The nonpartisan CBO estimated that 14 million Americans could lose their insurance next year under the Republican's Obamacare-replacement plan, a dire picture for Republicans of the bill's effects heading into the 2018 congressional elections.
Sen. Ted Cruz, R-Texas, said he and two other conservative leaders - Sen. Health and Human Services Secretary Tom Price also said regulatory changes in particular could increase competition in markets.
Despite the tweaks Ryan said the bill needs, he added that he feels "very good" about the legislation's progress and where things now stand. It is not expected to garner any support from Democrats and at this point it is not clear if enough Republicans will back the legislation.
Those over 50 but not yet 65 - and thus eligible for Medicare, the federal health program for seniors - represent a major issue in forging an alternative to the ACA. Rep. Steve Scalise, R-La., the House's No. 3 Republican and the leader responsible for rounding up votes, wrote Sunday night to his whip team that the "next few days could define us for years to come".
Ryan questioned that analysis, suggesting that administrative actions taken by the Trump administration would further lower premiums and questioning whether the ACA would remain viable in a decade.
He has been wooing lawmakers to vote for the bill and won the backing of a dozen conservative lawmakers on Friday after an Oval Office meeting in which the president endorsed a work requirement and block-grant option for Medicaid. They also complain that the GOP bill's tax credits create an overly generous benefit the federal government can not afford.
At the same time, insurance premiums will continue to rise in the near term, especially for older Americans. That, according to the CBO estimate, leads to substantial cost savings that - together with cuts to Medicaid - allow the GOP plan to eliminate almost all of the taxes imposed under the ACA.
The White House and House Republicans have agreed that the bill will be amended to let states impose work requirements on some healthy Medicaid recipients. Rand Paul, R-Ky. Vice President Mike Pence was in Louisville earlier this month to build support for the Trump-backed bill.
"They still believe that the conservatives in their caucus don't want Obamacare Lite", he said.
Even if these revisions somehow manage to propel the ACHA through the House, it is unlikely that the bill will pass in the Senate in its current form. He cited Trump's hands-on involvement as a key factor is moving the legislation forward. "We're making fine tuning improvements to the bill to reflect people's concerns, to reflect people's improvements", he told Mr. Wallace, adding he is impressed at how President Donald Trump is "helping us close this bill".