Arizona's John McCain and Kentucky's Rand Paul, said they will vote no. McConnell can't afford another defection since no Democrats support the bill. At deadline, McConnell's office did not respond for comment to confirm that a vote is still on track, nor did officials from the office of Sen. Bill Cassidy, one of the bill's co-authors.
As of Friday, Kansas' Jerry Moran, Ohio's Rob Portman, and West Virginia's Shelley Moore Capito had not indicated how they will vote. Nor had Alaska's Lisa Murkowski, who helped dash the last attempt at repeal. Maine's Susan Collins is a likely no vote.
"I believe we could do better working together, Republicans and Democrats," McCain said Friday. "Nor could I support it without knowing how much it will cost, how it will effect insurance premiums and how many people will be helped or hurt by it."
The Congressional Budget Office said it could only issue limited estimates on how the bill would affect deficits in time for a vote this week, not on coverage or premiums.
"We've seen this movie before, and sequels haven't been doing that well at the box office lately," said Tom Miller, a conservative health policy analyst at the American Enterprise Institute.
Many senators are nervous about the bill's big projected cuts in funding to their states. It would convert the ACA's funding for premium and cost-sharing subsidies into $1.2 trillion in state block grants through 2026 and let them design their own systems, with few limitations on how they could use the money. There is no provision for funding the block grants after 2026.
States that expanded Medicaid and saw large enrollment in ACA marketplace plans would suffer the biggest losses. Many of those states are represented by GOP senators whose votes are pivotal to passing the bill.
Under the bill, states could let insurers offer plans with fewer benefits than the ACA requires, such as coverage for maternity care, behavioral health and prescription drugs. They also could let insurers charge higher premiums for people with pre-existing conditions.
States would have to end their Medicaid expansion programs for low-income adults in 2020. Starting that year, federal payments for the traditional Medicaid program would be capped and cut, with per-capita payments growing more slowly than the rate of medical inflation after 2024. The Center for Budget and Policy Priorities estimated that Medicaid spending would fall by $175 billion between 2020 and 2026, and by far more in later years.
The ACA's individual and employer mandates would be abolished immediately, which critics say would quickly disrupt the market by prompting younger, healthier people to drop coverage. The ACA's taxes would be preserved with the exception of the 2.3% levy on medical-device sales.