Senate Majority Leader Mitch McConnell is still short the 50 votes he needs to pass the bill, with several senators saying they’re withholding their support until they see final legislation. | J. Scott Applewhite/AP Senate GOP reveals Obamacare repeal bill but still lacks the votes After weeks of work behind closed doors, the GOP released its plan and is now trying to find the votes to pass it. 
 
 Senate Republican leaders unveiled their long-secret plan to repeal Obamacare Thursday, formally kicking off the search for the 50 votes needed for passage amid stark party divisions. 
 
 Just hours after Republicans were briefed on the bill, four conservatives put out a statement saying they were withholding their support for the plan. A number of moderate GOP senators, meanwhile, said they were still poring through the the 142-page bill, which was crafted after weeks of work behind closed doors. 
 
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 The broad contours of the plan — which would tear down large parts of the 2010 health law, cap one of the nation’s biggest entitlement programs and overhaul one-sixth of the U.S. economy — have come into focus in recent days. 
 
 Senate Majority Leader Mitch McConnell is pushing for a vote as early as next Thursday, ahead of Congress’ July 4 recess and before more opposition can mount. 
 
 But the Kentucky Republican is still short the 50 votes he needs to pass the bill. 
 
 GOP Sens. Ted Cruz, Ron Johnson, Mike Lee and Rand Paul said in a statement Thursday that they are "not ready" to support the measure, though they remained open to voting for it after further negotiations. 
 
 "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," they said. 
 
 Cruz is pushing for an amendment to allow catastrophic, low premium plans, but it's not clear if the parliamentarian will allow them, according to Republicans. 
 
 Since Senate Democrats are unified in their resistance, Republicans are using a fast-track process that can evade filibusters. But they can only afford two defections and still maintain the thin majority needed to pass the repeal bill. 
 
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 Senate Minority Leader Chuck Schumer and other Democrats immediately took to the floor to blast the plan. 
 
 “The president said the Senate bill needed heart,” he said. “The way this bill cuts health care is heartless. The president said the House bill was mean. The Senate bill may be meaner.” 
 
 When asked if the Senate plan has enough heart at a White House event Thursday, President Donald Trump replied, “A little negotiation, but it's going to be very good.” Later, he tweeted that he was "very supportive" of the plan. 
 
 Former President Barack Obama blasted the Senate bill as a "massive transfer of wealth" that would skyrocket the cost of health care for poor and middle-class Americans. 
 
 "It hands enormous tax cuts to the rich and to the drug and insurance industries, paid for by cutting health care for everybody else," Obama wrote in a Facebook post. "Simply put, if there’s a chance you might get sick, get old, or start a family – this bill will do you harm." 
 
 The Congressional Budget Office hasn't yet weighed in on how many fewer Americans are likely to be insured under the Republican plan, or answered the crucial political question of whether premiums would be reduced. That report is expected by early next week, setting up a sprint to gather votes ahead of a potential late-week vote. 
 
 The House bill, whose fundamental framework can be seen in the Senate plan, would leave 23 million fewer Americans insured over the next decade, according to CBO. 
 
 The Senate bill — blandly dubbed the Better Care Reconciliation Act of 2017 — eliminates Obamacare’s mandates and hundreds of millions of dollars in taxes on the wealthy and the health industry. Notably, it doesn’t impose any new requirement that people purchase or maintain coverage — a major element that Republican leaders said they’re still working on. 
 
 The bill would also phase out Obamacare's Medicaid expansion over three years beginning in 2021 and make deep cuts to the long-term Medicaid program, while allowing states to impose work requirements on certain beneficiaries. It keeps the structure of Obamacare's insurance subsidies to help low-income people buy insurance, but tweaks them to cover only those making up to 350 percent of the federal poverty line — down from the 400 percent covered under Obamacare. 
 
 The bill bars the use of subsidies for plans that include abortion coverage, though some Republicans have said that the provision may not survive due to the Senate's strict procedural rules under reconciliation. Planned Parenthood would be defunded for one year. 
 
 Obamacare's $1 billion Prevention and Public Health Fund, which was designed to tackle threats like Zika and pay for preventive health services, would be eliminated by 2018. 
 
 Senate Republicans would allow states to opt out of some of Obamacare’s insurance requirements, including one requiring states to have an exchange, as well as rules for what benefits insurers must cover, what qualifies as a health plan, and the actuarial value of the plans. Those waivers are aimed at loosening oversight of insurers and paving the way toward even lower premiums, though they could also prompt insurers to dramatically cut benefits and increase deductibles. 
 
 The bill won't allow states to waive Obamacare requirements that insurers accept everyone and charge the same rates, with few exceptions. The House waived the latter requirement, triggering a storm of criticism that it was abandoning people with pre-existing conditions. 
 
 Still, the Senate bill was met with near-universal backlash from patient advocates, hospitals and public health organizations. 
 
 Republicans are holding out hope that health insurance groups will ultimately come to the legislation's defense, some senators said. But the bill's fate will rest on how factions on either end of the conference's ideological spectrum react to the bill's sweeping proposals. 
 
 Indeed, conservatives, moderates and senators from Medicaid expansion states all remained on the fence even after coming out of the meeting. 
 
 "By the time I get back to my office I'm told I'll have a copy," said Sen. Lisa Murkowski (R-Alaska), a key moderate swing vote. "There was no paper. ... I want to get back to my office and actually take a look at it." 
 
 Along with other Medicaid expansion-state senators, like Ohio's Rob Portman and West Virginia's Shelley Moore Capito, Murkowski is worried about the consequences of cutting off Obamacare's enhanced funding so quickly, and pushed instead for rolling back expansion over as many as seven years. 
 
 Murkowski and Sen. Susan Collins have also warned against defunding Planned Parenthood as part of the bill, and expressed reservations about the impact certain provisions may have on elderly Americans' ability to afford coverage. 
 
 McConnell full remarks on Senate health care bill poster="https://v.politico.com/images/1155968404/201706/3914/1155968404_5480170897001_5480145898001-vs.jpg?pubId=1155968404" true 
 
 And among conservatives, there remain serious concerns over whether the repeal bill amounts to a "true" repeal of Obamacare and the regulations it imposes on the health care system. 
 
 
 
 Freedomworks, a conservative advocacy group, panned the proposal as "an amendment to ObamaCare" rather than a repeal, and urged Paul, Lee and Cruz to hold out until their demands are met. 
 
 Senate Republican leaders have spent the last few weeks trying to manage that delicate ideological balance, in hopes of charting a narrow path to 50 votes 
 
 Still, Republicans said Thursday's all-conference meeting demonstrated there are still a number of issues yet to be solved. 
 
 "It's obviously a discussion draft," said Sen. John Thune (R-S.D.). "So we've got members who are going to be interested in looking at the text and see what they can do to refine, improve and dial things accordingly to try to figure out how we get 50 votes." 
 
 Brianna Ehley, Rachana Pradhan and Rachael Bade contributed to this report. ||||| With only a slim majority in the Senate, Mitch McConnell always faced an uphill battle uniting the fractious Republican Party behind his plan to repeal and replace the Affordable Care Act. But in the four days since the majority leader revealed the draft text of his clumsily named Better Care Reconciliation Act, the revolt within his own caucus has proved more serious than it first seemed. With 10 senators saying they have reservations or outright oppose the bill, as of Sunday afternoon, it was already looking as if McConnell would need a legislative miracle to fulfill the G.O.P.’s seven-year quest to repeal Obamacare—and that was before the Congressional Budget Office released its report on the impact of the bill, which the federal scorekeeper estimated would increase the ranks of the uninsured by 22 million. One person on McConnell’s staff has reportedly been telling people they have only a 60 percent shot at closing the deal, though the odds may actually be lower. Josh Holmes, who previously served as McConnell’s chief of staff, said passing the bill would be like “a 747 landing on a suburban driveway.” 
 
 While McConnell can afford to lose two votes, the holdouts are split ideologically between conservatives and moderates. In the former camp are Senators Rand Paul, Ted Cruz, Mike Lee, and Ron Johnson, who say the legislation doesn’t go far enough in dismantling Barack Obama’s signature legislation. In the latter group are Susan Collins, Dean Heller, Lisa Murkowski, and Cory Gardner—among others—who have voiced concerns about the impact the legislation will have on the uninsured rate and its steep cuts to Medicaid, which begin slower but ultimately go deeper than what was prescribed in the House bill. “This bill would mean a loss of coverage for millions of Americans, and many Nevadans. I’m telling you right now, I cannot support a piece of legislation that takes insurance away from tens of millions of Americans, and hundreds of thousands of Nevadans,” Heller said on Friday during a press conference. 
 
 On Monday, the C.B.O. confirmed the concerns of Heller and his fellow moderates. While the Senate bill is expected to reduce the federal deficit by $321 billion by 2026, over that same period, tens of millions of Americans are also expected to lose coverage. The budget office estimates that over the next year alone, 15 million more Americans would join the uninsured ranks under the B.C.R.A. than under the current law, and an additional 4 million people would lose employer-sponsored coverage. Over the next decade, that figure would balloon to 22 million—representing a marginal improvement over the House health-care bill. Premiums are also expected to spike by 20 percent in the first year, though the C.B.O. estimates that they will be roughly 30 percent lower in 2026 than under the A.C.A—primarily because plans would be stingier, and deductions much higher. While the highest-income households would benefit from a cumulative tax cut of some $541 billion over the next decade, that’s likely cold comfort to moderates like Collins, Heller, Murkowski and Gardner, who could face an electoral revolt in their home states. 
 
 Prior to the release of the C.B.O. score, Collins was already seen as less persuadable than some of her Republican peers. Along with Murkowski, the Maine senator has raised issue with language that would effectively defund Planned Parenthood—the removal of which could be a nonstarter for staunch conservatives like Lee and Cruz. And while Murkowski could be won over by changes to the bill that would help her home state of Alaska, Collins would be a much tougher sell. “She wants to remain engaged in negotiations, so it makes sense not to foreclose the option to vote ‘yes,’ ” the source told Allen. “But there is no way she'll vote for this bill, just on pro-life protections alone.” 
 
 Some of the protests are likely less than genuine, designed to extract concessions from McConnell that those senators can then bring back to their states. But other dissenters seem more ideologically opposed to the bill. Paul, Mike Allen notes, seems hung up on conservative principles and is expected to use his opposition to make a stand. He's talking about getting a 60-vote threshold revamp of [Obamacare],” one Senate source told him. “He wants this bill to fail.” 
 
 Nor are Collins and Paul the only Republicans who may end up voting “no.” Heller, who is widely seen as the most vulnerable G.O.P. senator in 2018, is the only moderate to have outright opposed the bill as currently written. McConnell, who is famously protective of his caucus, is expected to give Heller a pass, if they can’t negotiate a compromise. A pro-Donald Trump political group, meanwhile, has announced plans to launch a series of attack ads against Heller over health care, leaving the Nevada senator in an even tougher spot, and potentially undermining McConnell. Under attack from Trump’s allies, any concession by Heller now would look as if he folded under pressure—particularly in light of the C.B.O.’s devastating report. 
 
 The strict rules governing the budget reconciliation process, which McConnell plans to use to avoid a Democratic filibuster, create a separate set of problems. While Lee is considered amenable to negotiating, the changes he is seeking to the bill might violate the parameters for reconciliation. “I do think [Lee] wants to get to ‘yes.’ I think he realizes that if this fails, it kills the reconciliation vehicle and possibly the chance to repeal major elements of Obamacare,” Allen’s source noted. “But his vote will come [with] major improvements that may or cannot be accommodated by the budget rules constraining [reconciliation].” Lee and the rest of the conservative coalition will, however, likely applaud the $772 billion cut in Medicaid over and the cumulative $541 billion tax cut the Senate bill will provide over the next ten years—whether it will be enough to sway their votes remains to be seen. 
 
 McConnell is facing a narrow window to wrangle enough support for the Better Care Reconciliation Act ahead of the vote, which is expected as early as Thursday. And there is still one unknown factor at play: Trump. On Sunday, the president confirmed earlier media reports that he had told Republican senators that he thought the House’s American Health Care Act was “mean.” So far, surrogates for his administration have been insisting that the Senate bill’s massive Medicaid cut would not actually break his campaign promise to protect the program—an obvious deception that other allies have struggled to spin. Who knows what will happen if anyone manages to explain to Trump what the legislation would actually do. ||||| 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. ||||| 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 
 
 Sen. Rand Paul leaves a closed-door meeting where Senate Majority Leader Mitch McConnell announced the release of the GOP health care bill on June 22, 2017. (Photo: J. Scott Applewhite, AP) 
 
 WASHINGTON — Senate Republicans need 51 votes to pass their bill to repeal and replace Obamacare. 
 
 Because no Democrats are expected to vote to repeal the Affordable Care Act — they spent nearly all of Thursday after the GOP bill's release railing against it on the Senate floor — Republicans can't lose more than two of their own members for the bill to pass. (The GOP has a narrow 52-48 majority in the Senate, but Vice President Pence can be brought in to break ties.) 
 
 That slim margin means a difficult job for Senate Majority Leader Mitch McConnell, R-Ky., who must try to convince the various factions of his party to come together and back legislation that was written pretty much in secret and is supposed to be voted on just one week after its release. 
 
 Here are nine senators USA TODAY is watching to see whether they break with their party: 
 
 The conservatives 
 
 Sen. Ron Johnson makes his way through a crush of reporters at the Capitol on June 22, 2017. (Photo: J. Scott Applewhite, AP) 
 
 Sens. Rand Paul, R-Ky., Mike Lee, R-Utah, Ted Cruz, R-Texas and Ron Johnson, R-Wis., were out the gate just a couple hours after the bill’s release with a joint statement that said they weren’t ready to vote for the bill as-is, but “we are open to negotiation and obtaining more information before it is brought to the floor.” 
 
 “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,” the group wrote. 
 
 Paul told reporters that the goal of releasing the statement as a bloc was to get the attention of Republican leadership: “Now that it is known that there are not 50 votes for this, I hope that those who ... have written the bill will negotiate with us.” 
 
 Paul said it was his “hope” that the four senators would keep their votes together as a bloc. But he acknowledged that the only agreement the group had made so far was to issue Thursday’s joint statement. 
 
 The anti-opioid crusaders 
 
 Sen. Shelley Moore Capito walks through the U.S. Capitol on June 22, 2017, following the release of a draft of the Senate GOP health care bill. (Photo: Saul Loeb, AFP/Getty Images) 
 
 Sens. Rob Portman, R-Ohio, and Shelley Moore Capito, R-W.Va., are concerned the GOP plan would undermine efforts to curb the opioid epidemic, which has taken a deadly toll on their respective states. The biggest sticking point: Medicaid expansion. 
 
 Ohio and West Virginia — along with 30 other jurisdictions — expanded Medicaid enrollments under the Affordable Care Act. That expansion has dramatically increased access to addiction treatment for low-income childless adults — a population heavily affected by the opioid crisis. 
 
 Leading up to Thursday’s bill unveiling, Portman and Capito worked in quietly and in concert to try to soften the GOP legislation — with mixed results. They sought a seven-year phase-out of the extra federal Medicaid expansion funding, urging GOP leaders to gradually ratchet down that money through 2027. They also pushed for an extra $45 billion over 10 years in funding for opioid treatment as a cushion for those who might lose access to treatment. 
 
 GOP leaders included a four-year phase-out of the Medicaid expansion funds and $2 billion for one year of extra opioid money. Portman signaled that might not be enough to win him over, and Capito seemed lukewarm as well. 
 
 The Planned Parenthood defenders 
 
 Sen. Lisa Murkowski leaves a meeting with GOP senators in the U.S. Capitol on June 22, 2017. (Photo: Chip Somodevilla, Getty Images) 
 
 The Senate bill would cut Medicaid funding from Planned Parenthood for one year, and prevent clients from using federal money for services at the group's clinics, but Sens. Susan Collins, R-Maine, and Lisa Murkowski, R-Alaska, have defended the women's health organization and said it shouldn't lose government funding. 
 
 "I do not like the provision that eliminates federal funding for Planned Parenthood," Collins told reporters Thursday. "It makes no sense to single out Planned Parenthood from all the Medicaid providers and say that it can’t be a Medicaid provider." 
 
 "There’s absolutely no need for that," Collins said, pointing to the Hyde Amendment, legislative language that already prohibits federal funds from being used for abortions. 
 
 Murkowski, like Collins, is a supporter of Planned Parenthood. In a speech to the Alaska state legislature in February, she vowed not to vote for any Obamacare replacement bill that would defund the organization. 
 
 "I, for one, do not believe that Planned Parenthood has any place in our deliberations on the Affordable Care Act," she said in her address to state lawmakers. "Taxpayer dollars should not be used to pay for abortions, but I will not vote to deny Alaskans access to the health services that Planned Parenthood provides." 
 
 Both senators have also been vocal about providing a softer landing for people who had been on Medicaid. 
 
 "It’s no secret that health care needs to be reformed, but it needs to be done right," Murkowski said in a statement Thursday. 
 
 "I can’t support a bill that's going to greatly increase premiums for older Americans or out-of-pocket costs for those who aren’t quite old enough for Medicare yet," Collins said on MSNBC Thursday night. "I cannot support a bill that's going to result in tens of millions of people losing their health insurance. And I cannot support a bill that is going to make such deep cuts in Medicaid, It isn’t any one factor ... But it is all of those factors put together that'll influence my decision. 
 
 The most vulnerable senator 
 
 Sen. Dean Heller speaks at a town hall meeting on April 17, 2017, in Reno, Nev. (Photo: David Calvert, Getty Images) 
 
 Nevada Sen. Dean Heller is considered the most vulnerable Republican senator up for re-election in 2018. He is the only GOP senator running for re-election in a state won by Hillary Clinton in the 2016 election, and the state also expanded Medicaid under Obamacare — both of which put Heller in a tough position. In a statement Thursday Heller said “I have serious concerns about the bill’s impact on the Nevadans who depend on Medicaid.” 
 
 “I have made clear that I want to make sure the rug is not pulled out from under Nevada or the more than 200,000 Nevadans who received insurance for the first time under Medicaid expansion,” Heller said. 
 
 At a press conference Friday with Brian Sandoval, Nevada's Republican governor, Heller said he will not vote for the bill. "I'm announcing today that in this form, I simply will not support it," Heller said. 
 
 Read more: 
 
 Read or Share this story: https://usat.ly/2tBSi33 ||||| If you’re wondering what will happen with the Senate’s effort to repeal Obamacare, I recommend you follow the words, actions and eventually the votes of four Republican senators over the next days or weeks: Susan Collins (Maine), Mike Lee (Utah), Lisa Murkowski (Alaska) and Rand Paul (Kentucky). 
 
 Why those four? First, they are part of a broader group of Republican senators who have been complaining about the GOP’s repeal-Obamacare process since the start of the year. Lee and Paul, along with Texas Sen. Ted Cruz, have generally worried that the Obamacare repeal may still leave too much of the law in place. “No Obamacare lite,” Paul wrote in February. 
 
 On the other ideological end, Collins and Murkowski — along with Sens. Bill Cassidy (Louisiana), Shelley Moore Capito (West Virginia), Cory Gardner (Colorado), Dean Heller (Nevada) and Rob Portman (Ohio) — have at times pushed back against repealing too much of Obamacare, worrying that the Republicans may not be doing enough to protect people on Medicaid or those with pre-existing conditions. 
 
 SENATOR STATE EXPANDED MEDICAID TRUMP MARGIN TRUMP SCORE Susan Collins -3 86.0% Rand Paul ✓ +30 87.8 Lisa Murkowski ✓ +15 92.9 Dean Heller ✓ -2 93.0 Ted Cruz +9 95.3 Cory Gardner ✓ -5 95.3 Mike Lee +18 95.3 Rob Portman ✓ +8 95.3 Shelley Moore Capito ✓ +42 97.6 Bill Cassidy ✓ +20 97.7 Senators who have expressed doubts about the Obamacare repeal Trump score measures how often members of Congress vote with Trump’s position on major legislation. Source: Kaiser Family Foundation 
 
 So any of these members could provide the three votes that would kill this bill. I chose those four because I would argue they would have the clearest rationales to stop an Obamacare repeal and be able to explain that vote to their Republican constituents. Based on our “Trump Score,” Collins and Murkowski are among the five Senate Republicans who most vote against Trump’s positions on major legislation. Collins has a reputation as a more moderate Republican and is in a state that Hillary Clinton carried in 2016. In 2010, Murkowski was defeated by a more conservative Republican in Alaska’s GOP primary, but then ran in the general election and won as a write-in candidate. 
 
 Also, both of these senators, unlike many of the others in the group of more moderate Republicans, have specifically complained about a provision in the bill that would effectively bar, for one year, Medicaid recipients from getting coverage at Planned Parenthood clinics. Republicans object to Planned Parenthood because it offers abortion services. (There is an existing ban on the use of federal funds to pay for abortions.) 
 
 I’m not saying other moderates won’t oppose this legislation. But if a coalition of more moderate members rises up to oppose this bill, it is very likely to include Collins and Murkowski. 
 
 On the conservative end, Cruz has been hinting that he wants to use this bill to show fellow Republicans that he can be a team player, working with the party instead of clashing with it as he did for much of 2013 and 2014. It’s hard to see him leading a lonely charge against this legislation. 
 
 In contrast, Paul in particular has been scathing. Speaking to reporters this week, before the bill’s official release, he called what he had seen of the Senate’s work on Obamacare repeal “weak-kneed.” Lee has also been a regular critic of the Senate’s bill, even before its release. And the Senate bill, like Obamacare, will use a system of tax credits that vary based on income, which makes it easier for poorer people to buy insurance. The House bill gave tax credits to people to purchase insurance based on age. That change could embolden both Paul and Lee further. 
 
 What else might affect these senators’ decisions and potentially those of their colleagues? First, how will outside groups react? Generally, groups representing patients, such as AARP, and medical groups, like the American College of Physicians, have been wary of this legislation. Will they try to aggressively mobilize their members against it? Perhaps more importantly, how will major conservative groups view the bill? One important factor in the initial failure of the House version of Obamacare repeal was that conservative groups felt it did not repeal enough of Obamacare. 
 
 Indeed, Philip Rocco, a political scientist at the Marquette University who co-wrote a book called “Obamacare Wars” that details the fights over the law in states from essentially the moment it passed, said it was particularly important to watch the moves of conservative groups such as Americans for Prosperity and Heritage Action in the context of Lee and Paul. He argued that if key parts of the conservative movement said this bill is enough of an Obamacare repeal, it will be hard for Lee and Paul to oppose it. 
 
 “I don’t think it’s right to think of them as lone wolves,” Rocco said. 
 
 Second, how will Republican House members, particularly the hard-to-please Freedom Caucus, view this legislation? Freedom Caucus members have been in contact with the Senate about the legislation, Alyssa Farah, the group’s spokesperson, told me. That said, it’s not clear if they have signed off on the final product. Republican senators will be leery of backing a bill that the Freedom Caucus does not want, since that means this legislation may not be able to pass the House. 
 
 Third, don’t forget the Congressional Budget Office. The CBO is expected to release its “score” of the bill next week. That will be a heavily covered news event. But it is unlikely to be very surprising, since this legislation is not radically different from the two House different bills that the House had evaluated by the CBO. Last month, Collins blasted the House version of this legislation, specifically citing numbers from the CBO report on it. 
 
 I have not included President Trump’s reaction as something to watch, because I’m not convinced he will be a major factor. His closed-door comments about the bill the House passed being “mean” were probably not helpful to Republicans, but it’s hard to see him publicly blasting the Senate bill or ultimately vetoing whatever legislation comes through Congress. I will acknowledge that the president’s behavior is unpredictable and that a strong denunciation of a Republican health care bill by a Republican president might shift things. 
 
 We don’t know where this process is headed. Senate Republicans say there could be a vote next week, but it could be put off if senators demand changes. A broad coalition of members could come to McConnell and say that they can’t back this bill, as what happened to the initial version. The House is still a wild card. 
 
 But this legislation will only be truly dead if it’s clear that at least three Senate Republicans are prepared to vote against it — or they actually do. And that gives a little power to this group of four senators. ||||| 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. ||||| 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 ||||| The day after unveiling their new bill to replace Obamacare, the Republican authors of the Affordable Health Care Act find themselves in a bind. 
 
 Even if the new bill has the votes in the House, it will also have to pass the Senate. Because this legislation is moving forward through the budget reconciliation process, which only requires 51 votes, the 52 Republicans in the Senate can only afford two defections and still pass the bill (assuming Vice President Mike Pence would break a tie in their favor). A third defection would doom the Obamacare replacement package. 
 
 And, already, four Senate Republicans have already criticized Speaker Paul Ryan’s first proposal, saying it doesn’t do enough to protect Medicaid beneficiaries. That group consists of Rob Portman (R-OH), Sen. Shelley Moore Capito (R-WV), Sen. Cory Gardner (R-CO) and Sen. Lisa Murkowski (R-AK). Assuming Democrats stick together in opposition, that moderate bloc of Republicans could torpedo the bill on their own. 
 
 But appeasing moderates could carry risk for Republican leadership as well: Conservative senators could defect in protest of a bill they think is too far to the left. The most conservative senators are already blasting the first draft as not doing nearly enough to slow entitlement spending, with Sen. Ted Cruz (R-TX), Sen. Rand Paul (R-KY), and Sen. Mike Lee (R-UT) echoing the arch-conservatives in the House Freedom Caucus who say that the bill amounts to “Obamacare-lite” and leaves too much of Obama’s law intact, including the expansion to Medicaid in place until 2020 and the “Cadillac tax” on health care plans for those with high incomes. 
 
 National Review’s John Fund points out the difficult spot that Republican leadership is in on Twitter: 
 
 Biggest obstacle to House health bill: 7 GOP senators on fence - 4 who said didn’t adequately protect Medicaid, 3 who say bill too generous — John Fund (@johnfund) March 7, 2017 
 
 If anything, Fund’s tweet undersells the challenge leading Republicans face in building the coalition to get to the 51 votes they’ll need at a minimum to get Trumpcare through reconciliation. 
 
 It’s not just the fight over Medicaid. Sen. Bill Cassidy (R-LA), for instance, has said that the bill has to cover the same number of people as Obamacare. Sen. Bob Corker (R-TN) wants it to be neutral, meaning it doesn’t add to the deficit. 
 
 "I'm going to be very anxious to hear how we'll get to 51 votes and [how] the House gets to 218," said Sen. Roy Blunt (R-MO). 
 
 The Congressional Budget Office hasn’t yet estimated how many people the bill will cover or how much it will cost, key to Cassidy and Corker’s support. But the challenge is obvious from a mile away. 
 
 Meanwhile, Sen. Susan Collins (R-ME) and Sen. Murkowski say the House health bill should be stripped of its provisions to defund Planned Parenthood. 
 
 “If you go too far and have too many drastic cuts, you lose the moderate four,” says Josh Huder, a congressional scholar at the Government Affairs Institute at Georgetown University, citing Portman, Caputo, Gardner, and Murkowski. “And if you don’t go far enough, you lose the conservatives.” Republicans need both to get to 51 votes. 
 
 It’s perfectly possible either or both factions of Republicans are bluffing, simply hoping to pull the negotiations as far to their side as possible. “There's a high probability of that,” Huder says. That’s what happened during the debate over Obamacare. 
 
 In 2010, it looked like then-Majority Leader Harry Reid didn’t have the votes for the Affordable Care Act. Two versions of the bill were shot down after passing separate committees, Democrats like Joe Lieberman threatened to withhold support, and the future of health care reform seemed to be in danger. 
 
 Then the bill was reworked — and Reid had the votes. “All of a sudden, Harry Reid dropped a bill on the Senate floor that found the right mixture of people, and then the House swallowed the pill,” Huder says. “It looked like Obamacare was dead in the water — and then all of a sudden it sprang back to life.” 
 
 But even if some Republicans are bluffing because they hope to influence what the final bill looks like, the balancing act between conservatives and moderates is a real challenge. 
 
 “It’s going to be really, really hard for them to do this,” Huder says. “It’s the key question: Can they find a way to thread the needle here between the moderates and the conservatives in the Senate? There’s no way forward if not.” 
 
 Tara Golshan contributed reporting. ||||| Senate Republicans on Tuesday narrowly cleared their first hurdle toward repealing Obamacare. What comes next is complicated and unpredictable. At the end, it’s not clear anything will pass. 
 
 Senators will start with pretty meaty proposals H.R. 1628 (115) to take the guts out of Obamacare — but after debate, amendments, more debate, the parliamentarian’s rulings, budget points of order and a “vote-a-rama” — it’s highly uncertain whether the GOP will have 50 votes to pass even a “skinny” backup piece of legislation. 
 
 Story Continued Below 
 
 “All we have to do today is to have the courage to begin the debate with an open amendment process,” Senate Majority Leader Mitch McConnell said Tuesday, urging Republicans to let the debate begin. “And let the voting take us where it will.” 
 
 Here’s what to watch for. 
 
 THE REPEAL AND REPLACE PACKAGE 
 
 The Senate had to shelve its repeal-replace package because it didn’t have 50 votes — partly because the nonpartisan Congressional Budget Office projected that it would lead to 22 million fewer Americans having health insurance coverage in a decade. That’s partly because of changes to Obamacare — and partly because of sweeping changes to federal financing of Medicaid, a low-income health care program that predated Obamacare by decades. 
 
 POLITICO Pulse newsletter Get the latest on the health care fight, every weekday morning — in your inbox. Email Sign Up By signing up you agree to receive email newsletters or alerts from POLITICO. You can unsubscribe at any time. 
 
 The revised version that came up didn't have the votes -- it was defeated Tuesday night on the first substantive vote of the repeal battle. Technically it killed because it didn't have a full Congressional Budget Office score, including all its amendments. But still it served as a starting point and let senators dispatch with various big amendments. 
 
 For instance, it included Sen. Ted Cruz’s (R-Texas) amendment, which would let insurers sell skimpy health plans as long as they also sell Obamacare-compliant ones, Critics of Cruz’s provision, including some in his own party, say it would send premiums sky high for people who are older and sicker, and lead the insurance market into a “death spiral.” It also contained Sen. Rob Portman’s (R-Ohio) proposal to add $100 billion to help people who are now covered under Obamacare’s Medicaid expansion shift into the private insurance market. 
 
 THE REPEAL-ONLY BILL 
 
 The Senate will move to a straight repeal bill, and the vote may occur Wednesday. It’s very similar to the one that the chamber passed in 2015 that then-President Barack Obama vetoed. That’s almost certain to fail too. One big reason: CBO projected it would lead to more than 30 million fewer Americans with coverage. It was easy for Republicans to vote for the measure when they knew that Obama would veto it. Now there are consequences. 
 
 Allowing a vote on straight repeal was necessary in order to get legislation to the floor. Conservative hardliners like Sens. Rand Paul (R-Ky.) and Mike Lee (R-Utah) can then tell voters they followed through on campaign promises to dismantle the Affordable Care Act. 
 
 It will also give conservative advocacy groups, which are still crusading for repeal, a chance to hold senators who fail to back the bill accountable. They’re likely to seek primary challengers to some of the senators who fail to back straight repeal. They’ve already begun attacking Sens. Lisa Murkowski (R-Alaska) and Shelley Moore Capito (R-W.Va.) as hypocrites for failing to follow through on campaign promises. 
 
 VOTE-A-RAMA 
 
 Once the Senate burns through its 20 hours of debate, split among Republicans and Democrats, it goes to a vote-a-rama, which at this point looks like it will be late Thursday. Theoretically that allows for unlimited amendments as long as they are relevant. But probably a few dozen will be voted on. 
 
 Here’s where Democrats get to offer a laundry list of ideas and force Republicans to take tricky votes. That could include efforts to stabilize the Obamacare markets, such as seeking funding for cost-sharing subsidies that the Trump administration has threatened to eliminate — potentially making the markets implode. 
 
 THE PARLIAMENTARIAN 
 
 Senate Republicans also face major procedural hurdles in moving forward with legislation. The parliamentarian has determined that several key provisions of their repeal plan — including eliminating funding for Planned Parenthood for one year and banning coverage of abortion in Obamacare insurance plans — don’t meet the strict budget reconciliation rules required to pass legislation with just a majority of votes, and no filibusters. 
 
 To keep provisions flagged by the parliamentarian as a no-go, the GOP could try to get 60 votes -- a nonstarter with every Democrat opposed. Or it can try to modify the language to past muster. For instance, it already tweaked language about defunding Planned Parenthood that the parliamentarian had flagged. 
 
 MEDICAID 
 
 The biggest sticking point for Republicans, particularly in the Senate, has been how to deal with Obamacare’s Medicaid expansion. Senators from states that adopted expansion, such as Ohio and West Virginia, are deeply troubled by the prospect of taking away coverage from low-income people. That’s exacerbated by concerns about the opioid crisis roiling the country, and whether people who are now on Medicaid would no longer have access to treatment. 
 
 The Senate’s repeal package cut nearly $800 billion from the program over a decade — and not just from expansion. It also overhauls the funding formula so that federal payments would be capped for each beneficiary. 
 
 SKINNY BILL... AND THE HOUSE 
 
 When all else fails, McConnell will probably offer senators a “skinny” repeal bill. It could change over the next few days, but the plan right now is simply to scrap the individual and employer mandates and the medical device tax. 
 
 Basically no senators will like it — but they may vote for it just to keep the repeal drive going. Passing a skinny bill would enable the Senate to negotiate with the House on a compromise package that can clear both chambers. But it’s not clear that even that stripped-down package can garner the 50 votes from Republicans needed to pass. 
 
 Nor is it clear that a deal can be struck with the House, which voted for a far more sweeping repeal and replace package, including the Medicaid changes and state waivers that could wipe out Obamacare patient protections for people with health conditions. 
 
 THE WHITE HOUSE 
 
 President Donald Trump’s messaging on health care has been a mess. He’s cheered the prospect of the collapse of the Obamacare — and called the House bill “mean.” But he’s hungry for a legislative win. If a repeal bill lands on his desk — fat, skinny, or in between — chances are he’ll sign it. 
 
 Rachana Pradhan contributed to this report. ||||| A frantic scramble to influence the Senate’s healthcare legislation intensified on Monday, with House conservatives pressuring their allies in the Senate and Democrats mounting a furious public relations blitz to kill the bill. 
 
 The pace of activity is picking up ahead of the informal July 4 deadline set by Senate Majority Leader Mitch McConnell Addison (Mitch) Mitchell McConnellSenate passes 0B defense bill Overnight Health Care: New GOP ObamaCare repeal bill gains momentum Overnight Finance: CBO to release limited analysis of ObamaCare repeal bill | DOJ investigates Equifax stock sales | House weighs tougher rules for banks dealing with North Korea MORE (R-Ky.) for a vote. 
 
 McConnell does not want the ObamaCare debate to eat up more precious legislative time, with nearly half the year gone and congressional Republicans and President Trump still looking for a major legislative victory. 
 
 Senate Republican Policy Committee Chairman John Barrasso John Anthony BarrassoDems force 'Medicare for All' on Americans but exempt themselves GOP sees fresh opening with Dems’ single payer embrace Overnight Health Care: CBO predicts 15 percent ObamaCare premium hike | Trump calls Sanders single-payer plan ‘curse on the US’ | Republican seeks score of Sanders’s bill MORE (Wyo.) told reporters that he expects a Senate vote on the bill as soon as next week, underlining the importance of the next two weeks. 
 
 McConnell is walking a tightrope in seeking to win over centrists and conservatives for a Senate version of the House-passed American Health Care Act — which is being negotiated entirely behind closed doors. 
 
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 Much of the focus has been on winning over moderates in the 52-member conference, a strategy that risks losing conservative Sens.(R-Ky.),(R-Utah) and(R-Texas). McConnell can only afford two defections, with every Senate Democrat expected to be a “no” vote. 
 
 In an effort to buck up the conservatives, the Republican Study Committee (RSC) — the largest group of conservatives in the House — warned that the Senate risks seeing its bill die in the House if it drifts too far to the center. 
 
 The RSC specifically warned that the bill would lose support in the House if it did not keep four provisions, including the phasing out of extra federal funding for Medicaid in 2020. They also warned McConnell against preserving ObamaCare’s tax increases, removing language defunding Planned Parenthood or barring refundable tax credits from being used to “federally fund abortions.” 
 
 In a bid to keep moderate Republicans on board, McConnell has proposed phasing out enhanced federal funding for Medicaid expansion in 2023. 
 
 GOP senators have also discussed keeping ObamaCare taxes to help pay for the costs of the bill, and language on Planned Parenthood in the House bill may be struck down by the Senate parliamentarian. The Senate plans to use special budgetary rules to prevent Democrats from filibustering the healthcare bill, but this makes certain provisions vulnerable under other Senate rules. 
 
 James Wallner, a former aide to Lee and Sen. Pat Toomey (R-Pa.), who are both playing active roles in the healthcare talks, said the RSC letter shows that conservatives are laying down their markers before it’s too late. 
 
 “To the extent that the bulk of the party wants to pass the House-passed bill or a modified version of the House-passed bill, individual members need to take steps to give themselves leverage heading into that kind of high-stakes showdown,” he said. 
 
 Senate Democrats are hoping to have an impact, too. They threatened Monday to grind the Senate to a halt to protest Republicans’ decision to craft the bill in private meetings, skipping the regular order of holding hearings and marking it up in public committee sessions. 
 
 “If Republicans won’t relent and debate their healthcare bill in the open for the American people to see, then they shouldn’t expect business as usual in the Senate,” said Senate Democratic Leader Chuck Schumer Charles (Chuck) Ellis SchumerSenate Dems hold floor talk-a-thon against latest ObamaCare repeal bill This week: Senate wrapping up defense bill after amendment fight Cuomo warns Dems against cutting DACA deal with Trump MORE (N.Y.). 
 
 Democrats planned to hold a late-night talk-a-thon on the Senate floor Monday night to put the spotlight on the GOP’s secretive tactics — a strategy Democrats used earlier this year to protest some of Trump’s controversial Cabinet picks. 
 
 The three conservatives are pressing different issues on healthcare. 
 
 Paul has made clear to colleagues that he will not support legislation that creates a new GOP-sponsored entitlement program in the form of refundable tax credits to help low-income people buy private insurance plans. 
 
 Lee and Cruz are pressing GOP leaders to allow states to get out of two major regulatory requirements under ObamaCare. 
 
 One, known as guaranteed issue, mandates that insurance companies sell insurance plans to people regardless of how sick they are, and another, known as community rating, prohibits insurance companies from pricing those plans to reflect the greater financial risk of insuring people with pre-existing medical conditions. 
 
 A GOP source familiar with the negotiations said McConnell has so far refused to promise conservatives to let states opt out of the community rating requirement — which keeps health plans more affordable for sick people but sends premiums soaring — or to exempt states altogether from the regulatory mandate and allow them to opt in. 
 
 McConnell, however, is worried that if he effectively guts ObamaCare’s popular prohibition against insurers charging higher prices for sick people, he would lose moderate votes. 
 
 Conservatives are stepping up their efforts to mold the bill, as it’s become apparent that Trump is primarily interested in a political victory and is willing to cater to moderates to get one. 
 
 At a meeting at the White House last week with prominent centrists such as Sens. Lisa Murkowski Lisa Ann MurkowskiSenate Dems hold floor talk-a-thon against latest ObamaCare repeal bill Collins skeptical of new ObamaCare repeal effort How Senate relationships could decide ObamaCare repeal MORE (R-Alaska), Rob Portman Robert (Rob) Jones PortmanWeek ahead in tech: Debate over online sex trafficking bill heats up 'Hillbilly Elegy' author won't run for Senate Brown, Portman urge Trump administration to move quickly on a steel decision MORE (R-Ohio) and Susan Collins Susan Margaret CollinsSenate Dems hold floor talk-a-thon against latest ObamaCare repeal bill Ryan: Graham-Cassidy 'best, last chance' to repeal ObamaCare Collins skeptical of new ObamaCare repeal effort MORE (R-Maine), Trump criticized the House-passed bill as “mean” and urged Senate Republicans to craft legislation that is “generous, kind [and] with heart.” 
 
 “That may be adding additional money into it,” the president said at the start of the meeting. 
 
 Moderate Republicans have sought to put their imprint on the legislation by pushing it further to the center. 
 
 A group led by Portman wants to extend the phase-out of extra federal funding for the Medicaid expansion to 2027 but would likely accept 2025 as a split-the-difference compromise with McConnell’s proposed end date of 2023. 
 
 Murkowski and Collins have also emphasized the importance of preserving funding for Planned Parenthood. 
 
 Murkowski wrote in a recent letter to a constituent that she is committed to providing insurance coverage to people with pre-existing conditions, continuing support for Medicaid expansion and preserving funding for Planned Parenthood. 
 
 — Jordain Carney and Rachel Roubein contributed.
– 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.