A White House official said Republicans are still two or three votes away from being able to guarantee passage, adding that the conservative House Freedom Caucus can accept the new amendment.

Moderates still opposed

But several moderates, including Representatives Charlie Dent of Pennsylvania, Leonard Lance of New Jersey and Ileana Ros-Lehtinen of Florida said Wednesday they remain opposed even with the latest changes.

"I’m still a no," Lance said, adding Upton’s amendment isn’t enough to resolve his concerns about coverage for people with pre-existing conditions.

Even so, the reversals by Upton and Long give new energy to the GOP’s bill, which appeared to be short of the votes needed for passage, with a number of moderates opposed.

Since no Democrats are expected to vote for the bill, Republicans can only lose 22 Republicans if everyone in the House casts a vote.

Even if the bill makes it out of the House, it remains well short of the 50 votes it would need in the Senate. A number of senators are unhappy with an earlier Congressional Budget Office estimate showing it would result in 24 million more people without insurance within a decade and skyrocketing premiums for lower-income people, particularly those over the age of 50.

At least eight Senate Republicans have expressed significant reservations about different elements of the bill, including the recent changes related to pre-existing conditions, and GOP leaders can only afford to lose two votes.

White House optimism

The White House earlier signaled optimism, with budget director Mick Mulvaney telling Fox News on Wednesday that the chamber might vote on the health bill as early as Saturday. Mulvaney said he believes the amendment by Upton -- who became perhaps the most significant Republican defection yet on Tuesday -- will help draw moderates’ support for the legislation.

Upton’s amendment would provide $8 billion over five years to reduce premiums and other costs for those with pre-existing conditions who have a gap in coverage and reside in states that received waivers from some of Obamacare’s requirements under another provision in the bill.

Democrats immediately blasted the change, with Senate Minority Leader Chuck Schumer saying: “The proposed Upton amendment is like administering cough medicine to someone with stage 4 cancer."

AARP, the influential lobby that advocates for older Americans, says it remains opposed to the GOP bill, posting in a tweet that the Upton amendment is an "$8 billion giveaway to insurance companies; won’t help majority of those w/preexisting conditions."

Other Republicans haven’t seen details or text of the amendment, but health-care experts said the added funding is unlikely to make a big difference, unless very few states receive those waivers.

The $8 billion in funding is a “drop in the bucket,” said Matt Fiedler, a fellow at the Brookings Institution’s Center for Health Policy. He said the money, even including the bill’s stability fund and risk-pool funding, wouldn’t be enough to fully protect people with pre-existing conditions from facing higher costs.

The Center for American Progress, a progressive think tank in Washington, estimated that the Republican health bill, which includes about $130 billion over 10 years that could be used to help low-income Americans with pre-existing conditions, would fall about $20 billion short annually.

About 27 percent of adults have a pre-existing condition like cancer or heart disease that insurers refused to cover before Obamacare, said Larry Levitt, senior vice president for special initiatives at the Kaiser Family Foundation.

“There are millions with pre-existing conditions,” he said.

The latest efforts come after Ryan told Republicans Tuesday to “pray” as they try to win over holdouts. Representative Dennis Ross of Florida, a senior member of the House vote-counting team, described Republicans’ closed-door meeting and said they were about “five votes away” from the number needed to pass the bill.

Representative Phil Roe of Tennessee said Tuesday that GOP House members plan to hold a closed-door meeting Thursday to decide whether to proceed with a vote this week.

Upton Amendment

Upton’s defection was significant because until last year, he was chairman of the Energy and Commerce Committee, which has jurisdiction over much of health-care policy, and he has been a staunch supporter of Obamacare repeal.

Voters have confronted lawmakers at town hall-style meetings across the U.S. in recent weeks with their concerns about losing health insurance under the GOP plan, giving some moderate Republican lawmakers jitters about backing the measure.

Yet party leaders have pushed to create a sense of urgency among their members to make good on a years-long promise to repeal former President Barack Obama’s signature health-care law now that Republicans control Washington.

‘Now is the time’

“Now is the time,” House Majority Leader Kevin McCarthy told House Republicans on Tuesday, adding that they should be prepared to vote Wednesday or Thursday on the measure.

Ryan also tried to boost the pressure on Republican moderates to advance the bill. “This is who we are. This will define us,” the speaker told Republicans, according to Ross.

Upton on Tuesday cited the bill’s provision on pre-existing conditions as a reason for his defection. Under the bill -- prior to the amendment he is now working on -- states could allow insurers to charge higher premiums for people with pre-existing conditions who have had a gap in coverage of at least 63 days in the prior year. States could also let insurers charge older customers more than the original bill allowed -- at least five times more than younger ones, beginning in 2018.

“I told the leadership I cannot support the bill with this provision in it,” Upton said Tuesday. “It’s not going to get my ‘yes’ vote the way it is.”

Copyright 2018 Bloomberg. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.