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Senate leaders on Wednesday were putting the final touches on proposed legislation that would reshape a big piece of the US health care system by rolling back Medicaid while providing a softer landing, compared with legislation passed by the House, to Americans who stand to lose coverage gained under former President Barack Obama's law. Obama's individual mandate requires that most Americans obtain and maintain health insurance or an exemption each month, or to pay a tax penalty.

Facing uniform Democratic opposition, the Senate plan would fail if just three of the chamber's 52 Republicans defect.

At the White House, Trump spoke of a bill "with heart". It would provide less generous subsidies for people than Obama's law but provide billions to states and insurance companies to buttress markets that in some areas have been abandoned by insurers. "The whole process is not satisfactory", the Arizona senator said.

The number of years it will take to phase out federal funding for that Medicaid expansion under the Senate Republicans' plan.

"I gotta tell you, the fights on Medicaid, there are a whole bunch of Republicans that are arguing we need to spend more, more, more, more, more, who frankly sound like Democrats", Cruz said.

As part of that campaign, Senate Democrats held a hearing on Tuesday with health care providers and other experts to show how the Republican bill would "devastate" rural communities, depriving people of Medicaid coverage and putting rural hospitals at risk of closure. "Surely we can do better than what the Republican health care bill promises", said Senate Minority Leader Chuck Schumer, D-N.Y.

Republicans say that federal regulations unfairly restrict consumer choice.

Conservative Republican Senator Rand Paul, who wants a full repeal of Obamacare, said he feared that with the legislation being developed, "we're actually going to be replacing Obamacare with Obamacare", referring to the continuing role of government.

Ending Obama's expansion has been a major problem for some GOP senators.

Thirteen senators - none from New Mexico - have been meeting behind closed doors ever since the American Health Care Act passed the House of Representatives in May, making changes to the bill.

The bill seeks to allow states to loosen some of the ACA's insurer mandates, such as the Essential Health Benefits, which mandate the 10 broad coverage areas insurers must offer.

Now that the bill is public, a review from the bipartisan Congressional Budget Office is expected in the coming days.

Unlike the House bill, which bases its subsidies for private insurance on age, the Senate bill uses age and income. Unlimited federal dollars now flow to each state for Medicaid, covering all eligible beneficiaries and services.

Lawmakers will be "looking to see if there are things that we can do to refine it, and make it more acceptable to more members in our conference, to get to 50", Senator John Thune said. She says the protesters rely on Medicaid to help them live and she says the health bill amounts to "tax cuts for the wealthy on the backs of people with disabilities".

The draft bill proposes repealing the 3.8 percent net investment income tax on high earners retroactively to the start of 2017, not at some point in the future, as some analysts had speculated. They also identify trouble with Obamacare's insurance markets, which have been plagued by rising premiums and the departure of insurers (though the Trump administration is to blame for the latest palpitations, because it has threatened to cut off payments to insurers that are crucial to Obamacare's design).


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