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ASHINGTON — In a high-stakes bid for conservative support, Senate Majority Leader Mitch McConnell has agreed to demands from Republican Sen. Ted Cruz of Texas to allow insurers to sell low-cost, skimpier plans as part of a new but still-reeling health care bill he was releasing Thursday, GOP aides said.

However, including that provision seems likely to alienate moderates and perhaps other conservatives as the party struggles to unite behind a plan to scuttle much of the Obama health care law. Sen. Mike Lee of Utah, who’d partnered with Cruz, tweeted that the version they crafted wasn’t in the bill, adding, “Something based on it has, but I have not seen it or agreed to it.”

Cruz’s original proposal would let insurers sell plans with minimal coverage, as long as they also sell policies that meet strict coverage requirements set by Obama’s 2010 statute. Moderate Republicans have objected to the idea, arguing it would make policies excessively costly for people with serious illnesses because healthy people would flock to the cheaper coverage.

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The maneuvering by McConnell, R-Ky., came as he unveiled his plan at a closed-door meeting of GOP senators. He was laboring to prevent losing a showdown vote next week on the legislation, a vote in which he has no margin for error. Since Democrats uniformly oppose the effort, McConnell needs the votes of 50 of the 52 GOP senators to prevail, and two already seem certain to vote “no” — conservative Sen. Rand Paul of Kentucky and moderate Sen. Susan Collins of Maine.

McConnell also faces pressure from President Donald Trump, who has warned he will be “very angry” if the majority leader doesn’t deliver.

According to GOP aides and lobbyists, McConnell’s revamped bill includes what seemed a blow to moderates seeking to protect Medicaid, the federal-state program for the poor, disabled and nursing home patients.

They said 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. Since its creation in 1965, the program has provided open-ended federal funds to help states pay the program’s costs.

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.

It also has $45 billion for states to combat the misuse of drugs like opioids. That’s a big boost from the $2 billion in the initial bill and an addition demanded by Republicans from states in the Midwest and Northeast that have been ravaged by the drugs.

To help pay for the added spending, the measure would retain three tax increases Obama’s law slapped on higher- earning people to help finance his law’s expansion of coverage. Under the current statute, families earning more than $250,000 annually got a 3.8 percent boost on their investment income tax and a 0.9 percent increase in their payroll tax. Obama also imposed a new tax on the salaries of high-paid insurance executives.

The revised bill would also allow people to use money from tax-favored health savings accounts to pay health insurance premiums, another favorite proposal of conservatives.

The details were described by people who spoke on condition of anonymity because they weren’t authorized to describe the legislation publicly before its release.

Many details on the Cruz amendment were not clear. Adding to the uncertainty, the aides and lobbyists said the Cruz provision would appear in the legislative text in brackets, meaning the specific language was still being composed. That could give McConnell, Cruz and other conservatives time to work out a provision with broader support.

In an interview Wednesday with the Christian Broadcasting Network’s “The 700 Club,” Trump said he will be “very angry” if the Senate fails to pass the health care measure and said McConnell must “pull it off.”

McConnell’s new bill was expected to offer only modest departures from the original version, which he yanked off the Senate floor two weeks ago to avoid certain defeat at the hands of a broad range of unhappy Republicans.

The reworked measure’s key elements remain, easing Obama’s requirements that insurers cover specified services like hospital care and cutting the Medicaid health care program for the poor, disabled and nursing home patients. Obama’s penalties on people who don’t buy coverage would be eliminated and federal health care subsidies would be less generous.

Paul told reporters the revised measure has nothing “remotely resembling repeal.”

Collins has long complained the measure will toss millions off coverage. Spokeswoman Annie Clarke said Collins would vote “no” next week “if the Medicaid cuts remain the same” as those that have been discussed.

Besides Paul and Collins, other Republican senators have also been noncommittal on whether they will back McConnell’s bill next week, including Tim Scott of South Carolina and Rob Portman of Ohio.

AP reporters Erica Werner, Jill Colvin, Matthew Daly and Ricardo Alonso-Zaldivar contributed to this report.

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  • I like the Cruz amendment. I have three genetic disorders which are, at this time, untreatable by the medical field. Any treatment I use is an out of pocket expense to me. To say that I have to pay for everyone else AND my own is unfair. I would carry catastrophic insurance, and take care of what I have to do by myself. I don’t want or need a government agency telling me how to receive my care. I don’t have a lot of affordable options except prevention. All I want is for the government to stay out of my life as much as possible. I don’t ask for anything, I take personal responsibility for my choices, and I don’t want the interference from people who have no idea how to tratment me. I am fine with knowing I will probably die sooner from two of the three, but I have also prepared my family and taken care of my end of life care. Why do I have to pay for people I consider reckless? The cheapest form of birth control is to say no with a baby aspirin between my knees. Teach that and personal responsibility, and hold men accountable for children they conceived. Obesity is NOT a disease…look up the definition. Addiction is, but is more rare. It is highly preventable in most cases. ED is not life threatening and should not be covered under a public program. Stop trying to use cookie cutter medicine. Many vaccines are a matter of opinion and are often more about kickbacks and misinformation than individual needs. It is reckless to treat humans as a “herd” and compromises our immune system in the process. Bottom line: stay out of my life.

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