Yes, again: After spending the spring and summer trying and failing to repeal the Affordable Care Act, Republicans in the Senate have come up with one last Hail-Mary bill to take down the ACA and revamp American healthcare.

So what is it this time?

Senators Lindsey Graham (SC) and Bill Cassidy (LA), joined by Dean Heller (NV) and Ron Johnson (WI) on Wednesday released a new, last-ditch ACA repeal bill.

Graham and Cassidy actually first pulled together their proposal in July, while the Senate was foundering on the McConnell bill that eventually failed.

Most folks call this attempt the Graham-Cassidy bill, although the Senators’ offices are trying to make “GCHJ” happen. (It won’t.)

What does it do?

Although this bill [141-page PDF] takes a slightly different approach to repeal than the failed July bill, Graham-Cassidy still aims for several similar outcomes, including:

• Repealing the individual mandate
• Repealing the employer mandate
• Permitting states to opt out of requiring insurers in their borders cover essential health benefits
• Ends the Medicaid expansion
• Replaces some Medicaid funding with block grants that states can use for whatever

An analysis from the non-partisan Center for Budget and Policy Priorities concludes that Graham-Cassidy would result in large cuts to federal funding for healthcare overall, without replacement. The bill would also hurt anyone with pre-existing conditions on the individual market, because of the way in which states would be able to opt out of benefits and coverage requirements.

Graham-Cassidy would “cause many millions of people to lose coverage, radically restructure and deeply cut medicaid, and increase out-of-pocket costs for individual market consumers, the CBPP concludes.

Our colleagues down the hall at Consumers Union agree. “Just like its predecessors, this plan would leave tens of millions uninsured, threaten key consumer protections and coverage requirements, and fundamentally alter Medicaid by drastically cutting funding and shifting billions of dollars of healthcare costs onto states and consumers,” CU’s Betsy Imholz said in a statement.

In short: it’s basically a new skin on the same set of policy proposals we all saw circulating earlier this year.

Is it actually going to happen?

Hill-watchers and Washington media largely consider Graham-Cassidy an unlikely long shot at best — but if watching Congress in 2017 has taught us anything, it’s: ¯\_(ツ)_/¯

The math in the Senate is the same now as it was in July: Senate Majority Leader Mitch McConnell needs 50 members to vote in favor of something in order to get it to pass. (Vice President Mike Pence can cast a tie-breaking 51st vote as needed.)

That’s leading Republicans in favor of the bill to crow that they’re almost there, boasting that at least 47-49 members are already in line to vote for it.

But as we saw this summer with Sen. John McCain’s (AZ) dramatic late-night thumbs down, it’s that 50th vote that you can’t get by without.

There are 52 Republicans in the Senate, meaning that if three choose not to support the bill, it’s dead in the water. Sen. Rand Paul (KY) has already gone on the record as a “no.”

Sens. Susan Collins (ME) and Lisa Murkowski (AK) were the other holdouts over the Senate’s July bill. At the time, both cited objections to cuts in coverage and in Medicaid funding. Consdiering Graham-Cassidy promises equally dire cuts, it seems unlikely that either would suddenly be swayed — but unlikely is not the same as impossible.

That said, anything that did manage to get through the Senate would still have to get through the House before becoming law… and the clock is ticking. Because the procedural tactic Congress has been using to try and rewrite healthcare, budget reconciliation, has a deadline. Congress has to be completely done with any bill before the clock strikes midnight on Sept. 30.

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