Ms. Collins and Senator Rand Paul of Kentucky said on Thursday that they are opposed to the current version of the bill, so Mr. McConnell can’t afford to lose anyone else. The question now is, has he done enough to win over senators like Dean Heller of Nevada, Lisa Murkowski of Alaska, Shelley Moore Capito of West Virginia and Rob Portman of Ohio? The answer is most likely no. The changes meant to appeal to them amount to crumbs. For example, the new version includes $45 billion to help states fight the opioid epidemic. Gov. John Kasich of Ohio, who opposed the original bill, has said that this level of federal spending on this huge problem would be “like spitting in the ocean.”

Mr. McConnell is also trying to make his legislation look less extreme by continuing some of the taxes from the A.C.A., or Obamacare, rather than jettisoning them all. But this is not a big improvement, because a majority of the taxes in the Obama-era law that helped pay for expanded health coverage would still be lost. In addition, the revised bill would expand the use of tax-free health savings accounts, which primarily benefit rich families.

The biggest losers in the new bill are the sick. A provision by Mr. Cruz would let insurers discriminate against people with pre-existing conditions. And they would be allowed to sell plans that do not cover essential services, which would be cheaper and attract healthier people. They would still have to offer comprehensive plans to everyone, but those policies would cost a lot more because they would attract sicker patients. That is why the American Cancer Society’s Cancer Action Network said the bill “would significantly weaken the ability of millions of cancer patients, survivors and those at risk for the disease to find and afford adequate, meaningful health care coverage.”

Mr. McConnell wants to hold a vote on his legislation early next week. Congressional aides say he might even proceed before the C.B.O. can analyze all the changes. Senators who vote for this bill will send a simple message to their constituents: Get sick, and you are on your own.