Four Republican senators say they are not ready to vote for the GOP health care bill, putting the measure in jeopardy.

The four are Ted Cruz of Texas, Ron Johnson of Wisconsin, Mike Lee of Utah and Rand Paul of Kentucky. They say in a statement that they are open to negotiation before the full Senate considers the measure. “Currently, for a variety of reasons, we are not ready to vote for this bill, but we are open to negotiation and obtaining more information before it is brought to the floor. There are provisions in this draft that represent an improvement to our current health care system, but it does not appear this draft as written will accomplish the most important promise that we made to Americans: to repeal Obamacare and lower their health care costs.”

(Scroll down to read statements from regarding this bill.) 

The four say there are provisions that are an improvement to the current health care system. But they add that the measure fails to accomplish what they have promised to their constituents, “to repeal Obamacare and lower their health care costs.”

GOP leaders hope to vote on the bill next week and can only afford two defections from the 52 Senate Republicans.

The health care bill would do away with the individual mandate, taxes and cut back the expansion of Medicaid, although at a slower rate than the House-passed bill.

The 200-page measure would also eliminate federal funding for Planned Parenthood and provide tax credits based on income, making more money available to lower income recipients to help them buy insurance. The House bill tied its tax credits to age.

Senate Majority Mitch McConnell, R-Kentucky, aims to hold a vote on the legislation before lawmakers leave at the end of next week for the week-long July 4 recess.

A cost estimate of the bill from the nonpartisan Congressional Budget Office (CBO) is expected to be released by early next week. White House staff met with Senate Republican staffers Wednesday night on Capitol Hill to review the bill.

Republicans need a simple majority to pass it, rather than a supermajority since they're using the budget reconciliation process. They may still have to rely on Vice President Mike Pence to cast a tie-breaking vote. The Senate currently has 52 Republicans and 48 Democrats. That means if all Democrats vote against the bill, only three no votes from Republicans can torpedo it.

Even if Republicans are successful in getting it through the upper chamber, they would then still need to reconcile it with version passed by the House in early May, reach a bicameral agreement with House Republicans, and hold votes in the House and Senate on that version again.

The House bill, narrowly passed in a 217-213 vote on May 4, would significantly reduce the funding for the law's subsidies, revamp tax credits so that they're tied to a person's age, freeze the Medicaid expansion in 2020 and allow states to seek waivers from a rule that requires states to offer essential benefits in their plans and a provision that prevents insurers from charging people with pre-existing conditions more money compared to healthy people. Instead of the law's insurance mandate, the House Republican bill would incentivize people to have continuous coverage whereby if coverage is interrupted for more than 63 days, insurers can charge a 30 percent penalty over the original premium for one year.

The CBO didn't release its cost estimate on the House bill until May 24, which projected that 23 million more people would be without health insurance over the next decade under the bill.

The American Academy of Pediatrics says the bill would hurt children by scaling back Medicaid. Its president, Dr. Fernando Stein, says the plan was crafted without input from pediatricians and "would tear down" the progress the nation has made by achieving insurance coverage for 95 percent of children.
America's Essential Hospitals, which represents more than 300 safety-net health facilities, says the version the Senate released Thursday "might be worse overall" than the House legislation and might lead to hospitals reducing services or closing.
The Association of American Medical Colleges says the Senate plan would leave millions of people without health coverage, and others with only bare-bones insurance plans.

The Senate's version was supposedly crafted by a working group consisting of 13 Republican men -- and no women -- but one of the group's participants, Sen. Mike Lee, R-Utah, said even he's been left in the dark. Lee said it's "apparently being written by a small handful of staffers for members of the Republican leadership in the Senate."

Other Senate Republicans voiced frustration that the process has been too secretive and out of the public eye. Senate Republicans don't intend to hold an committee hearings on the bill, despite their commitment to so-called "regular order."

Nearly three-quarters of Americans said Senate Republicans should discuss their health care plans publicly, according to a CBS News poll released Tuesday. A quarter of the public, by contrast, said it should be developed in private. It also found 57% said the law needs some changes, 28 percent said it should be repealed entirely and 12% said it should be kept in place.

U.S. Senator Dean Heller (R-NV) released this statement:
“Throughout the health care debate, I have made clear that I want to make sure the rug is not pulled out from under Nevada or the more than 200,000 Nevadans who received insurance for the first time under Medicaid expansion. At first glance, I have serious concerns about the bill’s impact on the Nevadans who depend on Medicaid. I will read it, share it with Governor Sandoval, and continue to listen to Nevadans to determine the bill’s impact on our state. I will also post it to my website so that any Nevadans who wish to review it can do so. As I have consistently stated, if the bill is good for Nevada, I’ll vote for it and if it’s not – I won’t.”

U.S. Senator Catherine Cortez Masto (D-NV) released the following statement:

“Leave it to Senate Republicans to come up with a more atrocious, callous version of the House Republican bill to repeal the Affordable Care Act and strip healthcare from millions of Americans – and hundreds of thousands of Nevadans. Because of the ACA, nearly 400,000 Nevadans have gained access to quality care; Senate Republicans would end Medicaid as we know it, devastating thousands of Nevada’s low-income families, children, and seniors.

“The ACA is not perfect and my Democratic colleagues and I are more than willing to work across the aisle to improve the current law so all Americans can have access to affordable, quality healthcare. Fast-tracking a bill that makes devastating cuts to the health coverage Nevadans rely on in an effort to hide the truth from the public is a reckless and unacceptable way to handle the lives of millions of Americans.

“Let’s be clear about this Republican bill: it does absolutely nothing to provide ‘better care’ for Americans. The Republican’s bill risks the lives of thousands of Nevadans and millions of Americans.”

Nevada Congressman Mark Amodei (NV-2) sent this statement:

“My staff and I have begun the process of reviewing the Senate’s health care bill. As always, we will continue doing our homework to see what this bill means for folks in Nevada. I will be paying special attention to the Medicaid portion of this bill, and eventually determine if the Senate’s proposals are sensible for our state. Our goal here is to ensure this reform package will increase Nevadans' access to quality and affordable care, while paying respect to rural communities like ours.”

Congresswoman Jacky Rosen (NV-3) released the following statement:
“Senate Republicans are rallying around a plan that will make health care even more expensive for Nevadans and with the deep cuts to Medicaid, entirely out of reach for some of our families. It's disappointing to see how far Senate Republicans are willing to go to give the wealthiest among us a tax cut, which this bill pays for by passing the bill to hundreds of thousands of Nevadans, including vulnerable children, women, working families living paycheck to paycheck, and middle class seniors with long-term care needs who rely on Medicaid.

“The vast majority of Nevadans oppose this repeal bill because they see it for what it is: a cruel bill that implements a crushing age tax on older Americans, weakens essential health benefits protections, defunds Planned Parenthood, and strips away access to care for our most vulnerable citizens.

“People in my district will be personally devastated by this disastrous legislation. Senate Republicans should reject this partisan repeal effort and focus on working across the aisle to lower your costs and expand access to affordable health care for all Americans."

Rep. Ruben J. Kihuen (NV-4) released this statement:

“It should come as no surprise that Senate Republicans are rushing their flawed healthcare bill to the floor without giving the American public an opportunity to understand what a tragedy this will be for our country. This bill would be devastating for hardworking Americans and Nevadans, likely increasing the cost of their healthcare and threatening their ability to obtain coverage. Senate Republicans have spent weeks behind closed doors concocting this bill in secret, now they are rushing a vote on the floor just so they can skip out of town in time for the Fourth of July weekend.”

Rep. Dina Titus of Nevada’s First Congressional District released the following statement:

“Today I urged Nevada’s senators and all other lawmakers in Congress to oppose the latest version of Trumpcare,” Rep. Titus said. “The Senate’s version is just as callous and shameless as the House’s disastrous bill. It will eliminate vital care in order to shift billions of dollars to the wealthiest Americans. The repercussions of this law, just to make the rich even richer, are unimaginable. States will have fewer resources and millions will lose their health care as a result. 

“By 2024, Medicaid expansion will be terminated, Medicare will lose funding, an age tax on older Americans will be implemented, and guaranteed Essential Health Benefits for cancer screenings, preventive care, and maternity care will become a thing of the past. Be assured that I will cast a no-vote on this terrible bill if it comes to the House. The cuts in this bill will hurt working families, children with disabilities, and the health of our nation at large.” 

Statement by Elisa Cafferata, Director of Government Relations, Nevada Advocates for Planned Parenthood Affiliates:
“Senator Heller must keep his promise to Nevadans and protect Planned Parenthood. Nevadans expect Senator Heller to keep his word. If this is the Senate’s idea of a bill with heart, then the women of America should have fear struck in theirs. Slashing Medicaid and blocking millions of women from getting preventive care at Planned Parenthood is beyond heartless. The Senate bill closely mirrors the House bill, which has been widely criticized as ‘mean’ and the worst bill for women’s health in a generation. If this bill passes the Senate, the consequences are dire: It would ‘defund’ Planned Parenthood, which over 16,000 Nevadans rely on every year; gut maternity coverage; strip millions of their health insurance; force new moms back to work shortly after giving birth; and reduce access to contraception. In short, this bill makes it harder to prevent unintended pregnancy, harder to have a healthy pregnancy, and harder to raise a family. One in five women in this country rely on Planned Parenthood for care. They are demanding that the Senate reject this bill and keep Planned Parenthood’s doors open.” 

Governor Brian Sandoval released the following statement: 

"My office and the Department of Health and Human Services are reviewing the bill and will assess its potential effect on all Nevadans. I am disappointed that Congress did not include us in the consideration of this bill and we have not seen it until today. While the current healthcare system needs improvement, it remains my priority to protect Nevada's expansion population to ensure our most vulnerable, especially individuals with mental illness, the drug addicted, chronically ill, and our children, will always have access to healthcare. Preliminarily, it appears that the proposed bill will dramatically reduce coverage and will negatively impact our future state budgets, which causes me great concern. My office is in regular communication with Senator Heller’s office and I have had ongoing discussions with the Senator about the impact of healthcare reform on the State of Nevada. "

(The Associated Press and CBS News contributed to this report.)