The partial repeal of Obamacare is endangered in the U.S. Senate after four conservatives declared they would not support a plan put forward by Majority Leader Mitch McConnell.

Sen. Rand Paul (R-Ky.), who said earlier this year he was heartened by changes in the House bill, is among those who now oppose the Senate version, which was unveiled Thursday.

“The current bill does not repeal Obamacare. It does not keep our promises to the American people,” Paul said in a terse statement on Thursday.

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Paul’s office told LifeZette that the senator wants a bill that actually repeals Obamacare and lowers premiums.

In addition to Paul, the Senate bill has already drawn opposition from Sens. Ted Cruz (R-Texas), Ron Johnson (R-Wis.), and Mike Lee (R-Utah).

This is bad news for McConnell. There are 52 Republican senators in the 100-member Senate. McConnell can lose only two votes to repeal the signature legacy marker of former President Barack Obama.

“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,” the four senators said in a joint statement Thursday.

Conservatives believe the bill leaves in place too much of the infrastructure of the Affordable Care Act, something with which Obamacare’s defenders agree.

“On the one hand, this is no longer an Obamacare repeal bill. That’s good,” said Professor Jonathan Gruber of MIT, a main architect of the Affordable Care Act. “On the other hand, this is just a giant cut in Medicaid,” he said, “That’s what this bill now amounts to. And that’s bad.”

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Yet Avik Roy, a health-care expert, wrote in Forbes that the bill is an improvement from the House version because it assists older Americans with premiums.

“Because the Senate bill’s tax credits are robustly means-tested and available to those below the poverty line, the bill is able to repeal Obamacare’s Medicaid expansion while offering higher-quality coverage to individuals who signed up for Medicaid under the expansion,” Roy wrote.

That provision addresses a key concern of senators: that the House bill left pre-retirement Americans with few options. And for conservatives, the bill ends Obamacare’s hated mandates and also ends the expensive expansion of Medicaid.

But for now, those improvements are not enough to draw in Paul, Cruz, Johnson and Lee.

Here are four ways changes to the current GOP plan that could get the conservatives on board:

Do More to Lower Health Care Costs
Lowering health care costs is key to any reform.

Obamacare simply failed to do that. Expenses per person hit $10,365 in mid-2016, according to the federal government. Then, the Associated Press noted, “Health care spending will grow at a faster rate than the national economy over the coming decade. That squeezes the ability of federal and state governments, not to mention employers and average citizens, to pay.”

The government also reported hospital expenditures grew 5.6 percent, to $1.04 trillion in 2015, faster than the 4.6 percent growth in 2014.

While other industries are seeing beneficial disruption from technology to help lower costs and give consumers choices, so far technological changes in U.S. health care have not delivered savings to consumers. This has to change before large numbers of retiring Baby Boomers bust the budget.

Assure GOP Caucus on Full Repeal
Cruz told LifeZette earlier this year that he wanted full repeal, and wanted the Senate to override its parliamentarian to be able to pass a full repeal with a simple majority.

Short of taking that unlikely path, Cruz and Paul likely want to hear ideas on how to unravel the law without actually repealing it. Obamacare is already showing signs of complete collapse.

Lower Premiums
One key demand is to allow consumers to purchase health insurance across state lines, as they do with automobile insurance. This is a key Trump promise, too.

Paul would like to see “associations” of consumers band together and offer insurance as well.

And Cruz would like to see health savings accounts used for premiums. These are all key parts of ambitious plans to lower premiums and the related burden on consumers, which is no easy task for legislators.

Medicaid Flexibility
Cruz handed out fliers in the Capitol on Friday that listed “how to get to yes.”

One idea was to allow states greater flexibility on Medicaid. The $545 billion health program for the poor and disabled is growing — almost 10 percent in 2015, more than double Medicare — but the Senate bill would cut about $800 billion out of the program over 10 years.

Republicans such as Cruz and House Speaker Paul Ryan (R-Wis.) believe states know best how to tailor the program for their populations. Cruz is asking for more state flexibility on Medicaid — perhaps through “block grants” — in part to help avoid ballooning the national debt.