The sudden death of Sen. Lindsey Graham has removed a longtime opponent of the Affordable Care Act’s major medical insurance provisions from the Senate and changed the gameboard for efforts to pass “Reconciliation 3.0” legislation this year.
Graham, 71, died Saturday shortly after returning home from a trip to Ukraine. The cause of death was the rupture of an aortic aneurysm, or a tear in the wall of the main artery that leads to the heart.
The South Carolina Republican became the chairman of the Senate Budget Committee in January 2025.
He had been in the Senate since 2003, after serving in the U.S. House from 1995 to 2003.
Sen. Ron Johnson, R-Wis., is believed to be in line to succeed Graham as Senate Budget chair, according to press reports.
South Carolina Gov. Henry McMaster, a Republican, can choose an interim senator to fill Graham’s Senate seat. President Donald Trump said in a Truth Social post that he has recommended Graham’s sister, Darline Graham Nordone, as a possible replacement.
The early years: Graham was born in 1955 in Central, South Carolina. Both of his parents died before he was 22, and he ended up becoming Darline’s legal guardian when she was 13.
He earned a bachelor’s degree and a law degree from the University of South Carolina, then served in the U.S. Air Force Judge Advocate General’s Corps.
He later worked as an attorney in private practice and in local government positions in South Carolina while serving in the U.S. Air Force Reserve.
Graham’s Senate career: Graham teamed with Sen. Bill Cassidy, R-La., to try to create an alternative to the ACA major medical insurance sections, or Obamacare sections, that would remove many provisions that Republicans have generally opposed while keeping provisions that would prohibit health insurance underwriting based on an individual’s health status.
In 2025, he played a major role in shaping the final version of the legislation that created the One Big Beautiful Bill Act.
The version he helped draft cut Medicaid funding by about 10% over 10 years, eliminated individual coverage health reimbursement arrangement improvements sought by Republicans, and created a provision letting holders of health savings accounts use some HSA cash to pay for direct primary care memberships before the HSA holders have met their deductibles.
Although Graham became a staunch supporter of President Donald Trump, he could also work with Democrats. In July 2023, he joined with Sen. Elizabeth Warren, D-Mass., to introduce a bill that could have given the Federal Trade Commission and the U.S. Department of Justice new powers they could use to regulate online platforms.
Ron Johnson: Johnson was born in Wisconsin in 1955, earned a bachelor’s degree from the University of Minnesota, and later helped start a manufacturing company in Oshkosh, Wisconsin.
He later ran for the Senate as part of the populist “Tea Party” movement.
He has been an advocate for budget discipline and strongly opposed the ACA Obamacare provisions.
In recent years, he has been a fierce critic of the Food and Drug Administration’s approach to approving COVID-19 vaccines. He held a hearing in May on what he said was the failure of officials in the administration of former President Joe Biden to detect COVID-19 vaccine safety problems.
The impact: Some members of Congress have been hoping to create a big “Reconciliation 3.0” package that could ferry many popular, budget-related health and retirement benefits bills through Congress with just 51 votes in the Senate, rather than the 60 votes usually required to get legislation through the Senate.
Some candidates for inclusion in the Reconciliation 3.0 package might soften the ACA employer “shared responsibility” coverage mandate provisions, and others could make health savings accounts and other types of health accounts more attractive.
Graham’s death means that Senate leaders have lost the involvement of someone with decades of experience with creating and passing reconciliation bills.