The push to repeal and replace Obamacare seemed likely to fail yet again as many House Republicans on Tuesday expressed unease with how the proposed legislation would affect people with pre-existing conditions.

In a reversal of the dynamic when Republicans last attempted to repeal Obamacare in March, the new plan has received backing from the Freedom Caucus, a recalcitrant group of arch-conservatives who are more often associated with spoiling the GOP leadership’s agenda than supporting it. This time around a significant number of the holdouts are moderates who are making a rare break with the leadership to oppose the legislation.

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The current bill would allow states to waive provisions that require insurers to cover “essential health benefits”, which include maternity, prescription drug treatment and mental health care. It also allows removes protections that guarantee people with pre-existing medical conditions will not be charged higher rates.

Republicans disagree publicly about how the new amendment will affect Americans with pre-existing conditions. Paul Ryan, the House speaker, has stated that sicker Americans would be “better off” under the Republican healthcare plan, and promised that there are a “few layers of protections for pre-existing conditions in this bill”. But the bill is opposed by a coalition of influential advocacy groups, including the American Medical Association.

These changes have alienated previously loyal members of the Republican caucus. On Tuesday, Fred Upton of Michigan, the former chairman of the House energy and commerce committee, announced his opposition to the new version of the healthcare plan, saying an amendment added to appease conservatives “torpedoes” protections for people with pre-existing health conditions.

“I’m not at all comfortable with removing that protection,” Upton said during an interview on a local radio show, WHTC on Tuesday morning. He added: “I cannot support this bill with this provision in it.”

Upton is well respected among fellow Republicans for his expertise on healthcare policy, and has been a leader in past GOP efforts to repeal and replace Obamacare. His defection is viewed as a bad sign for the legislation’s prospects. At least 20 Republicans have publicly stated their opposition to the bill and several more remain undecided. House Republicans can only afford to lose 22 votes and pass the bill, assuming all Democrats oppose the measure.

Upton’s loss follows a surprising defection by Billy Long, a Republican from Missouri and a longtime supporter of the president, who said on Monday that he could not support the bill. “I have always stated that one of the few good things about Obamacare is that people with pre-existing conditions would be covered.”

While moving the bill to the right helped Republicans gain support from members of the Freedom Caucus, it further alienated moderates who are well aware that the current bill is likely to be drastically changed in the Senate.

“There is a concern that this is going to be a model to try to placate the hard right and get these bills out of the House knowing that they have an uncertain fate in the Senate,” said Charlie Dent of Pennsylvania.

Dent, the leader of the center-right Tuesday Group, added: “It just further exposes members of marginal districts politically because we know darn well that the bill on the rebound from the Senate won’t satisfy those on the hard right. All this political capital is being expended on the first launch knowing damn well that the only battle that matters is the last one won’t get the support of those very same people.”

Tom MacArthur of New Jersey, a co-chair of the Tuesday Group who helped craft the current compromise that won over the far-right Freedom Caucus with an amendment that would allow states to waive key pieces of the healthcare law, dismissed any efforts to throw in additional funding to woo wavering Republicans.

McArthur said: “I think the question is more fundamental for people: are they comfortable with this balance, of this is the best way to protect the vulnerable and cut expenses. If they’re not, you can throw billions here and billions there and it’s probably not going to move anyone. I don’t think money is the answer now.”

The Republican leadership said on Tuesday it was “close” to securing the 216 votes needed for the bill to pass, but still had more corralling to do. Ryan has said he will not schedule a vote until the bill has enough support to pass.

However, Ryan’s efforts have been complicated by White House efforts to project confidence about the bill’s prospects – and Trump’s offhand remarks about the legislation. Top Trump aide Gary Cohn said on Monday that “we’re convinced we have the votes” and in an interview with Bloomberg News, Trump insisted, inaccurately, “it will be every bit as good on pre-existing conditions as Obamacare” and said the legislation was “not in its final form”.

The Republican leadership is also working against rapidly changing public sentiment on the law in addition to an onslaught of political attack ads, opposition from the left and even an emotional plea from late-night host Jimmy Kimmel.

Play Video 2:03 Jimmy Kimmel reveals newborn son’s surgery in healthcare plea – video

On his Monday night show, Kimmel delivered a heartfelt monologue on the importance of affordable healthcare, especially for people with pre-existing conditions. He told the audience that his son was born last week with a heart defect. The doctors performed surgery and the operation was successful.

“Before 2014, if you were born with congenital heart disease like my son was, there was a good chance you’d never be able to get health insurance because you had a pre-existing condition,” Kimmel said.

“You were born with a pre-existing condition. And if your parents didn’t have medical insurance, you might not live long enough to even get denied because of a pre-existing condition. If your baby is going to die, and it doesn’t have to, it shouldn’t matter how much money you make. I think that’s something that, whether you’re a Republican or a Democrat or something else, we all agree on that, right?”

Barack Obama, whose signature legislative achievement was the passage of the 2010 law, commended Kimmel on speaking out. “Well said, Jimmy,” Obama wrote on Twitter. “That’s exactly why we fought so hard for the ACA, and why we need to protect it for kids like Billy. And congratulations!”