Senate Health Care Bill Revisions Released In Attempt To Appease GOP Critics

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Updated 6:56 p.m. ET

Senate Republicans on Thursday released a revised version of the Better Care Reconciliation Act, their plan to replace the Affordable Care Act.

The new version comes after the Congressional Budget Office found that the original BCRA would in the next decade increase the uninsured population by 22 million over what it would otherwise be. Senate Majority Leader Mitch McConnell had hoped for a vote before July 4, but was forced to delay that because he couldn't garner the 50 votes he needed among the 52 GOP senators.

The question now is whether this version of the bill could pass the Senate. Shortly after its release, Maine Sen. Susan Collins and Kentucky Sen. Rand Paul both said they intend to vote against letting the bill go forward. With two no votes, Vice President Pence could provide the 51st vote needed for passage. But if three Republican senators defect, the bill cannot pass.

The new bill makes some big changes from the last BCRA draft, but it also leaves some major parts of the original Senate proposal intact — it would still repeal the individual and employer mandates, it would still mean cuts to Medicaid spending, and it would still allow states to opt out of key parts of Obamacare.

In their summary of the bill, Senate Republicans laid out the major provisions. Here are some of those big changes that this new version of the bill would make to the original BCRA, and what they would mean:

Health savings accounts will be able to pay for premiums. Under IRS rules, people with high-deductible plans are eligible for health savings accounts (HSAs), accounts into which people can put money for health care expenses tax-free. Under this bill, people would for the first time be able to use that money for premiums. Americans' deposits in HSAs have ballooned over the last decade, according to HSA consulting firm Devenir. However, those accounts also tend to benefit higher-income people more than others, as Kaiser Health News' Michelle Andrews wrote in December — for example, richer people are more likely to have the extra money to sock away for health expenses.

More money for the opioid epidemic. The Senate's initial bill offered $2 billion to address the opioid crisis for 2018. This version would offer about $45 billion over 10 years, which is what Republicans Ohio GOP Sen. Rob Portman and West Virginia Sen. Shelley Moore Capito had requested at one point. However, some experts say that around $4.5 billion a year is nowhere near enough for combating America's massive opioid epidemic, as the New York Times reported in June.

Keeping some Obamacare taxes. The first BCRA version would have repealed an array of Affordable Care Act taxes, which would have overwhelmingly benefited higher-income Americans. This newer version of the bill keeps some in place, including the net investment income tax and a payroll tax that hit higher-income Americans.

Allowing insurers to offer non-Obamacare-qualified plans. This mirrors an idea that Texas Sen. Ted Cruz and Utah Sen. Mike Lee had proposed in recent weeks: The Senate's bill would allow an insurer to offer skimpier plans. As long as an insurer does offer a plan on the individual insurance exchanges that meets the demands of Obamacare's Title I (for example, covering certain areas like preventive care and protecting people with pre-existing conditions), that insurer will be allowed to offer additional plans off of the individual insurance exchanges that don't meet those criteria.

That idea had created worries of a two-tiered insurance system — one in which older and sicker people would opt into the more comprehensive plans, while younger and healthier people would choose the cheaper plans that covered less, potentially causing a "death spiral" on the exchanges for those older and sicker people.

Extra stabilization money, in part for high-risk customers. The original version of the BCRA provided $112 billion that would have allowed states to stabilize their markets or help high-risk customers in a wide variety of ways. In this version, that is bumped up to $182 billion. One function of this money is to mitigate some of the two-tier issues created by new, nonqualified plans. If an insurer offers a plan that meets the Obamacare criteria, that insurer would be eligible for money to help high-risk customers.

This all means that the new version doesn't make major changes to one big part of the BCRA: Medicaid. Under the original Senate bill, the Obamacare Medicaid expansion would be rolled back, and Medicaid spending would be capped — states would either be allotted a certain amount per capita, or they could get a block grant instead. It also caps Medicaid spending growth in the medium-to-long-term. This bill doesn't change any of that.

According to the CBO, the original BCRA would have cut Medicaid spending by $772 billion over 10 years, and would have resulted in 15 million fewer Medicaid enrollees by 2026 than under current law.

A new CBO score on the bill is expected Monday or Tuesday. By the end of next week, there is likely to be a key procedural vote. That would put things on track for a final vote the following week.

Were this bill to pass the Senate, it would then have to be reconciled with the House's attempt to repeal and replace Obamacare, known as the American Health Care Act.

Meanwhile, Republicans Bill Cassidy of Louisiana and Lindsey Graham of South Carolina released an alternative plan Thursday morning.

A summary of the bill is embedded below. You can read the full draft here, and see the previous Senate version here.

Washington Desk editor Arnie Seipel contributed to this report.

This report has been updated to reflect that the extra $70 billion for stabilization funding will be in part used for helping insurers defray the costs of high-risk individuals.</s>Senate Republicans have posted their updated version of the Better Care Reconciliation Act (BCRA), which is still in draft form. Read the full text of the draft below:</s>Republican senators released a revised version of a bill to repeal and replace the Affordable Care Act Thursday, which contains more flexibility for insurers, new funding to combat the opioid crisis and leaves some of the ObamaCare taxes intact.

While Republicans cheered the initial bill’s elimination of the ACA-related taxes, critics claimed the GOP was using health care as a backdoor tax cut for the wealthy. In the new draft, the 3.8% net investment income tax and the 0.9% payroll tax to help fund Medicare will remain— these taxes apply to individuals with incomes in excess of $200,000 and couples filing jointly with incomes in excess of $250,000. Some Republicans have suggested those taxes could be tackled during the health care reform debate.

The bill will also keep the limit on executive pay in the health care industry as mandated under the Affordable Care Act.

Sen. Ted Cruz’s (R-Texas) Consumer Freedom Amendment has been added to the bill, which allows insurers to offer plans that do not comply with ObamaCare requirements so long as they simultaneously leave existing plans on the individual market. This essentially allows insurance companies to offer cheaper plans that don’t have all the bells and whistles necessitated under the Affordable Care Act. It also allows individuals to use health savings accounts to pay for premiums.

The new draft recommends providing $45 billion to combat the country’s growing opioid epidemic. The GOP also proposes allocating an additional $70 billion for state-based reforms, which could include strategies to cut premium costs; in total the bill includes $170 billion for these efforts.

Notably, the bill doesn’t significantly alter plans to gradually slow the expansions of Medicaid. That was a big criticism of the first bill, with some groups asserting it would hurt America’s most vulnerable populations. Many of the other provisions, including coverage for preexisting conditions and the elimination of the employer and individual mandates, have been kept the same.

There is at least one Republican senator who has already said he is opposed to the new bill. Sen. Rand Paul (R-Ky.) told FOX Business Thursday he did not support the stabilization fund for insurance companies.

“I’m not willing to subsidize insurance companies. I think that’s a terrible thing to do,” he said. “It’s crony capitalism and there has to be somebody left in Washington who doesn’t believe in crony capitalism.”

The CBO is expected to release a score for the revised bill as soon as Monday and the bill could be put up for a vote as early as the latter part of next week.</s>Senate Republicans on Thursday released a revised version of the Better Care Reconciliation Act, their plan to replace the Affordable Care Act.

The new version comes after the Congressional Budget Office found that the original BCRA would in the next decade increase the uninsured population by 22 million over what it would otherwise be. Senate Majority Leader Mitch McConnell had hoped for a vote before July 4, but was forced to delay that because he couldn't garner the 50 votes he needed among the 52 GOP senators.

The new bill makes some big changes, but also leaves some major parts of the original BCRA intact — it would still repeal the individual and employer mandates, it would still mean cuts to Medicaid spending, and it would still allow states to opt out of key parts of Obamacare. Below is the text of the Senate's new version (and you can compare it to the old version, which can be found here).

Here are some of the change that this new version of the bill would make to the original BCRA:

Health savings accounts will be able to pay for premiums. Under IRS rules, people with high-deductible plans are eligible for health savings accounts (HSAs), accounts into which people can put money for health care expenses tax-free. Under this bill, people would for the first time be able to use that money for premiums. Americans' deposits in HSAs have ballooned over the last decade, according to HSA consulting firm Devenir. However, those accounts also tend to benefit higher-income people more than others, as Kaiser Health News' Michelle Andrews wrote in December — for example, richer people are more likely to have the extra money to sock away for health expenses.

More money for the opioid epidemic. The Senate's initial bill offered $2 billion over 10 years. This version would offer $45 billion over 10 years, which is what Ohio GOP Sen. Rob Portman and West Virginia Sen. Shelley Moore Capito had requested at one point. However, some experts say $4.5 billion a year is nowhere near enough for combating America's massive opioid epidemic, as the New York Times reported in June.

Keeping some ACA taxes. The BCRA would have repealed an array of Obamacare taxes, which would have overwhelmingly benefited higher-income Americans. This version of the bill would keep some in place, including the the net investment income tax, which hits higher-income Americans.



This all means that the new version doesn't make major changes to one big part of the BCRA: Medicaid. Under the original Senate bill, the Obamacare Medicaid expansion would be rolled back, and Medicaid spending would be capped — states would either be allotted a certain amount per capita, or they could get a block grant instead. It also caps Medicaid spending growth in the medium-to-long-term. This bill doesn't change any of that.

A new CBO score on the bill is expected Monday or Tuesday. By the end of next week, there is likely to be a key procedural vote. That would put things on track for a final vote the following week.

Meanwhile, Republicans Bill Cassidy of Louisiana and Lindsey Graham of South Carolina released an alternative plan Thursday morning.</s>The U.S. spends more on health care than 10 other countries in a study by The Commonwealth Fund, but was found to have the worst health-care system.

Health-care spending accounts for 16.6 percent of the U.S. gross domestic product, 5 percentage points more than Switzerland, the next closest country. Yet in a measure of health-care system performance among 11 high-income nations, the U.S. ranked dead last.

The United Kingdom's health-care system was ranked the best, followed by Australia and the Netherlands. France placed second to last, and Canada placed third to last.

Of the countries studied, the U.S. is the only one that does not offer universal health insurance coverage. Each of the other 10 countries, though, uses a slightly different model.

The study's publication comes one day after the Senate Republicans released details of a new bill to repeal and replace the Affordable Care Act.

"We have not had time to digest the (Senate) bill, but in general, the proposals we've seen would actually reverse progress, especially on insurance coverage," said Eric Schneider, senior vice president of policy and research at The Commonwealth Fund.

The study identified four main problems plaguing the U.S. health-care system: a large number of uninsured patients, limited primary care, administrative burdens, and disparities in care between higher- and lower-income patients.

The House and Senate proposals do not address problems the Affordable Care Act, also known as Obamacare, does, specifically the availability of primary care, nor do they simplify the insurance system, said David Blumenthal, president of The Commonwealth Fund. The disparity of access would "likely not get better" because the proposals include cuts to Medicaid.

One part of the health-care debate has been whether to create high-risk insurance pools. The Netherlands, the second-highest ranked country in the study, does the opposite and makes sure the risk is balanced, Schneider said.

Countries that rely on minimal or no cost sharing health systems scored better than the U.S., said Blumenthal. Evidence suggests that cost sharing does not improve a country's health-care performance, he said.</s>The GOP's latest proposal to repeal and replace the Affordable Care Act hews closely to the earlier bill that didn't win enough support among lawmakers to bring to a vote.

Perhaps the biggest change in the document released Thursday is that it leaves in place the Affordable Care Act taxes on wealthy individuals. It uses that money to reduce the number of people left without insurance coverage by the law's changes. This latest version adds $70 billion to a fund for states — bringing the total to $132 billion — to help support coverage of low-income people.

It also would allow insurance companies to offer health plans without the consumer protections included in the Affordable Care Act, or Obamacare. That means insurers could sell stripped-down policies that cover fewer conditions and offer fewer benefits than currently allowed under the law.

Those plans would very likely be cheaper than the policies currently offered on the Obamacare exchanges. But for people who would like to purchase plans that cover the essential health benefits mandated by the Affordable Care Act, including mental health coverage, addiction treatment, maternity care and prescription drug coverage, costs could go way up.

The nonpartisan Congressional Budget Office hasn't yet analyzed the new bill. It weighed in on the earlier Senate bill, saying that proposal would result in 22 million fewer people having health coverage in the next 10 years, compared with under the Affordable Care Act. Of those, 15 million would lose Medicaid coverage. That version was projected to lower the deficit by billions over 10 years — but that may have changed as the latest version offers billions more for state grants and also doesn't repeal as many of the Obamacare taxes.

Yet this new variant is the same as its predecessor when it comes to subsidies to help individuals pay for insurance. It would mostly reduce subsidies and cause out-of-pocket costs to rise, as the CBO said about the previous bill. It's not yet clear how the state grants would alter that dynamic.</s>WASHINGTON - Senate Republicans’ revised proposal to rewrite the Affordable Care Act still makes significant cuts to Medicaid funding and subsidies for low- and moderate-income people who buy private insurance.

But the latest version released Thursday retains some of the ACA’s taxes and allows insurers to offer plans that provide only partial coverage.

Here’s a look at how the bill, which the Senate could vote on next week, could affect you.

Would you get a tax cut?

The revised version keeps the taxes imposed by the ACA on investment income, on high earners. And it no longer eliminates the ACA’s limit on how much of the executive’s pay an insurance company can write off as a corporate tax deduction. The bill would still repeal other ACA taxes, including those on tanning beds, sectors of the health care industry and on high-cost employer-provided insurance plans.

Would you still receive a subsidy to reduce the cost of premiums?

You could still lose all or some of your subsidy, which is now available to people earning up to $84,650 for a family of three. That income limit would still be lowered slightly and would become less generous. But people who have tax-advantaged Health Savings Accounts can use their HSA contributions to pay for premiums, instead of just for health services and products as they can now.



 Could you buy bare-bones insurance plans with the subsidy?

The bill would let anyone buy catastrophic plans, including those who qualify for subsidies. Those plans have low premiums, but high deductibles and limited benefits.

What if you need a lot of health care services?

If an insurer offers plans that meet the ACA’s requirements for minimum benefits and not charging sicker people more, theinsurer could receive funding to help cover the cost of sick customers. But it’s unclear whether the funding would be enough to keep the plans affordable. Because insurers would also be able to sell plans that don’t meet the ACA’s requirements, experts say that would segment the market into sick and healthy people. Insurance companies say that would destabilize the market and increase costs for people with pre-existing conditions.

But would insurers have to cover you if you have a pre-existing condition?

The plans that don’t meet the ACA’s requirements would not have to accept sick people, according to Larry Levitt, senior vice president at the Kaiser Family Foundation. And the bill would make it easier for states to waive requirements that insurance plans cover specific benefits, which could make it difficult for those with expensive health conditions to find affordable plans. Like the earlier version, the new bill would also still end the ACA's requirement that insurers spend a specific amount of the premiums they collect on benefits, instead of on profits, administration and other expenses

Would you still get help paying for deductibles and co-payments?

The bill would still sunset in two years cost-sharing subsidies for people who purchase insurance on an exchange. But it now includes an additional $70 billion – up from $112 billion – for states to reduce insurance costs in other ways. States would have to match the funds.

Could older people be charged more?

The bill would still eliminate the ACA's requirement that insurers can't charge older customers more than three times what younger customers pay for the same coverage. Instead, those in their 60s could be charged five times as much, or more.

Would young adults be able to stay on their parents’ plan?

The bill would not change the ACA’s rule that dependent children can stay on a parent's plan until age 26.

What happens to people on Medicaid?

If you are among the more than 14 million Americans who gained eligibility through the Affordable Care Act, you could still lose it. Enhanced federal funding for the low-income adults who became newly qualified under the ACA would be phased out, ending after 2024.

Federal support for traditional Medicaid would also still be scaled back. States, which pay a portion of the cost of Medicaid, would have to find new funding or cut the program through restricting enrollment, curbing benefits, reducing payments to health care providers or finding efficiencies.

The revised bill does include changes to the way hospitals are paid by the federal government to help cover the bills of the uninsured, which are expected to increase. And if a state has a health emergency, the extra spending needed would not count toward the state’s limit on federal Medicaid dollars.

Would you still be required to buy health insurance?

The bill still effectively removes the ACA’s requirement that most people buy insurance by eliminating the tax penalties for failing to do so. But those who have a gap in their insurance coverage have to wait six months before the can reapply.

What if you receive insurance through an employer?

The bill would still end the ACA’s penalties for larger employers who don't offer insurance to workers. The nonpartisan Congressional Budget Office has said fewer employers will offer coverage if that change is made.

What if you or a family member are struggling with addiction?

The revised bill increases funding to states for addiction services, including $45 billion instead of the $2 billion in the initial version. That’s how much GOP Sens. Rob Portman of Ohio and Shelley Moore Capito of West Virginia were seeking to help fight the opioid epidemic in their hard-hit states. But it could still fall short of what’s needed.

What would happen to coverage for abortion services?

As in the original version, insurance plans sold through the exchanges could not cover abortion services. There’s an exception for abortions performed to save the life of the mother, or to end a pregnancy that resulted from rape or incest.

What about services offered by Planned Parenthood?

The bill would also continue to block Planned Parenthood from receiving Medicaid funding for a year. The federal government already prevents Medicaid patients from receiving abortion services. But the bill would also block them from using Planned Parenthood for contraception, testing for and treatment of sexually transmitted diseases, and other services. GOP Sens. Susan Collins of Maine and Lisa Murkowski of Alaska oppose this provision.</s>A revised health care bill is set to be unveiled Thursday, as leaders in the Senate say they are working hard to get the 50 votes needed to repeal and replace the Affordable Care Act.

Senate Majority Leader Mitch McConnell said Wednesday he hopes to have the new bill scored by the Congressional Budget Office and up for a vote by next week. The “score” is a budget analysis of a piece of legislation.

The revised bill grew out of the controversy over the Senate’s first attempt to repeal the ACA, also known as Obamacare. A vote on that bill was canceled after it became clear that Senate leaders did not have the 50 Republican votes needed to pass the bill.

Senate Democrats have pledged not to vote for a GOP repeal of the ACA.

Here’s a look at what may be in the new bill.

1. What could be included in the bill is an amendment proposed by Sen. Ted Cruz, (R-Texas), and Sen. Mike Lee, (R-Utah), that gives insurance companies the option of offering less expensive health care plans that do not force customers to pay for the essential health benefits Obamacare required. Companies would be allowed to do that only if they provide at least one plan that includes those essential health benefits.

According to healthcare.gov, essential health benefits include, “doctors’ services, inpatient and outpatient hospital care, prescription drug coverage, pregnancy and childbirth, mental health services, and more. Some plans cover more services. Plans must offer dental coverage for children. Dental benefits for adults are optional. Specific services may vary based on your state’s requirements. You’ll see exactly what each plan offers when you compare plans.”

2. An increase in funds available to states to help deal with the problem of opioid abuse. In the new plan, $45 billion would be available to states. In the old plan, it was $2 billion.

What from the first Senate bill likely stays in the revised bill?

1. The ACA requirement that insurers cover specified services.

2. The plan to reduce funds for Medicaid (the health care program for the poor, disabled and those in nursing homes) would set a fixed amount to be given to states.

3.The plan to eliminate the ACA tax penalty on people who don't buy health care coverage.

4. The plan to cut federal subsidies for health care coverage.

5. The new bill will likely keep the ACA taxes that the first bill would have repealed. The taxes include a 3.8 percent tax on net investment income for high-income earners, a 0.9 percent Medicare surtax, and the “insurance executive tax break.”

The tax on net investment income imposes a 3.8 percent surtax on income a person gains from investments. It affects couples with more than $250,000 of adjusted gross income, and single tax filers with more than $200,000 of adjusted gross income.

The Medicare surtax is an additional Medicare tax for couples who make more than $250,000 and single tax filers who make more than $200,000.

The “insurance executive tax break” allows a health care insurance company to deduct from its taxes up to $500,000 of the pay of each top executive in the company.

The Senate will stay in session for the first two weeks in August, per orders from McConnell, to work on the health care legislation and other items.

Sources: The Associated Press; The Washington Post; taxfoundation.com; healthcare.gov.</s>The revised Senate GOP health care bill released Thursday maintains the one year prohibition against federal funding for Planned Parenthood that was included in the original version of the bill.

The provision prohibits federal funding of any organizations that provide abortions, except in instances of incest or rape or those in which the mother’s life is threatened.

The legislation keeps Obamacare subsidies until 2020 rather than adopting the tax credits implemented in the House passed health care bill, since limiting those tax credits to exclude abortion providers may have violated Senate budget rules.

While the one year defunding of Planned Parenthood and other abortion providers helped ensure support from the GOP’s conservative wing, it may imperil the bill’s prospects for success, as two centrist GOP senators cited Planned Parenthood defunding as a primary obstacle to their support.

Sens. Susan Collins of Maine and Lisa Murkowski of Alaska both voiced opposition to Planned Parenthood defunding after the release of the initial Senate health care bill. Murkowski has refrained from publicly expressing her opinion on the revised draft, while Collins has stated her opposition. (RELATED: Alaska Gets Special Treatment In Revised Health Care Bill)

Planned Parenthood, which relies on federal money for roughly 40 percent of their total funding, harshly criticized the GOP after the initial draft of the bill was released.

“If this is the Senate’s idea of a bill with heart, then the women of America should have fear struck in theirs. Slashing Medicaid and blocking millions of women from getting preventive care at Planned Parenthood is beyond heartless,” the Planned Parenthood statement reads. “One in five women in this country rely on Planned Parenthood for care. They will not stay silent as politicians vote to take away their care and their rights.”

In response to a request for comment, Planned Parenthood directed The Daily Caller News Foundation to a statement made by Planned Parenthood President Cecile Richards shortly after the revised draft was released.

“With this latest version of Trumpcare, Americans will pay more and get less, but women will pay the biggest price of all. This is, hands down, the worst bill for women in a generation, especially for low-income women and women of color,” the statement reads.

Content created by The Daily Caller News Foundation is available without charge to any eligible news publisher that can provide a large audience. For licensing opportunities of our original content, please contact .</s>In a departure from current law, the bill would allow insurers, under certain conditions, to offer health plans that did not comply with standards in the Affordable Care Act. Under that law, insurers sell regulated health plans through a public insurance exchange in each state.

A summary of Mr. McConnell’s bill, circulating on Capitol Hill, describes his proposal this way: If an insurer offered “sufficient minimum coverage” on the exchange that remains subject to federal mandates in the Affordable Care Act, it could also offer coverage outside the exchange that would be exempt from many of those mandates.

Policies that comply with the Affordable Care Act would provide more extensive coverage but would also attract sicker people with higher medical costs. To address this concern, the Republican bill would create a fund to make payments to insurers for the costs of covering high-risk people enrolled in health plans on the exchanges.

People who enroll in catastrophic health insurance plans would be eligible for federal tax credits to help pay premiums. Such plans typically have lower premiums and high deductibles. But under the Affordable Care Act, consumers generally cannot use the tax credits for such plans.

The bill would, for the first time, allow people to use tax-favored health savings accounts to pay insurance premiums. Republicans said this policy change would increase health care coverage.

The bill also provides $45 billion to help combat the opioid abuse crisis — a provision that is particularly important to two Republican senators who opposed the previous version of the bill, Rob Portman of Ohio and Shelley Moore Capito of West Virginia.

The new draft bill would not include any changes from current law to the net investment income tax or the additional Medicare payroll tax paid by certain high-income people. Nor would it change the limits on the tax deductions that insurers can take for salaries and other remuneration paid to top executives.

The Senate is, in effect, trying to catch up with the House, which on May 4 narrowly approved a bill to repeal and replace much of the Affordable Care Act.

To succeed, Mr. McConnell must win over almost all the holdouts in his caucus, a daunting and delicate task given the litany of complaints he faces and the sharp policy differences that he must find a way to bridge.

The revised bill is broadly similar to the earlier measure that Senate leaders hoped to vote on before the Fourth of July recess, though the new version includes some additional provisions meant to entice reluctant Republican senators with varying policy concerns.

Like the previous bill, it would end the requirement that most Americans have health coverage, and it would make deep cuts to Medicaid, capping payments to states and rolling back its expansion under the Affordable Care Act. Though some Republican senators expressed concern about how the previous bill would affect Medicaid, Senate leaders stuck with the same approach in the new version.

In a notable change, the bill would keep the two taxes imposed by the Affordable Care Act on people with high incomes: the 3.8 percent tax on investment income and the 0.9 percent payroll tax. The taxes apply to individuals with income over $200,000 and couples with income over $250,000.

Both of those taxes would have been repealed under the previous Senate bill, reducing federal revenue by about $231 billion over a decade, according to the congressional Joint Committee on Taxation.

Mr. McConnell is trying to avoid a repeat of his first attempt to push his bill through the chamber, when he was forced to delay a vote planned for late last month because of opposition from Republican senators.

Already, Senator Rand Paul of Kentucky has said he will vote against beginning debate next week, and Senator Susan Collins of Maine is viewed as likely to vote against it as well, though for different reasons. If one more Republican joined them, the bill could not even be considered.

During debate on the bill, senators are expected to propose numerous amendments on the Senate floor, some of which could modify provisions of the bill affecting Medicaid.

Republicans expect that an analysis of the new bill will be released by the nonpartisan Congressional Budget Office early next week. The previous bill would have increased the number of people without health insurance by 22 million in 2026 compared with the Affordable Care Act, the budget office found.

Mr. McConnell has said he intends to take up the revised bill next week, although it is unclear if he would try to move ahead if he did not know for sure whether he had the votes to begin debate — or to ultimately pass the bill.
The U.S. Senate releases a revised version of the American Health Care Act, the Better Care Reconciliation Act.