort, either.

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“As I have repeatedly stressed, health care reform legislation ought to be the product of regular order in the Senate,” he said. “Committees of jurisdiction should mark up legislation with input from all committee members, and send their bill to the floor for debate and amendment. That is the only way we might achieve bipartisan consensus on lasting reform, without which a policy that affects one-fifth of our economy and every single American family will be subject to reversal with every change of administration and congressional majority.”

McCain insisted his decision gives him no pleasure, especially considering one of the lead authors of the bill was his close friend, Sen. Lindsey Graham (R-S.C.).

“Who knows why McCain is doing this. It’s very discouraging. You just have to wonder what his motivations are.”

With Sen. Rand Paul (R-Ky.) already having come out against the bill as an insufficient repeal, that leaves the GOP with no margin for error. But Sen. Susan Collins (R-Maine) has given every indication she would oppose it. She told a local newspaper in Maine on Friday that she is leaning against it.

Grace-Marie Turner, president of the Galen Institute, said Republican opponents are being “very short-sighted.” She noted that McCain based his previous opposition to repealing Obamacare on concerns from his state’s governor, Republican Doug Ducey. But Ducey supported the current bill, which would convert Obamacare subsidies and Medicaid expansion funds into block grants to the states.

“Who knows why McCain is doing this,” she said. “It’s very discouraging. You just have to wonder what his motivations are.”

Graham vowed in a statement to move forward despite McCain’s announcement.

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“I’m completely convinced taking money and power out of Washington and returning it to states to administer health care is the best way to replace a collapsing Obamacare system,” he stated. “I’m excited about solutions we have found in Graham-Cassidy-Heller-Johnson. We press on.”

In his statement, McCain indicated that he might support something along the lines of what Graham and three other senators have proposed if it emerged after extensive hearings and debate, and senators could offer amendments.

“We should not be content to pass health care legislation on a party-line basis, as Democrats did when they rammed Obamacare through Congress in 2009,” he said in the statement. “If we do so, our success could be as short-lived as theirs when the political winds shift, as they regularly do.”

But Turner noted that the Senate planned to hold two hearings next week, which would make the process more deliberative than in 2015 when both houses of Congress — including McCain — approved a straight repeal of the Affordable Care Act. It ran into an immediate veto by then-President Barack Obama.

“Frankly, the process is not the problem here,” Turner said.

Instead, she said, some Republican senators simply are protecting government funding that their states receive.

“They’re really trying to protect their entitlement dollars,” she said.

Turner said it is still possible Collins might be persuaded to vote “yes” on the bill or that supporters could change Paul’s mind. But both seem unlikely, and even if supporters could get one of them, they would still need to secure the vote of Sen. Lisa Murkowski (R-Alaska). And she helped kill the so-called skinny repeal.

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The reason for the rushed process is that September 30 looms as the deadline for passing a repeal under different rules that require only 51 votes in the Senate. With Republicans wanting to use that process next year for tax reform, any Obamacare repeal would need 60 votes to avoid a filibuster.

McCain referenced his desire for bipartisanship and compromise. But Democrats have shown no interest in any bill that significantly alters the taxes, spending or structure of Obamacare. That leaves only a chance for small-scale changes of the kind Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) have pursued.

Such a deal would include permanent funding of subsidies to help low-income Obamacare recipients pay deductibles and out-of-pocket expenses. In exchange, Democrats might be willing to give states a little more flexibility in waiving some regulations. But conservative health policy experts have said such changes are not big enough to fundamentally address the flaws of the Affordable Care Act or reduce premiums.

(photo credit, homepage and article images: Gage Skidmore, Flickr)