Unless those holdouts can be swayed, their numbers are more than enough to torpedo the measure developed in private by Senate Majority Leader Mitch McConnell, R-Ky., and deliver a bitter defeat for the president. Several senators whose states embraced the Obamacare expansion of Medicaid expressed concerns that the bill may go too far.
If three Republicans defect, the party can not reach the majority vote it needs to pass the measure. Erasing Obama's law has been a marquee pledge for Trump and virtually the entire party for years, and failure would be a shattering defeat for the GOP.
A handful of Republicans - more than Mr. McConnell can afford to lose - were quick to disparage the measure. "And now the Senate doubling down on that I think means, it's extra mean".
"We have to send the message to our elected officials and we depend on our elected officials to champion our cause in Washington", said Pamela Clarke, the health center's CEO. She says she'd like to see a more open debate. The bill also makes major cuts and structural changes to Medicaid, a health insurance program relied upon by almost 75 million Americans - primarily low-income, disabled, and elderly. It would offer tax credits to help offset the cost of coverage, and eliminate most ACA taxes on corporations and higher-income Americans, according to an analysis by NPR News.
Either way, it's clear that this bill is not the one either party at the local level was hoping for.
Those senators are Ted Cruz of Texas; Ron Johnson of Wisconsin; Rand Paul of Kentucky; and Mike Lee of Utah. Three of them said they anxious it does not go far enough in repealing the ACA, known as Obamacare. As five conservatives are now against the bill.
Trump said the Democrats' theme is "resist" - which he interpreted as "obstruction" - and that "if it was the greatest bill ever proposed in mankind, we wouldn't get a vote" from them. "And we'll see if we can take care of that". She said she's focusing on senators who previously said they didn't want to cut Medicaid.
President Trump said, "Little negotiation, but it's going to be good".
The House approved its version of the bill last month. Reducing taxes, Republicans argue, will boost the economy, and shrinking spending on programs such as Medicaid will slow the growth of the federal debt.
Former Indiana State Health commissioner Woody Myers says the bill worsens an already-weakened health care situation after large insurers this week left Indiana's Obamacare marketplace - something Myers blames federal Republicans for. The legislation would phase out federal funding for Medicaid expansion - now covering about 11 million people in 31 states - beginning in 2020, and shift more of those costs back to states. Those additional funds would continue through 2020, then gradually fall and disappear entirely in 2024.