From both sides of the Atlantic, President Donald Trump and other administration officials lobbied Republicans Friday to support the Senate GOP's reworked health care bill, with the president saying wavering senators "must come through" to keep the measure from collapsing.
But the bill, repealing much of President Barack Obama's health care overhaul, hovered near failure as Senate Majority Leader Mitch McConnell strained to keep more Republicans from deserting. Complicating the effort, Ohio GOP Gov. John Kasich called the revised measure "still unacceptable," largely because of its cuts to Medicaid, the same concern that's been voiced by Ohio Republican Sen. Rob Portman, one of the holdouts.
McConnell, R-Ky., released the measure Thursday, a plan that caps seven years of his party's promises to obliterate Obama's 2010 law.
But two GOP senators immediately said they'd vote "no" on a crucial vote planned for next week. Facing uniform Democratic opposition, a third Republican defection would sink it — a reality not lost on Trump.
"After all of these years of suffering thru ObamaCare, Republican Senators must come through as they have promised!" the president tweeted from Paris, where he was attending Bastille Day ceremonies.
Also under pressure, indirectly, was Sen. Dean Heller, R-Nev., who opposed McConnell's initial bill last month, also citing its Medicaid reductions. Heller, who faces a tough re-election next year, has stood arm-in-arm with his state's popular GOP Gov. Brian Sandoval in opposing cuts to that program for the poor, disabled and nursing home patients.
In an interview Friday, Sandoval said his initial understanding of the new bill was that it "really doesn't change the dynamic" about the Medicaid cuts, and "that's a big concern for me."
Sandoval said he expected to meet privately with Vice President Mike Pence and Health Secretary Tom Price at governors' meetings he is attending in Providence, Rhode Island, and had already heard from both men. Republicans consider winning over Sandoval a key to gaining Heller's vote.
The nation's largest doctors' group dealt another blow Friday, saying the plan falls short on coverage and access, particularly for low-income people on Medicaid. The American Medical Association said Medicaid cuts and "inadequate subsidies" will lead to "millions of Americans losing health insurance coverage."
The AMA said GOP leaders took a "positive step" by adding $45 billion for treatment to help victims of the opioid epidemic. But it pointed out that people dealing with addiction also need regular health insurance, and that many would lose it if Republicans succeed in rolling back Medicaid financing.
McConnell's reworked bill aims to win conservatives' support by letting insurers sell low-cost, skimpy policies. At the same time, he seeks to placate hesitant moderates by adding billions to combat opioid abuse and help consumers with skyrocketing insurance costs.
Moderate Republican Sen. Susan Collins of Maine told reporters she had informed McConnell she would be voting against beginning debate on the bill, citing in part cuts in the Medicaid health program for the poor and disabled. Sen. Rand Paul of Kentucky, who has repeatedly complained that McConnell's efforts don't amount to a full-blown repeal of Obama's law, also announced he was a "no."
Texas Sen. John Cornyn, the No. 2 Senate GOP leader, said in an interview he is hoping for the climactic vote Tuesday or Wednesday. "I'm optimistic we'll get there," he said of prevailing.
McConnell could cancel next week's vote if he's short of support, something he did last month when his original legislation was headed toward defeat. He and other GOP leaders are urging senators to at least vote in favor of opening debate, which would open the measure up to amendments.
Like legislation earlier passed by the House after struggles of its own, the Senate bill would get rid of the law's mandates for individuals to buy insurance and for companies to offer it, repeal taxes and unwind the Medicaid expansion created by the Affordable Care Act. Analyses by the Congressional Budget Office have found the House bill and the earlier Senate version both would eliminate insurance coverage for more than 20 million people over the next decade.
The new bill contains language demanded by conservative Sen. Ted Cruz of Texas letting insurers sell plans with minimal coverage, as long as they also sell policies that meet strict coverage requirements set by Obama's 2010 statute.
The retooled measure retains McConnell's plan to phase out the extra money 31 states have used to expand Medicaid under Obama's statute, and to tightly limit the overall program's future growth.
The rewritten package would add $70 billion to the $112 billion McConnell originally sought that states could use to help insurers curb the growth of premiums and consumers' other out-of-pocket costs. And it has an added $45 billion for states to combat the misuse of drugs like opioids.
Associated Press writers Ricardo Alonso-Zaldivar, Mary Clare Jalonick, Julie Bykowicz, Matthew Daly and Kevin Freking in Washington, Jennifer McDermott in Providence, Rhode Island, and Julie Carr Smyth in Columbus, Ohio, contributed to this report.