U.S. Senate Republicans on Monday released changes to their healthcare bill to replace Obamacare, adding a measure that would penalize those who let their insurance coverage lapse for an extended period, following criticism that the original bill would result in a sicker - and more expensive - insurance pool.
President Donald Trump and his fellow Republicans in Congress have been pushing to repeal and replace Obamacare, Democratic former President Barack Obama's signature domestic legislation.
The Senate bill unveiled last week was immediately criticized by both conservatives and moderates in the party, casting doubt over whether Republicans could win passage. They have only a 52-seat majority in the 100-seat Senate.
There were no signs yet if the revisions to the bill would sway any Republicans who had opposed the original measure.
Senate leaders want to hold a vote on the bill before the July 4 recess that starts at the end of this week.
But in another blow to the bill, the American Medical Association (AMA), the country's largest association of physicians, announced Monday that it opposed the legislation.
The nonpartisan Congressional Budget Office is to release its assessment of the bill's cost and impact on future budget deficits later on Monday.
The original Senate bill had dropped the Obamacare penalty on those who do not have insurance. Experts had warned that canceling the fine could lead to a sicker insurance pool because young and healthy people would not face consequences for failing to purchase insurance.
The revised bill imposes a six-month waiting period for anyone who lets their health insurance lapse for over 63 days and then wants to re-enroll in a plan.
The version of a healthcare bill passed by the Republican-majority House of Representatives last month includes a provision also aimed at those who let their insurance lapse for more than 63 days, allowing insurers to charge a 30 percent penalty over their premium for one year.
Senate Democratic Leader Chuck Schumer offered harsh criticism over the Senate Republicans' new provision for a waiting period, saying in a statement that tens of millions of Americans experience a gap in their healthcare coverage every year because of job losses or temporary financial problems.
The provision "would pour salt in that wound, locking American families out of health insurance for even longer, thanks to this six-month ban provision," Schumer said.
The AMA, in a letter to Senate leaders on Monday, said the Senate bill violated the doctors' precept of "first, do no harm."
The AMA said it was especially concerned with a proposal to put the Medicaid healthcare program for the poor on a budget. Doing so, it said, "could fail to take into account unanticipated costs of new medical innovations or the fiscal impact of public health epidemics, such as the crisis of opioid abuse currently ravaging our nation."
At least four conservative Republicans - Senators Ted Cruz, Rand Paul, Ron Johnson and Mike Lee - have expressed opposition to the draft legislation, saying it does not go far enough in repealing Obamacare.
Moderate Republican Senator Dean Heller said on Saturday that he could not support the Senate bill as written, and some other moderates have either withheld judgment or expressed doubts about replacing Obamacare with legislation that is similar to the House version.
They are concerned that the party's approach to healthcare would cause too many people, especially those with low incomes, to lose health coverage. Trump touted passage of the House bill as a victory but later called it "mean."
Republicans have targeted Obamacare since it was passed in 2010, viewing it as costly government intrusion and saying that individual insurance markets are collapsing. The legislation expanded health coverage to some 20 million Americans, through provisions such as mandating that individuals obtain health insurance and expanding Medicaid.
As he did during the House negotiations, Trump has personally pushed for a Senate bill, calling fellow Republicans to mobilize support.
White House spokesman Sean Spicer said on Monday Trump had "talked extensively to several Republican members over the weekend and he felt very positive about those discussions, but they're ongoing."
He said the president had talked to Cruz, Paul and Johnson, as well as Senator Shelley Moore Capito, "and I think several others."
Mizuho Securities analyst Sheryl Skolnick said in a research note that the addition of the six-month waiting period is "likely the first of several, albeit increasingly difficult 'fixes' the GOP leadership still need to make to the bill."
In the efforts by Senate Republicans to push through a bill, the party has split over a provision in the draft bill ending federal funding of Planned Parenthood, the women's healthcare provider, for one year.
Moderates are wary of this, while conservatives have called for an end to federal funding of Planned Parenthood because it provides abortions, even though they are not performed with taxpayer dollars.
Health insurance companies have expressed concern about the bill's plan to cut Medicaid and the impact on state governments as well as the prospect of losing Obamacare's mandate on individuals to buy insurance without creating alternative incentives for people to stay in their plans.
If the Senate passes a bill, it will either have to be approved by the House, the two chambers would have to reconcile their differences in a conference committee, or the House could pass a new version and bounce it back to the Senate.
(Writing by Richard Cowan and Frances Kerry; Additional reporting by Eric Walsh and Susan Cornwell; Editing by Jeffrey Benkoe and Leslie Adler)