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caption  Susan Collins  and Donald Trump source Kevin Lamarque/Reuters
 Sen. Susan Collins of Maine  announced Monday that  she  will vote ânoâ on the latest Republican healthcare bill  all but surely ending the latest effort to repeal and replace Obamacare.
 Collins  joins Sens. John McCain and Rand Paul in opposition  and since two GOP members could oppose the bill for it to pass  the bill is likely dead.  The Maine senator  also opposed the previous iterations of the Republican healthcare bills  helping to end that push in July.
âSweeping reforms to our health care system and to Medicaid canât be done well in a compressed time frame  especially when the actual bill is a moving target â said a statement from  Collins . âToday  we find out that there is now a fourth version of the Graham-Cassidy proposal  which is as deeply flawed as the previous iterations.â
 Collins  pointed to three primary issues with the bill that caused  her  to oppose it:
Cuts to Medicaid  estimated at roughly $1 trillion from 2020 to 2036  by shifting to a block grant system: âThis would have a devastating impact to a program that has been on the books for 50 years and provides health care to our most vulnerable citizens  including disabled children and low-income seniors â  Collins  said.Weakened protections for people with pre-existing conditions: âSome states could allow higher premiums for individuals with pre-existing conditions  potentially making their insurance unaffordable.âHealth insurance coverage losses: âThird  physicians  patient advocates  insurers  and hospitals agree that both versions of this legislation would lead to higher premiums and reduced coverage for tens of millions of Americans â said the statement.
 Collins  also said that despite the recent change by the authors of the Graham-Cassidy bill to include more money for  her  state in their formula for the new block grants  the overall cut was still too great for  her  to stomach. Additionally   Collins  took issue with the seat-of-the-pants changes to the formula that lead to  her  state gaining more money.
âBut even more important  if Senators can adjust a funding formula over a weekend to help a single state  they could just as easily adjust that formula in the future to hurt that state â  Collins  wrote. âThis is simply not the way that we should be approaching an important and complex issue that must be handled thoughtfully and fairly for all Americans.â
Sen. Bill Cassidy  one of the authors of the new proposal  was frank about the prospects for the bill if  Collins  was not on board during an appearance with CNNâs Wolf Blitzer just hours before the announcement.
âIf you lose  Susan Collins   itâs over right?â asked Blitzer.
Susan Collins opposes Graham