President Trump has called for an injection of what he called “heart” into the US Senate’s healthcare bill, as at least eight Republican senators continue to express doubts about the deal ahead of a critical vote this week.



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In an interview with Fox News’ Fox and Friends on Sunday, Trump admitted that he had described as “mean” the House bill to dismantle Barack Obama’s Affordable Care Act (ACA), which narrowly passed last month. He said “mean” was “my term, because I want to see – and I speak from the heart, that’s what I want to see – I want to see a bill with heart”.

As negotiations within the deeply divided group of Republican senators enter their decisive final stages, Trump professed to be tentatively confident that agreement would be reached.

“I don’t think they’re that far off,” he said. “Famous last words, right? But I think we’re going to get there. Can’t promise. I think we’re going to get there.”

As no Democrat will side with the bill, Republicans will be able to accommodate the opposition of just two of their 52 senators. Senate majority leader Mitch McConnell is facing a daunting task. The challenge is all the more onerous as conservative qualms about the bill are themselves cleft into two hostile camps.

From the right of the party, four senators – Ted Cruz, Ron Johnson, Mike Lee and Rand Paul – are expressing their intention to vote against the bill on grounds that it does not go far enough in unpicking the ACA, known colloquially as Obamacare. Johnson, from Wisconsin, went as far as to tell NBC’s Meet the Press that this week’s vote should be postponed.

“I don’t have the feedback from constituencies who will not have had enough time to review the Senate bill,” he said. “We should not be voting on this next week.”

Paul, from Kentucky, told ABC’s This Week he was willing to back a partial repeal of the ACA, but only if the current Republican draft were rewritten to remove what he described as “big government programs” and increase individual freedoms.

“I’m not voting for something that looks just like Obamacare and still doesn’t fix the fundamental flaws,” Paul said.

On the other, moderate side of the Republican divide, at least another four senators – Susan Collins, Cory Gardner, Dean Heller and Lisa Murkowski – are also showing signs of deep skepticism that could crystallize into “no” votes. Their hesitations are focusing in on provisions to cut more than $800bn from the Medicaid budget by phasing out the expansion of the program that had brought healthcare coverage to an extra 11 million adult Americans.

The removal of such a massive swathe of subsidy could have devastating effects on vulnerable groups such as older people in nursing homes, individuals struggling with opioid addiction and those with disabilities.

Trump’s White House counselor, Kellyanne Conway, made a rare return to the Sunday political shows to claim on ABC that the $800bn cut to Medicaid was not in fact a cut but a change in projections.

“We don’t see them as cuts, it’s slowing the rate of growth in the future and getting Medicaid back to where it was,” she said.

Such Orwellian word games are not likely to be enough to bring the moderate holdouts on board. Collins, from Maine, told the same show she was doubtful that the bill could pass this week, adding that she was very concerned about the proposals’ impact on older people and the most vulnerable.

“You can’t take over $800bn out of the Medicaid program and not expect that it’s going to have an impact on a rural nursing home that relies on Medicaid for 70% of the costs of its patients,” she said.

The closer the Senate gets to the vote, the more raw and exposed the wound becomes within the Republican party. While the conservative flank is committed to reining in federal government and extending tax cuts to the rich, the more pragmatic and moderate flank frets about the impact of the health bill on their poorer constituents.

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In part, the clash is being fueled by the messages the senators are receiving from their own constituents. One moderate holdout, Heller, faces a tough re-election battle next year in Nevada, where about 600,000 people benefit from Medicaid and 11% have no healthcare coverage at all.

The dispute is also being fanned by rightwing billionaires investing millions of dollars in attempting to push the Republican party further in their direction. This weekend the energy tycoons Charles and David Koch held a three-day retreat at a luxury resort in the Rocky Mountains, with hundreds of wealthy donors pledging $100,000 each to an ultraconservative campaign fighting fund.

One of the topics under discussion at the Koch retreat was how to ensure that Republicans in Congress move in a more radical anti-government direction over healthcare.

A spokesman for the Koch network, James Davis, told Associated Press the brothers intended to invest up to $400m in swaying the 2018 midterm elections, and would continue to push for changes to the healthcare legislation.

“At the end of the day, this bill is not going to fix healthcare,” Davis said.

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