The nonpartisan CBO estimated that 14 million Americans could lose their insurance next year under the Republican’s Obamacare-replacement plan, a dire picture of the bill’s effects that could hurt the party heading into the 2018 congressional elections.

At the same time, insurance premiums will continue to rise in the near term, especially for older Americans. As the bill now stands, older, poorer Americans will have far less help from Republican tax credits starting in 2020 than they get through Obamacare subsidies.

‘Older, rural Americans’

“We have to do something about the fact that the House bill disproportionately affects older, rural Americans,” Republican Senator Susan Collins of Maine said on NBC’s “Meet the Press” on Sunday.

Related: Rural America biggest beneficiary of ACA, studies show

Ryan didn’t say whether he had the 218 votes necessary to pass the bill, which would replace President Barack Obama’s signature Affordable Care Act, but he said he feels “very good about where we are.”

“We’re still having conversations with our members,” Ryan said. “We’re making fine-tuning improvements to the bill to reflect people’s concerns.”

Asked on Fox News Channel’s “Sunday Morning Futures” whether the bill would pass the House on Thursday, Republican Representative Cathy McMorris Rodgers of Washington said, “We’re definitely moving in the right direction” and “I am confident we will come together.”

Trump told reporters aboard Air Force One on Sunday that efforts to sell the bill are “going well, had a lot of meetings on that.” Trump met with Vice President Mike Pence and senior staff this weekend, and chief strategist Steve Bannon conferred with Republican senators Ted Cruz of Texas and Mike Lee of Utah, as well as Republican Representative Mark Meadows of North Carolina, chairman of the House Freedom Caucus, according to a White House aide.

Related: Rural hospitals hurt by lack of Medicaid expansion, study says

Ryan said that proposed changes to the health-care system that would occur outside of the bill also would lower payments. Health and Human Services Secretary Tom Price also said regulatory changes in particular could increase competition in markets.

“We’ve had insurers tell us not only will we stay in the market, we’ll get back in the market,” Price said Sunday on ABC’s “This Week.”

Senator Tom Cotton of Arkansas, a Republican critic of the bill who’s said voting for the measure as written may imperil the party’s majority in the Huse in the 2018 midterm elections, said he didn’t believe the bill would lower premiums for working people.

“It’s fixable, but it’s going to take a lot of work,” Cotton said on CNN’s “State of the Union.” “We need to roll up our sleeves and focus on fixing those problems, rather than trying to rush to some arbitrary deadline.”

Red areas

House Democratic Leader Nancy Pelosi said Obamacare can be improved and Republicans could work with Democrats to do that. Instead, she said, the bill championed by Republicans would hurt “millions of people who are benefiting” from the current law who voted for Trump, and hand tax breaks to wealthy people in regions that voted for Democrat Hillary Clinton.

“That money will be taken from red areas, and many of the people who will be advantaged by the money going to the high end will be in blue areas,” the California lawmaker said on CBS News’s “Face the Nation.” “How’s that? It’s so wrong.”

Mick Mulvaney, the White House budget director, said Trump voters and everyone else would be better off under the Republican bill. It provides tax-credit assistance and would spur increased competition to reduce costs, he said.

“We know who his voters are. And we’re going to take care of them,” Mulvaney said on CBS. “But that doesn’t mean we’re leaving Obamacare in place because that would actually hurt them dramatically.”