WASHINGTON • Senate Republican leaders have unveiled a fresh proposal to replace the Affordable Care Act (ACA), revising their Bill to help check insurance costs for consumers while allowing insurers to sell low-cost, stripped-down policies.
These changes and others - including a decision to retain two taxes on high-income earners - were intended to bridge a vast gap between the Senate's most conservative Republicans, who want less regulation of health insurance, and moderates concerned about people who would be left uninsured.
But Republican leaders will have to battle for votes before a final showdown that they hope will come next week.
Republican Senators Susan Collins of Maine, a moderate, and Rand Paul of Kentucky, a conservative, said they were not swayed - even on a procedural motion to take up the Bill for debate.
Several others, from both sides of the party's ideological spectrum, expressed misgivings.
Senator Mike Lee of Utah, a strong conservative, said, "The new Senate healthcare Bill is substantially different from the version released last month, and it is unclear to me whether it has improved."
But Republican moderates were upset by cuts to Medicaid, the health programme for low-income people. Senator Shelley Moore Capito of West Virginia, a more moderate voice, expressed "serious concerns about the Medicaid provisions" in the latest draft, as did Senator Rob Portman of Ohio.
NO CLEAR IMPROVEMENT
The new Senate healthcare Bill is substantially different from the version released last month, and it is unclear to me whether it has improved.
SENATOR MIKE LEE OF UTAH, a strong conservative.
"I want to make sure that, with regard to those people who are currently getting coverage under Medicaid expansion, we have some options for them," said Mr Portman.
Two other Republican senators, Ms Lindsey Graham of South Carolina and Mr Bill Cassidy of Louisiana, went on television to promote their own plan, just minutes before Senate leaders offered their latest.
With 52 Republicans in the Senate, and two firm "no" votes already, another defection would doom the Bill and jeopardise the Republicans' seven-year quest to dismantle a law that has become a pillar of former president Barack Obama's legacy.
Democrats probed for weaknesses in the Republican ranks.
"The Republican Trumpcare Bill still slashes Medicaid," said Senator Chuck Schumer of New York, the Democratic leader. "The cuts are every bit as draconian as they were in the previous version - a devastating blow to rural hospitals, to Americans in nursing homes, to those struggling with opioid addiction and so many more."
If enacted, the Bill would mark a sharp departure from more than half a century of efforts by Congress and the presidents of both parties to expand health insurance coverage, through a patchwork of federal programmes.
Repealing the ACA, dubbed Obamacare, is a high priority for President Donald Trump and House Republicans, who passed their own version of a repeal Bill on May 4. Republicans say they are trying to stabilise insurance markets and rescue consumers who face sky-high premiums and deductibles on ACA exchanges.
But the narrowly divided Senate is proving even harder to deal with than the House, which also struggled with its ACA repeal.
Overall, the new version of the Senate Bill made broad concessions to conservative Republicans who had said the initial draft left too much of the ACA in place. Senator Mitch McConnell of Kentucky, the majority leader, then backfilled the Bill with money intended to placate moderates. The resulting mix left neither side completely satisfied.