Four Republican senators from the conservative wing of their party say they oppose the the Senate health-care bill as it was introduced by Senate Majority Leader Mitch McConnell on Thursday, which places the effort to overhaul the American health-care system in jeopardy as it heads for an anticipated vote in the Senate next week.

Those senators — Rand Paul of Kentucky, Ted Cruz of Texas, Ron Johnson of Wisconsin and Mike Lee of Utah — released a statement stating that while they cannot support the bill as its currently written, they are open to negotiating changes that could ultimately win their support.

McConnell introduced draft text — crafted behind closed doors among a small circle of lawmakers and aides -- of the Senate GOP bill in a private meeting with Republican senators on Thursday morning.

Initial signs indicated the bill could be in trouble if the Kentucky Republican intends to subject it to a vote before lawmakers leave Washington for the July 4 recess. According to two Republicans in close contact with Senate GOP leadership granted anonymity to describe private conversations, McConnell is threatening to bring the bill to a vote next week even if he doesn’t have the necessary votes.

One potentially ominous sign for leadership was the reaction of Nevada Sen. Dean Heller (R), who is up for reelection in 2018. Heller released a statement saying he has “serious concerns” about the bill’s Medicaid provisions.

The 142-page bill would curtail federal Medicaid funding, repeal taxes on the wealthy and eliminate funding for Planned Parenthood as part of an effort to fulfill a seven-year promise to undo Barack Obama’s signature health-care law.

It abolishes two of the law’s central mandates — that individuals must show proof of insurance when filing their taxes, and that firms with 50 workers or more must provide health coverage — while providing less money for moderate and low-income Americans buying insurance on the individual market.

Sen. Tim Scott (R-S.C.) said the mood in the room made for an “interesting morning, a little tense.” He was one of several Republicans who pushed for the Senate measure to be “more gracious” than the House bill, an aim he feels was satisfied. But Scott predicted there was “a long way to go” before concluding whether it could pass.

Senate leaders plan to move the bill to the floor after receiving an analysis from the nonpartisan Congressional Budget Office, which said Thursday it will do “early next week.” The CBO is expected to release a comprehensive estimate of how many people are expected to lose coverage as a result of the bill and how much it is expected to cost.

The CBO concluded the House bill would leave 23 million more Americans uninsured by 2026 than under current law, while also concluding that premiums would drop overall.

Like the House bill, the Senate measure would make big changes to Medicaid that in effect would reduce federal spending on the program. The Senate measure would cut off expanded Medicaid funding for states more gradually than the House bill by phasing out the higher federal match between 2020 and 2024, but would enact deeper long-term cuts to a program that ]provides health care coverage for 74 million Americans.

It also would eliminate House language aimed at prohibiting federally subsidized health plans from covering abortions, a provision that may run afoul of complex Senate budget rules.

While the House legislation would peg federal insurance subsidies to consumers’ age, the Senate bill would factor in income as well,as the ACA does. But younger people would still get more generous subsidies than they do under current law.

The measure would preserve two of the ACA’s most-popular provisions: insurers could not deny coverage based on preexisting conditions and children may stay on their parents’ plans until the age of 26. Insurers must set prices based on the overall insurance pool rather than charging sicker Americans more.

But the bill would allow states to use an existing ACA program, known as 1332, for states to file waivers with the Centers for Medicare and Medicaid Services to scale back what sort of plans insurers offer. Through these waivers states could eliminate elements of the ACA’s essential health benefits package, which includes preventive and maternity as well as newborn care, along with substance abuse and mental-health treatment. Such changes would make plans cheaper, though they could lead to higher out-of-pocket expenses for consumers.

Insurance subsidies are currently available to Americans earning between 100 percent and 400 percent of the federal poverty level. Starting in 2020, that threshold would be lowered to 350 percent under the Senate bill — but anyone below that line could get the subsidies if they’re not eligible for Medicaid.

In a move that will please the health-care industry, the Senate bill also proposes repealing all the ACA taxes except for its “Cadillac tax” on high-cost health plans in language similar to the House version. Senators had previously toyed with the idea of keeping some of the ACA’s taxes.

It would also eliminate Medicaid reimbursements for Planned Parenthood for one year. Federal law already prevents taxpayer funding to pay for abortions except to save the life of the mother or in the case of rape or incest. But some Republicans want to ban all federal funding for Planned Parenthood, which also provides health services such as birth control and preventive screening.

In a move that is critical to insurers, the Senate measure would continue to fund for two years cost-sharing subsidies that help 7 million Americans with ACA plans. House Republicans have challenged the legality of the $7 billion in subsidies — which help cover consumers’ deductibles and copays — in court, and insurers warned they would have to increase premiums dramatically next year unless the federal government commits to continuing the payments.

Outside criticism of the GOP effort has been mounting. The heads of 10 managed care organizations penned a letter to McConnell and Schumer this week saying they were “united in our opposition to the Medicaid policies currently being debated by the Senate.”

Courtesy the WaPo.