GOP Sen. Susan Collins of Maine said she opposes the latest version of the Graham-Cassidy health care bill on Monday, dealing a major blow to top Republicans who saw the legislation as their best chance to finally repeal and replace Obamacare.

Collins joins GOP Sens. John McCain of Arizona and Rand Paul of Kentucky in coming out against the measure — providing the third “no” needed to sink the legislation as leadership could only lose two GOP members to successfully send the bill to the lower chamber. The moderate Maine Republican, who previously told reporters she was waiting on numbers from the Congressional Budget Office to see how the changes would impact her state, blasted the rushed process used while crafting the measure.

“Sweeping reforms to our health care system and to Medicaid can’t be done well in a compressed time frame, especially when the actual bill is a moving target,” she said in a statement. “Today, we find out that there is now a fourth version of the Graham-Cassidy proposal, which is as deeply flawed as the previous iterations. The fact that a new version of this bill was released the very week we are supposed to vote compounds the problem.”

Collins cited three concerns as her reasoning for declining to support the bill: cuts to Medicaid, too few safeguards for people with pre-existing conditions, and the fact that “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.”

According to Collins, the partial CBO report on the previous version of the bill and the changes made to accommodate certain states in an attempt to sway members to vote for the bill was cause for concern.

“There has been some discussion that the new version of the bill includes additional money for my home state of Maine. The fact is, Maine still loses money under whichever version of the Graham-Cassidy bill we consider because the bills use what could be described as a ‘give with one hand, take with the other’ distribution model,” she continued. “Huge Medicaid cuts down the road more than offset any short-term influx of money. But 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.”

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