Senate leaders are preparing to hold a vote on an alternative to the 2010 health care law next week, although 50 Republicans have not confirmed they would vote for the proposal.

“It is the Leader’s intention to consider Graham-Cassidy on the floor next week,” Don Stewart, a spokesman for Majority Leader Mitch McConnell of Kentucky, said Wednesday in an email.

The push to vote on the plan crafted by Sens. Lindsey Graham, R-S.C., and Bill Cassidy, R-La., comes ahead of a crucial Sept. 30 deadline when Republicans would lose their chance to repeal parts of the law under the fiscal 2017 budget reconciliation rules. McConnell had told lawmakers he would not bring the measure to the floor without 50 votes.

The measure would dramatically restructure the individual health insurance market by giving states block grants to fund health insurance coverage, replacing current federal funding that covers tax credits to help people purchase insurance, and cost-sharing reduction payments. Funding for Medicaid expansion in 31 states and the District of Columbia through 2026 also would come from those allotments.

The bill would also transition traditional Medicaid, which is an entitlement, to a system that gives states a capped amount of funding based on their Medicaid population.

It would repeal the health law’s individual and employer mandates and a tax on medical devices. The repeal would allow states to waive certain regulations, including one that bars insurers from charging higher premiums to individuals with pre-existing conditions.

Cassidy has defended that aspect of the measure, saying that states applying for waivers must ensure that individuals with pre-existing conditions have access to “affordable and adequate coverage.”

“I think the price will actually be lower,” he said Wednesday on CNN’s New Day. “What is being circulated is by those who wish to preserve Obamacare and they are doing everything they can to discredit the alternative.”

Sen. Rand Paul, R-Ky., has announced his opposition to the plan. Three Republican senators who voted against the repeal effort in July — Susan Collins of Maine, Lisa Murkowski of Alaska and John McCain of Arizona — have not declared which way they would vote on the new proposal.

The Senate Finance Committee is set to hold a hearing Monday afternoon on the proposal, and a preliminary analysis by the Congressional Budget Office is expected early next week.

A Wednesday analysis by the Avalere Health consulting firm showed 34 states and the District of Columbia would face cuts to the funding they receive from the federal government.

If the Senate does bring up the Graham-Cassidy plan, it would effectively pick up where it left off in July with a vote-a-rama — a series of amendment votes that can go on for hours under the budget reconciliation process.

Intensifying Lobbying Efforts

Republicans are now contending with widespread backlash to the last-minute effort, similar to what they faced earlier this year to the House-passed bill and the Senate GOP alternatives. Groups representing patients, hospitals, doctors and health insurance plans have criticized the proposal and left-leaning groups are intensifying efforts to pressure Republicans to oppose the plan.

On Wednesday, the Blue Cross Blue Shield Association said they “share the significant concerns of many health care organizations about the proposed Graham-Cassidy bill.”

“The legislation reduces funding for many states significantly and would increase uncertainty in the marketplace, making coverage more expensive and jeopardizing Americans’ choice of health plans,” the group’s statement read. “Legislation must also ensure adequate funding for Medicaid to protect the most vulnerable.”

Later Wednesday afternoon, America’s Health Insurance Plans sent a letter to Senate leaders stating that the group and its members “cannot support this proposal” but would continue to work to find common ground on mutual goals like lowering costs and increasing coverage. 

Other groups including the American Medical Association, the Federation of American Hospitals, AARP and the American Heart Association all voiced opposition to the plan this week.

Save My Care, a coalition of groups that favor the health law, released a series of advertisements this week targeting swing votes including Murkowski, McCain, and Sen. Shelley Moore Capito, R-W. Va.

Conservative groups have called the Graham-Cassidy proposal a step towards repeal. The conservative Club For Growth stopped short of endorsing the plan earlier this week, saying it’s not a full repeal of the health law.

“We hope that the Graham-Cassidy amendment will be considered a step toward that goal, not the end, because, whether this amendment passes Congress or not, it’s not ‘repeal,’” FreedomWorks President Adam Brandon said in a Wednesday statement.