(Bloomberg) – The latest plan by Senate Republicans to repeal and replace the Affordable Care Act would increase the number of uninsured Americans by 22 million in a decade, presenting a political obstacle as Majority Leader Mitch McConnell tries to shore up support for an effort that looked dead earlier this week.

The bill, called the Better Care Reconciliation Act, would raise costs for many people in private insurance coverage and slash Medicaid spending, the Congressional Budget Office said on Thursday. The number of people expected to be left uninsured is in line with CBO’s analysis of an earlier version of the bill.

The measure scored by CBO didn’t include a proposal backed by Texas Senator Ted Cruz designed to give individuals more coverage options but which insurers have said would undermine insurance markets and end protections for sick people.

The Cruz amendment could still be included later. It wasn’t in the most recent version of the bill because it’s not being scored by the CBO yet, said a Republican aide.

Money to Spend

The Senate bill reduces the deficit by $420 billion, the CBO said, compared with the $321 billion in deficit reduction in an earlier version, giving Republican leaders additional money they can use to court holdout votes. Much of the increased funding comes from a decision to no longer cut taxes on the wealthy.

One use of the funds may be to provide extra money to states to help move poor people from Medicaid coverage and on to private insurance plans. Seema Verma, the head of the Centers for Medicare and Medicaid Services, proposed that idea to some GOP senators on Wednesday night, Alaska Senator Dan Sullivan said. Sullivan said Verma called it a “wraparound” plan to provide extra help on the individual market for lower-income people.

Such a plan would be similar to the cost-sharing reductions that are currently in the ACA, and that lower out-of-pocket costs for people making between 100% and 250% of the poverty level. The GOP plan would end that help. Legislative text or policy details of Verma’s plan haven’t been made public, and it isn’t clear that there’d be enough funding in the bill to help all the low-income people who’d be moved off Medicaid maintain similar coverage to what the ACA provides.

Cuts to Medicaid account for much of the insurance losses, and may pose McConnell’s biggest challenge among moderate members of his party. The bill reduces federal spending on the health-insurance program for the poor by $756 billion over a decade, which would result in 15 million fewer people enrolled in the program in 2026, compared with current law.

The earlier version of the Senate bill cut Medicaid by $772 billion, with similar losses in coverage. Much of the rest of the coverage losses come from the individual market, where the Senate bill reduces the subsidies available to help people buy coverage.

Bloomberg News