The revised Senate health bill has a dwindling list of winners and a bigger pool of potential losers.

It would still make insurance much less affordable for poorer and older Americans who don’t get coverage through work or Medicare. It would make that insurance less valuable for many people with the most significant health care needs. The biggest beneficiaries of the original bill — the rich — would get less.

The new draft bill, released Thursday, is full of small tweaks and goodies throughout, but its most substantial policy change came at the behest of two Senate conservatives, Ted Cruz of Texas and Mike Lee of Utah. They wanted to roll back the Affordable Care Act’s regulations of health insurance, and largely got their wish. The Senate majority leader, Mitch McConnell, faced with objections to his original health care bill from both moderate and conservative Republicans, took a step to the right.

Mr. Cruz championed the change as a way to improve consumer choice and reduce the cost of insurance for Americans who do not have serious health care needs. It would, indeed, give some young and healthy consumers a chance to buy cheaper plans.