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Eleven governors, including five Republicans and a pivotal Alaskan independent, urged the Senate on Tuesday to reject a last-ditch push to dismantle the Affordable Care Act. But Republican leaders pressed toward a showdown vote. And they choked off separate bipartisan efforts to shore up health insurance markets under the Affordable Care Act, hoping to give Republican senators no alternative but to vote for repeal. (Pear and Kaplan, 9/19)

Opponents of the proposal co-authored by Sens. Bill Cassidy of Louisiana and Lindsey Graham of South Carolina seized on its plan to overhaul Obamacare’s subsidized insurance and Medicaid expansion and replace those with block grants to the states — a mass restructuring they warned would sow chaos in insurance markets. They panned its new regulatory flexibilities as a backdoor route to undermining key patient protections — including safeguards for those with pre-existing conditions. And in the biggest blow, several Republican governors urged the GOP to abandon a plan that would force states to swallow potentially billions in funding cuts — and instead to focus on stabilizing Obamacare. (Cancryn, 9/19)

Among the signers were Alaska Gov. Bill Walker (I), who holds some sway over Murkowski, a potentially decisive vote who opposed a previous Republican effort to repeal and replace the Affordable Care Act. Nevertheless, Murkowski said Tuesday afternoon that she was still weighing her options and explained how her position on the bill might ultimately differ from her opposition to the repeal effort that failed dramatically in July. “If it can be shown that Alaska is not going to be disadvantaged, you gain additional flexibility. Then I can go back to Alaskans, and I can say, ‘Okay, let’s walk through this together.’ That’s where it could be different,” she said. (Sullivan, Eilperin and Snell, 9/19)

Republicans must act by Sept. 30 in the Senate or face the prospect of a Democratic filibuster. That blocking action is currently staved off by budget rules that will expire at the end of the month. The new legislation, by Graham and Sen. Bill Cassidy of Louisiana, would undo the central pillars of former President Barack Obama’s health care law, and replace them with block grants to the states so they could make their own health care coverage rules. (Werner, 9/20)

Senate Majority Leader Mitch McConnell refused to promise a vote on Republicans’ last-ditch proposal to repeal Obamacare as Democrats and other opponents started ramping up a new campaign Tuesday to block it. "If we were going to go forward, we would have to act before Sept. 30," McConnell told reporters when asked if the GOP-only bill will come to the Senate floor before next week’s procedural deadline. "We are in the process of discussing all of this." (Litvan, 9/19)

President Trump and Vice President Pence have been making calls to senators and governors in a furious effort to gain support for a last-ditch ObamaCare repeal bill. The Trump administration is making clear it's all in on the repeal push, with Pence warning that the White House will not support efforts to "fix" or "prop up" ObamaCare. (Hellmann, 9/19)

The White House ... threw its muscle behind the legislation. Vice President Mike Pence flew back Tuesday to Washington from United Nations meetings in New York to publicly cheer on Republican senators, saying President Donald Trump and the administration are strongly behind the effort. (Armour, Peterson and Radnofsky, 9/19)

Sen. Lindsey Graham (R-S.C.) is predicting he will get enough votes on his bill to repeal ObamaCare and says House leadership has pledged they would also pass it. "I really believe we're going to get 50 Republican votes," Graham told reporters after a closed-door GOP caucus lunch on Tuesday. "I've never felt better about where we're at." (Carney, 9/19)

Rand Paul might soon go down as the Republican who saved Obamacare — and he couldn’t care less. "I'm actually happy to be out there as the leading advocate for repealing Obamacare, not keeping it," the Kentucky Republican said in an interview. Of his GOP colleagues, Paul added: "These people, they so totally do not get it." (Kim and Everett, 9/20)

Despite a hard sell from [Mike] Pence, endorsements from GOP leaders on both sides of the Capitol and a steady mobilization of influential conservative thought leaders, a handful of Senate Republicans remain uncomfortable with the bill’s many unknowns. (Dumain, 9/19)

Senate Republicans are rushing toward a vote on an ObamaCare repeal bill without getting a full analysis from the Congressional Budget Office on how their legislation would affect coverage and premiums. It’s a risky move, as Sens. Susan Collins (R-Maine) and John McCain (R-Ariz.) have both said they’d prefer to have a full score before casting their votes. (Sullivan, 9/19)

A bipartisan group of governors including Republicans John Kasich (Ohio) and Brian Sandoval (Nevada) is urging the Senate to reject the latest ObamaCare repeal effort. In a letter to Senate leaders, the governors urged lawmakers not to abandon bipartisan market stabilization talks led by Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.). (Weixel, 9/19)

Ohio Gov. John Kasich has a message for Republicans in Congress who may take up a last-minute effort to repeal Obamacare: Don't. Republican senators are making one last push to overhaul Obamacare days before an end-of-September deadline, but it is not clear whether they have the votes to pass a bill. (Weiser and Collins, 9/19)

Ohio Gov. John Kasich on Tuesday joined a bipartisan group of governors who formally declared opposition to the latest U.S. Senate plan to repeal and replace the Affordable Care Act. Kasich joined nine other governors including Colorado Democrat John Hickenlooper in a letter that asked Senate Majority Leader Mitch McConnell and Democratic Leader Chuck Schumer to not consider the controversial proposal. (Eaton, 9/19)

Massachusetts officials warned Tuesday that the latest Republican health care bill to emerge in the US Senate would inflict serious damage to the state’s medical system, adding their voices to another tense congressional skirmish over the future of the Obama-era health law. (Herndon, 9/20)

Gov. Larry Hogan urged Congress Tuesday to reject the latest version of a Senate Republican plan to repeal Obamacare, saying it would cost Maryland $2 billion a year. Hogan, a Republican, has so far opposed all of the measures supported by President Donald J. Trump to scrap the Affordable Care Act. The new version, known as Graham-Cassidy, faces a potentially close vote in the Senate before the end of September. (Dresser, 9/19)

Pat Toomey is making the most out of his new term in the Senate. Fresh off a near-political-death experience — winning reelection last year by 1.5 percentage points — the Pennsylvania Republican has dived into the two most contentious legislative battles of 2017, authoring conservative proposals and pushing some colleagues to go farther than first inclined. Toomey began the year by serving as a leading voice for rolling back the Affordable Care Act; he wrote one of the most controversial parts of the Senate GOP’s initial proposal, a plan to drastically scale back Medicaid spending. (Tamari, 9/19)

Iowa Gov. Kim Reynolds said Tuesday she supports a Republican initiative in Congress to repeal the Affordable Care Act and replace it with a plan to give block grants to the states to help individuals pay for health coverage. Reynolds, a Republican, pointed to the success of a welfare reform initiative approved by Congress under President Bill Clinton in the 1990s that resulted in reductions in welfare rolls. However, she quickly added she isn't suggesting that she supports major cuts in the rolls of Iowa's Medicaid program, which provides health care for thousands of low-income persons. (Petroski, 9/19)

Virginia gubernatorial candidate Ed Gillespie (R) on Tuesday appeared to distance himself from the Graham-Cassidy bill, a last-ditch effort by Senate Republicans to repeal and replace ObamaCare. During a debate with opponent Lt. Gov. Ralph Northam (D), the Republican said that while he supports a bill intended to replace the Affordable Care Act, also known as ObamaCare, the one put forth by Sens. Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.) doesn't protect states that chose not to expand Medicare. (Bowden, 9/19)