President Donald Trump hosts a working lunch with members of Congress, including Sen. Lisa Murkowski (left), at the White House on June 13. | Getty Trump knocks House health care bill as too harsh The president offered no detailed directives, but pressed for a deal. 
 
 President Donald Trump directed Senate Republicans to pass a generous health care bill at a meeting with more than a dozen GOP senators on Tuesday, arguing that the austere House health care bill is difficult to defend, according to people familiar with the meeting. 
 
 The president also said Republicans risk getting savaged in the 2018 midterms if they fail to repeal Obamacare after a seven-year campaign against the law. 
 
 Story Continued Below 
 
 But he made clear that the Senate needs to pass a bill that Republicans are able to more easily defend and is not viewed as an attack on Americans from low-income households, as the House bill has been portrayed by critics, the sources said. He also advocated more robust tax credits for people who buy insurance on the individual market, a move that would increase the bill’s cost. 
 
 Sen. Rob Portman (R-Ohio), who is pushing the Senate to slow the repeal of Medicaid expansion, indicated Trump is concerned about the people who are enrolled in the program for low-income Americans. 
 
 “He talked about the need to take care of people,” Portman said of the president. 
 
 The gathering included 13 GOP senators of varying ideological stripes, from the moderate Sens. Susan Collins of Maine and Lisa Murkowski of Alaska to the conservative Mike Lee of Utah and Ted Cruz of Texas. The meeting left some Republicans on Capitol Hill with the impression that Trump is siding with more moderate Republicans, particularly when it comes to winding down Obamacare’s Medicaid expansion, which brought insurance coverage to millions of people. 
 
 Trump has told associates that news coverage of the House health care bill was “terrible,” in the words of one associate who has spoken with him. 
 
 Trump threw a party in the Rose Garden celebrating the passage of the House bill and has publicly called it “terrific.” 
 
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 But aides and associates said he has not liked the news coverage and has shown little interest in what is in the bill — but wants it to be received well. 
 
 Conservatives want to wind down the expansion quickly and curtail future Medicaid spending, while more centrist senators are trying to preserve as much coverage as possible. Republicans said Trump spent a significant portion of the meeting observing senators disagreeing over the matter. 
 
 Murkowski, who, like Portman, is from a state that expanded Medicaid, said she made it clear to the president that she is concerned about repealing the expansion. 
 
 “I reinforced that I think Medicaid expansion has been very important to the state of Alaska,” she said. 
 
 Sen. Pat Toomey (R-Pa.), who is arguing to constrain future Medicaid spending to a rate lower than the House bill provides, said finding the sweet spot “remains a challenge.” 
 
 “It feels like we’re making a little bit of progress. It’s slow, but it was always going to be a tough slog,” said Toomey, who attended the meeting. 
 
 A White House official said Trump did not take a firm position on Medicaid, which is the subject of much deliberation within the Senate Republican Conference. Seema Verma, administrator of the Centers for Medicare and Medicaid Services, attended both the White House meeting and a subsequent GOP lunch on health care, playing point for the administration on the matter. 
 
 And rather than instructing senators to meet hard deadlines, Trump urged Republicans to have a more orderly process than the chaotic one in the House. Senate Majority Leader Mitch McConnell is trying to call for a vote this month, though it may slip until July due to ideological disagreements and the difficulty of drafting such a complex bill. 
 
 The president asked Republicans to set aside their vast policy differences and find consensus. 
 
 “The message really was, ‘I know you have your differences, but work through them and let’s figure out a way to get it done,’” said Sen. John Thune (R-S.D.). “We have to get a product.” 
 
 “He wants us to pass this bill and improve this House bill,” Senate Finance Chairman Orrin Hatch of Utah told reporters. 
 
 Republican senators believe it will be at least a week before a coherent blueprint emerges for the GOP to chew over. Leaders are still going back and forth with the Congressional Budget Office to lay out options for Medicaid and tax credits and how much each option would cost. 
 
 Hatch told reporters that he doesn’t think there will be a bill this week. If that prediction holds, it would be difficult for the Senate to vote on legislation before the Fourth of July recess. 
 
 McConnell refused to tell reporters when a bill might be released or how long it would be available to the public before a vote. 
 
 “We’ll let you see the bill when we finally release it,” McConnell said. “Nobody’s hiding the ball here.” 
 
 Trump has taken a much more hands-off approach to the Senate bill than he took with the House version. Many senators expect the president to weigh in with more one-on-one or group lobbying as the GOP gets closer to moving a bill to the Senate floor. 
 
 “He’ll be a big help, but I think the timing is important. And he’ll be an important part of this,” said Senate Majority Whip John Cornyn (R-Texas). “We need to consult among ourselves and come up with a consensus.” 
 
 Adam Cancryn contributed to this report. ||||| Breaking News Emails Get breaking news alerts and special reports. The news and stories that matter, delivered weekday mornings. 
 
 / Updated By Leigh Ann Caldwell 
 
 WASHINGTON — Senate Majority Leader Mitch McConnell acknowledged Monday night that he lacked the votes to pass the Senate health care bill after two more Republican senators came out against it, leaving the party short of a majority. 
 
 Instead, he said the Senate would vote on a full repeal of Obamacare, with two years before the repeal goes into effect to allow time to create a new system. The new plan may appear to fulfill a seven-year GOP promise, but it faces extremely difficult odds after many moderate Republican senators have already come out against repeal without an immediate replacement. 
 
 Sens. Jerry Moran of Kansas and Mike Lee of Utah set the chain of events in motion Monday night when they announced on Twitter that they both would oppose the current bill, which was released just last week. 
 
 Moran and Lee followed two other Republican senators who had already said they wouldn't support the bill: Rand Paul of Kentucky and Susan Collins of Maine. 
 
 "After conferring with trusted experts regarding the latest version of the Consumer Freedom Amendment, I have decided I cannot support the current version of the Better Care Reconciliation Act," Lee said in a statement. "In addition to not repealing all of the Obamacare taxes, it doesn't go far enough in lowering premiums for middle class families; nor does it create enough free space from the most costly Obamacare regulations." 
 
 Moran issued this statement: "We should not put our stamp of approval on bad policy. Furthermore, if we leave the federal government in control of everyday healthcare decisions, it is more likely that our healthcare system will devolve into a single-payer system, which would require a massive federal spending increase. We must now start fresh with an open legislative process to develop innovative solutions that provide greater personal choice, protections for pre-existing conditions, increased access and lower overall costs for Kansans." 
 
 The senators released their statements just as eight other lawmakers, including most members of leadership, left the White House, where they ate dinner with the president. President Donald Trump has been largely disengaged from the process in the Senate, and his dinner guests were members already supportive of the measure. 
 
 The president responded to the latest development just after 10:15 p.m. ET: 
 
 McConnell of Kentucky, the majority leader, is seeking to give Trump what he wants. McConnell, who had worked to craft the bill that couldn't muster enough support, said he would seek a vote on a full repeal — the same version that passed both the House and the Senate in 2015 — "in the coming days." 
 
 "Regretfully, it is now apparent that the effort to repeal and immediately replace the failure of Obamacare will not be successful," McConnell said in a statement. 
 
 While straight repeal passed the Senate in 2015, there was no possibility that it would go into effect because then-President Barack Obama vetoed the legislation. 
 
 Just last week, Sen. Roy Blunt, R-Mo., told reporters that straight repeal wouldn't get the support of 50 Republicans. 
 
 McConnell had expected to hold a vote on the bill this week but was forced to delay it after Sen. John McCain, R-Ariz., underwent surgery to remove a blot clot above his left eye over the weekend. McCain is unable to return to Washington while he recovers, and his vote would have been crucial before the latest defections. 
 
 The Better Care Reconciliation Act has hit numerous roadblocks since it was unveiled more than a month ago. The first version fell short of the support needed to pass when at least 10 Republican senators came out against it, forcing McConnell back to the drawing board to try to win the support of moderate and conservative Republicans who opposed the measure for different reasons. 
 
 The second iteration, released last week, seemed to have more support. Only Paul and Collins opposed it at the outset, and others with concerns seemed open to ongoing discussions about the bill. 
 
 But the coalition of 50 began to crack Monday when Sen. Ron Johnson, R-Wis., told reporters that he was concerned about McConnell's reassurance to centrists that Medicaid cuts set to go into effect in 2025 would never be realized. 
 
 "I did find the story about Leader McConnell's comments about Medicaid reforms just too far in the future probably never being enacted — I found those pretty troubling," Johnson said. 
 
 The delay due to McCain's medical emergency didn't help matters, either, as some worried that it would allow more time for opponents to press their efforts. The only polls at measure about 15 percent support, according to public surveys, and Republican Senate offices have been home to nearly daily protests by activists opposed to the Republican plan. 
 
 Senate Democratic leader Chuck Schumer of New York said Republicans should "start from scratch and work with Democrats" on a bill to fix problems with Obamacare. 
 
 "This second failure of Trumpcare is proof positive that the core of this bill is unworkable," Schumer said in a statement. 
 
 Still, Republican senators are promoting their own ideas on how to move forward. 
 
 McCain released a statement saying Republicans should forgo the current process, start over and work with Democrats. 
 
 "The Congress must now return to regular order, hold hearings, receive input from members of both parties, and heed the recommendations of our nation's governors so that we can produce a bill that finally provides Americans with access to quality and affordable health care," McCain said. 
 
 Sen. Bill Cassidy, R-La., tweeted a link to an opinion piece he wrote, promoting his idea of allowing each state to determine whether Obamacare — or another idea — works for the state. ||||| Senate Republican leaders on Thursday unveiled a revised version of their bill to repeal and replace ObamaCare as they race toward a high-stakes vote next week. 
 
 
 
 The measure includes changes intended to win over additional votes, with leadership making concessions aimed at bringing both conservatives and moderates on board. (READ THE BILL HERE.) 
 
 
 
 But Senate Majority Leader Mitch McConnell Addison (Mitch) Mitchell McConnellTrump dismissed warnings from GOP leaders that party could lose House: report Gender and race shouldn't define your politics Trump’s budget chief talks spending clawback with key chairman MORE (R-Ky.) is facing a tough task in finding enough votes to pass the bill. Sens. Susan Collins Susan Margaret CollinsHow long must women wait? Senators hope Trump's next VA pick will be less controversial GOP moves to cut debate time for Trump nominees MORE (R-Maine) and Rand Paul Randal (Rand) Howard PaulPompeo vote won’t guarantee Democrats a win in November Overnight Defense: Uncertainty for VA after Trump pick withdraws | Veterans groups hope for more input | Pompeo confirmed as secretary of State | Mattis defends Iran deal as Trump deadline nears Overnight Cybersecurity: DHS chief eyes new ways to bolster cyber workforce | Dems grill Diamond and Silk | Senate panel approves bill to protect Mueller | Two-thirds of agencies using email fraud tool MORE (R-Ky.) appear to be firmly against the measure, and one other defection would kill the bill. 
 
 
 
 
 
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 Overall, McConnell appears to have shifted the revised bill more toward the conservatives than the moderates.Importantly, the bill largely keeps the Medicaid sections the same, meaning that deeper cuts to the program will still begin in 2025, and the funds for ObamaCare’s expansion of Medicaid will still end in 2024.The changes to Medicaid have emerged as a top concern for moderates such as Sens.(R-Ohio),(R-W.Va.) and(R-Alaska).The Congressional Budget Office (CBO) found that those Medicaid changes in the original bill would result in 15 million fewer people being enrolled in the program and cut spending by $772 billion over 10 years. 
 
 Collins said she still plans to vote against a motion to proceed to the bill, adding that the legislation should move through the normal committee process. 
 
 "My strong inclination and current intention is to vote no on the motion to proceed," Collins told reporters after leaving a briefing on the legislation. 
 
 "The only way I'd change my mind is if there's something in the new bill that wasn't discussed or that I didn't fully understand or the CBO estimate comes out and says they fixed the Medicaid cuts, which I don't think that's going to happen." 
 
 
 
 For the conservatives, the measure includes a version of an amendment from Sens. Ted Cruz Rafael (Ted) Edward CruzBritish toddler at center of legal battle dies after taken off life support Kushner expected to attend opening of Jerusalem embassy: CNN Handholding with South Korea aside, North Korea still has its nukes MORE (R-Texas) and Mike Lee Michael (Mike) Shumway LeeOvernight Cybersecurity: DHS chief eyes new ways to bolster cyber workforce | Dems grill Diamond and Silk | Senate panel approves bill to protect Mueller | Two-thirds of agencies using email fraud tool The Hill's 12:30 Report Senate panel approves bill to protect special counsel MORE (R-Utah) aimed at allowing insurers to offer plans that do not meet all of ObamaCare’s regulations, including those protecting people with pre-existing conditions and mandating that plans cover certain services, such as maternity care and mental healthcare. 
 
 
 
 Conservatives argue the change would allow healthier people to buy cheaper plans, but moderates and many healthcare experts warn that premiums would spike for the sick people remaining in the more generous insurance plans. 
 
 Cruz said he will support the bill so long as the provisions he sees as a priority are not changed in amendment votes on the floor. 
 
 "If this is the bill, I will support this bill," Cruz told reporters after a meeting of GOP senators. "Now, if it’s amended and we lose the protections that lower premiums, my view could well change." 
 
 Senate Republicans had vowed to not change the ObamaCare protections for people from being charged more based on their health in their bill, which is why the debate over the Cruz-Lee amendment has been heated. 
 
 A Senate GOP aide said Thursday it is possible that the Cruz amendment would not be analyzed by the CBO in time for the vote next week. It is possible the Department of Health and Human Services could provide an alternative analysis. 
 
 Lee cautioned that he was not involved in the changes to the proposal, including the amendment, and would have to review the new language before deciding whether to support it. 
 
 The bill does include new funding, $70 billion over seven years, aimed at easing costs for those sick people remaining in the ObamaCare plans. 
 
 However, the new measure does not boost the generosity of the tax credits, as some moderates wanted. It still replaces ObamaCare’s tax credits to help people afford insurance with a smaller, scaled-down tax credit that provides less assistance. 
 
 The Kaiser Family Foundation found premium costs would increase an average of 74 percent for the most popular healthcare plan, given the reduced assistance in the GOP bill. 
 
 The new measure will leave in place two ObamaCare taxes on the wealthy, in a departure from the initial bill. 
 
 That original measure lacked the support to pass, as more moderate members pointed to the CBO's finding that 22 million fewer people would have insurance over a decade. 
 
 Senate Republicans are now awaiting a new score of the revised legislation from the CBO, which could come early next week. 
 
 The new bill does include $45 billion to fight opioid addiction, but moderates such as Capito and Portman who hail from states where the problem is rampant have said they also want changes to the Medicaid portion of the legislation. 
 
 Portman said his position on the bill had not changed, but he did not give a clear answer on whether he'd back his party on the procedural vote. 
 
 “I'm the same position I've been in. I'm looking at the language,” he said. 
 
 Capito also said she doesn’t know whether she’ll vote to proceed to the bill. 
 
 “We have another meeting this afternoon on the Medicaid cuts,” she told reporters. “I need to really look at it, look at the score; I still have concerns.” 
 
 Asked if she would vote for the motion to proceed next week, she said, “Wait and see.” 
 
 In a change that could appeal to Murkowski, the bill sets aside 1 percent of the stability funds for states with costs that are 75 percent above the national average, which would benefit high-cost states like Alaska. 
 
 — This story was updated at 3:15 p.m. Alexander Bolton contributed. ||||| CLOSE Senate Republicans have unveiled their latest health care legislation, which aims to repeal and replace Obamacare. As expected, both side voiced bold and passionate reactions to the measure. USA TODAY 
 
 Minority Leader Chuck Schumer holds a news conference on the reaction of Senate Democratic leadership to the release of the draft of the GOP health care plan on June 22, 2017. (Photo: Michael Reynolds, European Pressphoto Agency) 
 
 WASHINGTON — After days of protesting GOP “secrecy” in crafting their health care bill, Senate Minority Leader Chuck Schumer of New York and other Democratic leaders began a strategy on Thursday of trying to slow down consideration of the proposal. 
 
 Their first steps were to get Republicans on record objecting calls for transparency. Senate Majority Leader Mitch McConnell of Kentucky turned down their requests for any changes to the House-passed Obamacare replacement to be public for 72 hours and be subject to a Congressional Budget Office analysis — though CBO is promising to release an analysis next week. 
 
 Ultimately, there’s not much Democrats can do to block the bill’s passage if enough Republicans fall in line, but they can make the process onerous. Democrats have been calling on the American public to weigh in against “Trumpcare.” 
 
 “Every American should be asking their Republican senators one simple question this weekend: Why do the wealthy deserve a tax cut more than we deserve health care?” Schumer said. 
 
 Republicans are using a budget procedure to pass the bill with a simple majority of 51 votes, rather than the 60 votes typically needed for legislation. 
 
 The rules allow Democrats — and Republicans — to offer unlimited amendments on the Senate floor next week, when it is expected to come up for a vote. But Democrats are effectively blocked from filibustering the bill. 
 
 The bigger obstacle for Republicans may be within their own party, with some conservatives saying the bill doesn't go far enough in repealing the Affordable Care Act and one moderate, Sen. Dean Heller of Nevada, saying he’s concerned about the impact of the bill on Medicaid patients. Democrats are united against it, meaning that McConnell can afford to lose only two GOP votes. 
 
 If the Senate passes its version, the House and Senate would have to settle on compromise legislation before it can be signed by President Trump. 
 
 Though Trump celebrated passage of the House version of the health care bill in May, he has since called it “mean” and said the Senate plan should have more “heart.” The House-passed health care bill, called the American Health Care Act, would lead to 23 million fewer people having health insurance by 2026, according to the Congressional Budget Office. 
 
 Read more: 
 
 During a news conference, Schumer edited a “Mean” poster with a marker to make it say “Meaner.” 
 
 He said the Senate bill would raise health care costs for middle-class and working-class families, kick millions off Medicaid, abandon people with pre-existing conditions and defund Planned Parenthood, making it harder for millions of women to obtain health care. 
 
 “It’s every bit as bad as the House bill, in some ways even worse,” he said. 
 
 Regardless the outcome, there’s not much of a downside for Democratic senators to be seen by their base as fighting the bill as robustly as possible. The Progressive Change Campaign Committee is soliciting signatures for a petition, calling on Democrats to tie up the Senate with thousands of amendments to the bill. 
 
 "The longer it takes to get a vote on this bill, the more public scrutiny it will receive, the more time there will be for opposition to build, and the more likely it is that three Republican senators will get cold feet about voting for it," the campaign writes in an email to supporters. 
 
 Progressive icon, Sen. Elizabeth Warren, D-Mass., characterized the fight in stark terms: “These cuts are blood money. People will die.” 
 
 Democrats have been hammering Republicans this week on the Senate floor for a lack of transparency on their bill that was drafted behind closed doors, arguing that Democrats held about 100 hearings and meetings on the Affordable Care Act before its passage in 2010. 
 
 Democrats began their protest earlier this week by using procedural tactics to stall Senate business, forcing the postponement of committee hearings. 
 
 Contributing: Erin Kelly and Eliza Collins 
 
 Read or Share this story: https://usat.ly/2sYwm5n ||||| Breaking News Emails Get breaking news alerts and special reports. The news and stories that matter, delivered weekday mornings. 
 
 / Updated By Leigh Ann Caldwell 
 
 WASHINGTON — Senate Majority Leader Mitch McConnell said Tuesday he is preparing to bring before the full Senate a comprehensive repeal of the Affordable Care Act early next week — but Republican support for his plan has quickly eroded. 
 
 Three GOP senators — all women who were left out of the core group who met to write the first draft of the Senate's health care bill — have already come out against McConnell's move. 
 
 Sen. Lisa Murkowski, R-Alaska, was the fateful third to bail out, effectively killing the effort to repeal Obamacare without an alternative. 
 
 "I said in January we should not repeal without a replacement and just an indefinite hold on this just creates more chaos and confusion," Murkowski told reporters. 
 
 Murkowski joined two other centrist Republicans who said earlier Tuesday that they aren't willing to support a bill that only repeals Obamacare and provides no replacement or does not attempt to fix it. Loss of the three GOP votes means McConnell doesn't have the 50 votes he needs to move forward. 
 
 "I do not support the new plan," Sen. Susan Collins, R-Maine, told reporters. "A better approach would be...to begin hearings focused on the problems in the ACA, and let’s try to get bipartisan support to fix those egregious flaws." 
 
 Sen. Shelley Moore Capito, R-W.V., tweeted her statement in opposition, saying she can't vote for repeal without a replacement. "I did not come to Washington to hurt people," she said. 
 
 A member of Republican leadership acknowledged that the repeal-only plan had a slim chance of going anywhere. 
 
 "My guess is we’re now headed toward normal committee activity, take 60 votes on the floor to try to solve these significant problems one at a time," said Sen. Roy Blunt, R-Mo., vice chair of the Republican conference. 
 
 President Donald Trump deflected any blame for the Senate's failure. He instead blamed Democrats "and a few Republicans." 
 
 Republican senators gathered for their weekly Tuesday lunch divided on if they should proceed with a vote even as the bill's prospects are likely doomed. Numerous senators left the lunch not wanting to talk to the press or saying that the discussion was not definitive. 
 
 But some members said that the Senate should still move forward with a vote, saying that nearly every Republican had campaigned on repealing Obamacare. 
 
 "We ought to vote and people ought to be recorded up or down because a lot of promises were made when they ran and some people seem to be nervous about keeping their promise," said Sen. Richard Shelby, R-Ala. 
 
 McConnell suggested that a vote would take place soon. "That's a vote I think we're very likely to have in the very near future," McConnell said Tuesday afternoon. 
 
 Earlier, McConnell outlined his latest plan on health care after his previous version to partially repeal and replace Obamacare fell apart Monday night when two conservatives came out against it, effectively killing the bill. 
 
 "I regret that the effort that we repeal and immediately replace Obamacare would not be successful. That doesn’t means we should give up," McConnell said on the Senate floor, acknowledging defeat but looking forward to his next move in a months-long effort that has stymied the Senate. "This doesn’t have to be the end of the story." 
 
 He added, "We will now try a different way to bring the people relief from Obamacare. I think we owe them at least that much. In the coming days, the Senate will take up a vote on a repeal of Obamacare combined with a stable two-year transition period as we work toward patient-centered healthcare." 
 
 Senate Minority Leader Chuck Schumer, D-N.Y., said that repealing Obamacare without a replacement "would be a disaster." 
 
 "Our health care system would implode, millions would lose coverage, coverage for millions more would be diminished," Schumer said on the Senate floor. "Our healthcare system would be in such a deep hole that repair would be nearly impossible. In fact, passing repeal and having it go into effect two years later is in many ways worse than the Republican healthcare bill that was just rejected by my Republican colleagues." 
 
 Eleven governors, including five Republicans, five Democrats and one independent, also came out against a straight repeal, a move likely to cause further trouble for the plan. They said in a joint statement that the Senate should "immediately reject" a plan to repeal Obamacare. 
 
 The measure McConnell plans to bring to the floor is one that both the House and Senate passed in 2015 that would be close to a full repeal of Obamacare after a two-year phaseout. 
 
 The repeal vote in 2015, however, was mostly symbolic to prove to the GOP base that Senators supported dismantling the ACA because they knew full well that it would not be signed into law while Barack Obama was president. As expected, Obama vetoed the legislation. 
 
 "President Trump will sign it now," McConnell said. 
 
 After the bill collapsed on Monday night, Trump said that he'd like to see a repeal-only bill. 
 
 McConnell's move is a sign of frustration for the Senate leader who was unable to bring together his caucus on health care. 
 
 Conservatives disliked McConnell's bill because it didn't do enough to bring down premiums and provide enough choice in the insurance market. Some also opposed because it didn't repeal all of the Obamacare taxes and kept in place tax credits to help people purchase insurance. 
 
 For their part, moderates disliked the bill because of deep cuts to Medicaid and because the tax credits offered would lead to higher out-of-pocket costs for many in the individual market. 
 
 A vote on a full repeal will is supported by conservatives, however, who have long lobbied for it. 
 
 "I’m happy that we’re getting a chance to repeal, and replace, go back to the 2015 bill," said Sen. Luther Strange, R-Ala. 
 
 But that puts moderates, including at least two who are up for re-election in 2018, in a difficult spot. Sen. Dean Heller, R-Nev., opposed the first version of the Senate bill because of the cuts to Medicaid. A full repeal would also mean a loss of insurance and Medicaid for people in Nevada. 
 
 At least one Republican senator has questioned McConnell's leadership. Sen. Ron Johnson, R-Wisc., wouldn't say if he still had faith in McConnell, adding that he's been frustrated by the secretive process and that McConnell was selling different components of the bill to different factions in the party, including telling moderates that Medicaid cuts were so far down the road that they would never go into effect. 
 
 "This was the Senate’s responsibility," Johnson told reporters. "I tried to encourage my colleagues in leadership to follow that process but we followed a political process and it hasn’t been particularly successful." 
 
 But other senators ran to McConnell's defense. "I think the majority leader is trying to keep all the frogs in the wheelbarrow, and it’s a tough job, but he’s doing a good job," Sen. Murkowksi said. 
 
 House Speaker Paul Ryan said at a news conference Tuesday that he would prefer a bill that would also offer a replacement for Obamacare but that the Senate needs to act. "We would like to see the Senate move on something," Ryan said. ||||| WASHINGTON (Reuters) - U.S. Senate Republicans on Thursday unveiled legislation that would replace Obamacare with a plan that scales back aid to the poor and kills a tax on the wealthy, but the bill’s fate was quickly thrown into question as several senators voiced skepticism. 
 
 Four conservative lawmakers said they could not support it in its current form, leaving Republicans short of the votes they need for passage. Democrats are united in opposition. 
 
 The 142-page proposal, worked out in secret by a group led Senate Majority Leader Mitch McConnell, aims to deliver on a central campaign promise of President Donald Trump by rolling back former President Barack Obama’s signature healthcare law, which has provided coverage to millions of Americans since it was passed in 2010. 
 
 Republicans view the law, formally known as the Affordable Care Act, as a costly government intrusion into the private marketplace. 
 
 Trump welcomed the bill but indicated that changes may be in store. 
 
 “I am very supportive of the Senate #Healthcarebill. Look forward to making it really special!” he wrote on Twitter. 
 
 Trump urged the House of Representatives to pass a similar bill in May, only to criticize it in private as “mean” once it passed. He said on Wednesday he wanted a health plan “with heart.” 
 
 Democrats immediately attacked the legislation as a callous giveaway to the rich that would leave millions without coverage. 
 
 “The president said the House bill was mean,” said Senate Democratic leader Chuck Schumer. “The Senate bill may be even meaner.” 
 
 Obama weighed in on Facebook. “If there’s a chance you might get sick, get old, or start a family – this bill will do you harm,” he wrote. 
 
 The Senate’s most conservative members said the plan did not do enough to scale back the U.S. government’s role. 
 
 “This current bill does not repeal Obamacare. It does not keep our promises to the American people,” said Senator Rand Paul, who along with fellow Republican Senators Ted Cruz, Mike Lee and Ron Johnson said they could not support it in its current form. 
 
 Shares of hospital companies and health insurers rose on the bill’s release, with the overall S&P; 500 healthcare sector closing up 1.1 percent at an all-time high. 
 
 “The initial proposal I think is more generous and more positive to the industry than expected,” said Jeff Jonas, a portfolio manager with Gabelli Funds. 
 
 SHARPER CUTS TO MEDICAID 
 
 Over months of often bitter debate, Republicans have struggled to craft legislation that lowers costs and reduces government involvement, while minimizing the inevitable disruptions that would come with a revamp of a sector that accounts for one-sixth of the world’s largest economy. 
 
 The nonpartisan Congressional Budget Office found that the House bill would kick 23 million Americans off their health plans, and the legislation is unpopular with the public. Fewer than one in 3 Americans supports it, according to Reuters/Ipsos polling. 
 
 The Senate measure maintains much of the structure of the House bill, but differs in several key ways. 
 
 The Senate bill would phase out Obamacare’s expansion of the Medicaid program for the poor more gradually than the House version, waiting until after the next presidential election in 2020, but would enact deeper cuts starting in 2025. It would also allow states to add work requirements for some of the 70 million Americans who depend on the program. 
 
 The legislation also provides more generous tax subsidies than the House bill to help low-income people buy private insurance. 
 
 Senator Majority Leader Mitch McConnell is surrounded by reporters as he walks to the Senate floor of the U.S. Capitol after unveiling a draft bill on healthcare in Washington, U.S. June 22, 2017. REUTERS/Kevin Lamarque 
 
 Those subsidies would be based on income, rather than the age-based subsidies contained in the House bill - a “major improvement,” according to Republican Senator Susan Collins, a key moderate who has expressed concern over the bill’s impact on the poor. 
 
 The Senate legislation provides less money, however, for the opioid epidemic, allocating $2 billion in 2018, compared with $45 billion over 10 years in the House version. 
 
 Both versions would repeal the 3.8 percent net investment income tax on high earners, a key target for Republicans. 
 
 They also would repeal a penalty imposed on large employers that do not provide insurance to their workers, and remove the fine that Obamacare imposes on those who choose to go uninsured. 
 
 Policy experts said that would keep more young, healthy people out of the market and likely create a sicker patient pool. 
 
 The Senate bill would provide money to stabilize the individual insurance market, allotting $15 billion a year in 2018 and 2019 and $10 billion a year in 2020 and 2021. 
 
 It proposes defunding Planned Parenthood for a year, but abortion-related restrictions are less stringent than the House version because of uncertainty over whether they would comply with Senate rules. They could be included in another Senate bill. 
 
 McConnell said Democrats chose not to help frame the bill, which Republicans say would fix a collapsing health marketplace. 
 
 “Republicans believe we have a responsibility to act, and we are,” he said. 
 
 Democrats say they offered to help fix Obamacare but were rebuffed. 
 
 The bill’s real-world impact is not yet known, but the CBO is expected to provide an estimate early next week. 
 
 Slideshow (10 Images) 
 
 As lawmakers spoke about the legislation on the Senate floor, a protest erupted outside McConnell’s personal office, with many people in wheelchairs blocking a hallway, holding signs and chanting: “No cuts to Medicaid.” U.S. Capitol Police said 43 protesters were arrested and charged with obstruction. 
 
 Aside from the quartet of conservatives, none of the other 48 Republican senators appeared to reject the bill out of hand. But several said they would check with home-state constituents before taking a position. 
 
 “I expect there’s going to be a number of changes between now and the final vote,” said Senator John Barrasso of Wyoming. ||||| Shortly after the release of the Senate Republican health care bill on Thursday, a group of protesters — some wheelchair-bound or wearing medical devices — were dragged away by police from the hallway outside of Senate Majority Leader Mitch McConnell’s office. 
 
 The protesters were members of the national disability rights group ADAPT, who said the controversial health care bill is a direct threat to people with disabilities. 
 
 “We are at @SenateMajLdr demanding he stop the attacks on Disabled people’s freedom with #AHCA,” the group wrote on its Twitter page, including a video from the protest that appeared to show police officers carrying away one of the wheelchair-bound protesters. 
 
 Other footage shows protesters being removed by police from their wheelchairs and dragged or carried away. The Washington Post reported that several people were arrested during the protest. 
 
 Meanwhile, Sen. Chuck Schumer spoke out against the newly released Senate Republican health care bill on Thursday, calling the proposed legislation “heartless” and a “wolf in sheep’s clothing.” 
 
 “The way this bill cuts health care is heartless,” Schumer said on the Senate floor. “The president said the House bill was mean. The Senate bill may be meaner. The Senate Republican health care bill is a wolf in sheep’s clothing. Only this wolf has even sharper teeth than the House bill.” 
 
 “It’s clear that Republicans know that cutting Medicaid will hurt so many people in the middle class, so many in my home state of New York,” Schumer continued. “Republicans know that people want essential health benefits, so they’ve created a disguise by saying these changes won’t occur for a year.” 
 
 Schumer was far from the only one to slam the bill. After the closely guarded legislation — which was written entirely behind closed doors — was finally unveiled on Thursday morning, a protest formed outside Senate Majority Leader Mitch McConnell’s office in the Capitol. 
 
 Protest outside of McConnell's office after release of Senate healthcare bill pic.twitter.com/FfALhh52Rd — Vaughn Hillyard (@VaughnHillyard) June 22, 2017 
 
 House Minority Leader Nancy Pelosi also criticized the bill as a ruse, saying Thursday: This bill “is yet again a tax bill disguised as a health care bill. They need this in order to do their tax breaks for the high end to the tune of hundreds of billions of dollars. It’s unfortunate.” 
 
 Many other critics and Democratic leaders took to Twitter to express their anger and frustration. 
 
 If you're waiting for the right moment to call your Senator about Trumpcare, the moment is now. Don't wait until it's too late. 202-224-3121 — Hillary Clinton (@HillaryClinton) June 22, 2017 
 
 Minnesotans understand that the GOP health care bill will harm the well-being of millions of people in our state and across the country. — Sen. Al Franken (@SenFranken) June 22, 2017 
 
 Hi @SenateGOP, We will fight #Trumpcare like our lives depend on it—because they do. Signed, 
 
 All who believe health care is a human right — Women's March (@womensmarch) June 22, 2017 
 
 It's just this simple: The AHCA is a huge tax cut for the WEALTHY funded by GUTTING the United States health care system. — Mikel Jollett (@Mikel_Jollett) June 22, 2017 
 
 Health care bill sounds like it'll turn U.S. into a giant hunger games. @GOP wants the poor and sick to die off to free up resources for 1% — JW (@darkwavenyc) June 22, 2017 
 
 If you need treatment for opioid addiction, your plan may no longer cover it under #Trumpcare. — Chuck Schumer (@SenSchumer) June 22, 2017 
 
 We live in the wealthiest country on Earth; surely we can do better than what the Republican #healthcarebill promises. — Chuck Schumer (@SenSchumer) June 22, 2017 
 
 Schumer also tweeted out a message of warning about the bill, writing: “If you need treatment for opioid addiction, your plan may no longer cover it under #Trumpcare.” 
 
 “We live in the wealthiest country on Earth,” he added in a second tweet. “Surely we can do better than what the Republican #healthcarebill promises.” ||||| WASHINGTON (AP) — In a gamble with monumental political stakes, Republicans set course for a climactic House vote on their health care overhaul after President Donald Trump claimed he was finished negotiating with GOP holdouts and determined to pursue the rest of his agenda, win or lose. 
 
 House Speaker Paul Ryan set the showdown for Friday, following a nighttime Capitol meeting at which top White House officials told GOP lawmakers that Trump had decided the time for talk was over. 
 
 "We have been promising the American people that we will repeal and replace this broken law because it's collapsing and it's failing families. And tomorrow we're proceeding," Ryan tersely told reporters after scheduling what loomed as the most momentous vote to date for Trump and for the Wisconsin Republican's own speakership. 
 
 In an embarrassing and stinging setback hours earlier, leaders abruptly postponed the vote because a rebellion by conservatives and moderates would have doomed the measure. They'd hoped for a roll call Thursday, which marked the seventh anniversary of President Barack Obama's enactment of his landmark health care statute that Republicans have vowed ever since to annul. 
 
 There was no evidence that leaders had nailed down sufficient support to prevail, nor that their decision to charge ahead was a feint and that they'd delay again if necessary. But they seemed to be calculating that at crunch time, enough dissidents would decide against sabotaging the bill, Trump's young presidency and the House GOP leadership's ability to set the agenda, with a single, crushing defeat. 
 
 "The president has said he wants the vote tomorrow," White House budget chief Mick Mulvaney told the lawmakers, according to Rep. Chris Collins, R-N.Y., a Trump ally. "If for any reason it goes down, we're just going to move forward with additional parts of his agenda. This is our moment in time." 
 
 Even if they prevail, Republicans face an uphill climb in the Senate, where conservatives and moderates are also threatening to sink it. 
 
 The GOP bill eliminates the Obama statute's unpopular fines on those who do not obtain coverage and the often generous subsidies for those who purchase insurance. 
 
 Instead, consumers would face a 30 percent premium penalty if they let coverage lapse. Republican tax credits would be based on age, not income. The bill would also end Obama's Medicaid expansion and trim future federal financing for the federal-state program and let states impose work requirements on some of its 70 million beneficiaries. 
 
 In a bid to coax support from conservatives, House leaders proposed a fresh amendment — to be voted on Friday — repealing Obama's requirement that insurers cover 10 specified services like maternity and mental health care. Conservatives have demanded the removal of those and other conditions the law imposes on insurers, arguing they drive premiums skyward. 
 
 Many moderates are opposed because they say the GOP bill would leave many voters uninsured. Medical associations, consumer groups and hospitals are opposed or voicing misgivings, and some Republican governors say the bill cuts Medicaid too deeply and would leave many low-income people uncovered. 
 
 Republicans can lose only 22 votes in the face of united Democratic opposition. A tally by The Associated Press found at least 32 "no" votes, but the figure was subject to fluctuation amid frantic GOP lobbying. 
 
 Rep. Mark Meadows, R-N.C., head of the hard-right House Freedom Caucus, said he remained a "no" but didn't answer when asked whether the group still had enough votes to kill the legislation. He'd long said caucus opposition alone would defeat it without changes. 
 
 One member of that group, Rep. Paul Gosar, R-Ariz., responded indirectly when asked if his opposition had changed. 
 
 "Everybody asked us to take a moment and reflect. Well, we'll reflect," he said. 
 
 Other foes said they'd not flipped. These included moderate Reps. Charlie Dent of Pennsylvania, Dan Donovan of New York and Leonard Lance of New Jersey, plus conservative Walter Jones of North Carolina, who had his own words of warning. 
 
 "He's there for three-and-a-half more years," Jones said of Trump. "He better be careful. He's got a lot of issues coming." 
 
 The nonpartisan Congressional Budget Office said changes Republican leaders had proposed before Thursday to win votes had cut the legislation's deficit reduction by more than half, to $150 billion over the next decade. But it would still result in 24 million more uninsured people in a decade. 
 
 Obama's law increased coverage through subsidized private insurance for people who don't have access to workplace plans, and a state option to expand Medicaid for low-income residents. More than 20 million people gained coverage since the law was passed in 2010. 
 
 Many who purchase individual health insurance and make too much to qualify for the law's tax credits have seen their premiums jump and their choices diminished. 
 
 ___ 
 
 Associated Press writers Matt Daly, Kevin Freking, Mary Clare Jalonick, Richard Lardner, Stephen Ohlemacher, Vivian Salama, Ken Thomas and Erica Werner contributed to this report. ||||| Senate Republican leaders unveiled what they called a "discussion draft" of their long-awaited health care bill, a part of the party's ongoing efforts to repeal and replace the Affordable Care Act. 
 
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 Five Republican senators have already come out in opposition to the Senate bill, the Better Care Reconciliation Act, jeopardizing its passage. 
 
 Critics on both sides of the aisle said the bill, which was drafted behind closed doors by a small group of Senate leaders and committee staffers, has been shrouded in secrecy. 
 
 Trump told reporters Thursday that there will be "a little negotiation, but it's going to be very good." 
 
 Republicans 'not ready' to support the bill 
 
 GOP Sens. Ted Cruz of Texas, Ron Johnson of Wisconsin, Mike Lee of Utah and Rand Paul of Kentucky released a joint statement saying, "Currently, for a variety of reasons, we are not ready to vote for this bill, but we are open to negotiation and obtaining more information before it is brought to the floor." 
 
 They added, "There are provisions in this draft that represent an improvement to our current health care system, but it does not appear this draft as written will accomplish the most important promise that we made to Americans: to repeal Obamacare and lower their health care costs." 
 
 In a separate statement, Paul said he'll oppose the bill "in its current form, but I remain open to negotiations." 
 
 "The current bill does not repeal Obamacare. It does not keep our promises to the American people," he said. 
 
 On Friday, Sen. Dean Heller, R-Nev., joined the group, saying at a press conference that "this bill is not the answer, it's simply not the answer." 
 
 "In this form, I will not support it," said Heller. 
 
 Sen. Susan Collins, R-Maine, told reporters Thursday she has "not yet had the opportunity to read the text of the bill, and the details really matter." 
 
 "I see some positive features of this bill that are improvements over the House, and I see some negative features based on my first analysis," she said. "I don't like the provision that eliminates federal funding for Planned Parenthood. It makes no sense to single out Planned Parenthood from all the Medicaid providers. There's already a ban against using federal funds for abortions, so there's absolutely no need for that." 
 
 A vote from Collins, who has been willing to break from her party, would be key to ensuring the bill's passage. 
 
 Senate Republicans can afford to lose only two of their members to pass the bill, assuming Democrats remain united in their opposition. 
 
 Republicans acknowledge tough road ahead for bill 
 
 As members left a meeting about the bill, many said they were encouraged by their first impressions of the text but were hesitant to say if it would clear the 50 vote threshold for passage. 
 
 "There's a lot to digest. It's very complicated," Sen. Pat Toomey, R-Pa., said as he left the gathering. 
 
 Some Republicans said they liked how the Senate bill calculates the value of tax credits to help individuals pay for insurance. 
 
 While the House bill linked the tax credits to age only, the Senate bill considers age, income and geographical area. 
 
 "A person making about $12,000 a year will have more access and a lower cost of health insurance. And that's a really good thing," said Sen. Tim Scott, R-S.C. 
 
 But Sen. John Thune, R-S.D., a member of Senate leadership, acknowledged that the draft would not pass in its current form. 
 
 "Right now the challenge is, how do we get to 50?" he said. 
 
 Senate Majority Leader Mitch McConnell indicated that he wants to get a vote before the July 4 legislative recess. 
 
 Democrats and ACA supporters unhappy 
 
 The bill's release was met with significant opposition from Democrats and other supporters of the Affordable Care Act. 
 
 Under current law, all insurance plans have to include, at a minimum, specified essential health benefits, including ambulance service, hospitalization, maternity care and prescription drug coverage. Under the Senate bill, states would be allowed to apply for waivers from those regulations and essentially scrap them to write their own rules. 
 
 As the bill was being unveiled, a large demonstration formed outside McConnell's office, with people in wheelchairs staging a die-in and protesters chanting that no changes be made to Medicaid. Demonstrators were physically removed by Capitol Police officers. 
 
 Congressional Democrats were also forceful in their condemnation. 
 
 Senate Minority Leader Chuck Schumer slammed the Senate bill as "every bit as bad" as the American Health Care Act passed in the House. 
 
 "The president said the Senate bill needed heart. The way this bill cuts health care is heartless," Schumer said Thursday. "The president said the house bill was mean. The Senate bill may be meaner." 
 
 He continued, "The Senate Republican health care bill is a wolf in sheep's clothing, only this wolf has even sharper teeth than the House bill." 
 
 During her weekly press conference, House Minority Leader Nancy Pelosi said it's important to stop the legislation, which she called "a tax bill disguised as a health care bill." 
 
 Top medical organizations call on the Senate to reject the bill 
 
 So far, the Senate health care bill has not gotten any backing from top health or medical organizations. The American Public Health Association, the American Psychiatric Association and the American College of Obstetrics and Gynecology released statements urging the Senate to reject the Better Care Reconciliation Act and expressed concerns over the closed-door negotiation process. 
 
 "The Senate proposal represents a significant move in the wrong direction, resulting in fewer people having access to insurance, fewer patient protections and less coverage for essential behavioral health care," American Psychiatric Association's CEO and medical director, Saul Levin, said in a statement. 
 
 The American Public Health Association attacked the bill's closed-door shaping as "legislative malpractice." 
 
 The American College of Obstetrics and Gynecology said, "Despite numerous efforts to collaborate and provide input throughout this process, women's health expertise was rejected. It is reckless for legislation that will have such an immense impact on Americans' lives and the economy to proceed without opportunity for public hearings or any external commentary." 
 
 ABC News' John Parkinson, Mariam Khan and MaryAlice Parks contributed to this story. ||||| Photo: Mandel Ngan/AFP/Getty Images 
 
 Following the unveiling of the House Republican plan to shrink Obamacare dramatically, two surprising things happened. The first is that the conservative-movement apparatus has lined up rapidly against the bill. The major right-wing pressure groups — Freedom­Works, the Club for Growth, Americans for Prosperity, and Heritage Action for America — all announced opposition, and were quickly echoed by the most right-wing members of Congress, like House Freedom Caucus chair Jim Jordan and Senator Rand Paul. The second surprising thing is that Senate Majority Leader Mitch McConnell announced his intention to jam the House bill through the Senate quickly. Rather than develop its own bills through committees and the normal debate process, McConnell declared he plans to bring it directly to the Senate floor. Neither of these decisions makes a great deal of sense on their own, and they make even less sense in conjunction with each other. 
 
 The grounds for the right’s opposition is that the House bill would replace Obamacare with a “new entitlement,” albeit one funded almost entirely through cuts to an old entitlement (Medicaid) and which would provide such meager benefits as to be useless to large numbers of its purported beneficiaries. 
 
 What makes this revolt so confounding to the party leadership is that the House bill, while too liberal for the party’s right flank, is also almost certainly too conservative to pass the Senate. Senators Lisa Murkowski, Cory Gardner, Rob Portman, and Shelly Moore Capito signed a letter yesterday opposing the bill’s repeal of the Medicaid expansion. A fifth, Dean Heller, has raised concerns about protecting Medicaid. Susan Collins and Bill Cassidy have proposed a much more moderate replacement bill, which has also been co-sponsored by Capito and Johnny Isakson. Additionally, Lamar Alexander, Jeff Flake, and Lindsey Graham have urged caution and deliberation — all of which run counter to the leadership’s strategy of ramming a bill through as quickly as possible in order to enable the passage of a big tax cut later in the year. 
 
 That makes 11 Republican senators who have, in some form or fashion, expressed reservations about the party leadership’s preferred health care strategy. Even assuming the three senators who object to the law from the right — Ted Cruz, Rand Paul, and Mike Lee — can be corralled, Trumpcare seems to be very far from corralling the necessary 50 Senate votes. And this is before the Congressional Budget Office produces its score, which will probably show millions and millions of people losing coverage, and may possibly also show the deficit blowing up. 
 
 While McConnell’s plan might be necessary in order to keep the party’s legislative strategy on track, it is highly and even delusionally optimistic, given the state of his vote count. It also runs counter to the Senate’s institutional culture. Senators cherish their power to shape and control legislation. A strategy of photocopying the House bill and ramming it through seems almost designed to violate the Senatorial ego. 
 
 This raises a question: Is it designed to violate the Senatorial ego? And thus to fail? Neither the conservative revolt nor McConnell’s plan make a lot of sense if you view them as strategies designed to yield the most right-wing health-care policy that is attainable. They do make sense as a strategy designed to insulate Republicans from failure. 
 
 Republicans have made two promises that can’t be reconciled. They promised to repeal Obamacare, and to replace it with a terrific law that would take care of everybody. As the House Republican ad put it, they promised, “more choices and better care, at lower costs. … peace of mind to people with preexisting conditions … without disrupting existing coverage.” Those things cannot be reconciled. If Republicans repeal Obamacare, they will put in place something that not only fails to provide the better, cheaper care they have promised the country, but does not meet even the minimal threshold of access to basic care for people who currently receive it. 
 
 From that standpoint, the winning play for the GOP might be to try to repeal and replace Obamacare but fail. If they are seen trying and failing to repeal the law, it might upset the base, but most Republican lawmakers will have their opposition to Obamacare on the record. And if it is to fail, it should fail quickly, so they can move on to cutting taxes. 
 
 This may all be wrong. It is never safe to assume rational thought on the part of public actors, especially in the reality-distortion field of Trump’s Washington. Maybe ultra-conservatives think they are using their leverage to push the bill to the right. Or maybe McConnell believes he can whip his caucus into line. Whatever the explanation, the strategy behind the bill is almost as incompetent as the bill itself.
– Senate Republicans on Thursday finally unveiled their answer to the House bill to repeal and replace the Affordable Care Act, and Vox has an explainer of what's in it. Some major sticking points: The Better Care Reconciliation Act will ask poor and middle-class Americans to pay more for less coverage, and Medicaid would be cut after expansions are rolled back. Medicaid patients would be unable to get treatment at Planned Parenthood, which would be defunded for a year. The bill also includes a tax break for the wealthy. Here's what else you need to know: First, Politico has the full text of the 142-page document Republicans are calling a "discussion draft." Three Republican senators can defeat the bill by joining Democrats to vote against it. FiveThirtyEight reports the most likely candidates are Rand Paul and Mike Lee (who don't believe it goes far enough; Paul recently said he doesn't want "ObamaCare lite") and Susan Collins and Lisa Murkowski (who want more protections for Medicaid and pre-existing conditions). ABC News reports four Republican senators have already said they won't vote for the bill without more information and negotiation: Paul, Lee, Ron Johnson, and Ted Cruz. They released a joint statement saying the bill doesn't do enough to repeal ObamaCare. The bill's writing was cloaked in such secrecy that the Week reports as of Thursday morning quite a few Republican senators still had not seen it; Murkowski, for example, told a reporter, "I am not a reporter, and I am not a lobbyist, so I've seen nothing." President Trump had called the House bill "mean" and in need of "more heart." So Scientific American takes a look to see if the Senate version fulfills that requirement. When asked by a reporter if the Senate bill had enough heart, Trump called it "very good" but in need of "a little negotiation," CNN reports. According to People, police dragged protesters—some of them in wheelchairs or wearing medical devices—away from Mitch McConnell's office and arrested them. The protesters, members of a national disability rights group, say people with disabilities are threatened by the bill. Finally, USA Today reports Senate Democrats plan to fight the bill through procedural requests to slow down the process. They called for any changes to the House's bill to be made public for at least 72 hours and be subject to CBO analysis.