Five hurdles that remain,

Senate Republicans hope their latest bill proposed to replace Obamacare will attract enough votes from the moderate and conservative wings of their party to pass next week. But there are at least five hurdles that could derail efforts to reach consensus.

1 THE BILL STILL MAKES MAJOR CUTS TO MEDICAID More than 14 million Americans gained eligibility for Medicaid through Obamacare, and they could lose that coverage under the Senate bill, which phases out federal funds by 2024 for expanded Medicaid coverage.

That’s a problem for some moderate Republicans, who worry that their most vulnerable constituents will be harmed. Sen. Susan Collins, R-Maine, cited those cuts in a tweet Thursday saying that she will vote against a procedural motion to bring the bill to the floor, known as a “motion to proceed.”

Patients who rely on Medicaid to get treatment for opioid abuse also could lose that coverage, undermining efforts by moderate GOP Sens. Rob Portman of Ohio and Shelley Moore Capito of West Virginia to boost federal support to fight the epidemic in their states. However, the bill does provide $45 billion in additional funding for opioid treatment, in an effort to lure Portman, Capito and others.

2 IT DOES NOT FULLY REPEAL OBAMACARE

Conservatives want a complete repeal of the Affordable Care Act, especially its taxes. This bill would not do that.

While it eliminates taxes on health insurance, prescription drugs, medical devices and highcost employer-sponsored plans, the legislation leaves in place Obamacare taxes on wealthy Americans to help subsidize coverage for lower-income people.

Sen. Rand Paul, R-Ky., a conservative with a libertarian bent, said he cannot support a bill that leaves so much of Obamacare in place. His spokesman said the senator plans to vote against the motion to bring the GOP legislation to the Senate floor next week.

3 IT STILL RAISES COSTS FOR OLDER AMERICANS

Groups representing older Americans — who traditionally vote in higher numbers — are blasting the bill for continuing to impose an “age tax” on Americans 55 to 64, who are still too young to benefit from Medicare.

“AARP reiterates our opposition to the Age Tax which would allow insurance companies to charge older Americans five times more than everyone else for the same coverage,” the organization said in a statement Thursday. The organization has 38 million members 50 and older.

Democrats signaled that they would hit Republicans hard during next year’s congressional elections if they vote for this provision. 4 IT STILL DEFUNDS PLANNED PARENTHOOD The bill would block Planned Parenthood from receiving Medicaid funding for a year. Federal law already prohibits the organization from using federal funds to perform abortions, but the bill would also prevent the group from using Medicaid money to offer birth control services, treat sexually transmitted diseases, and provide other medical care.

Most Republicans support defunding Planned Parenthood, but two key moderates — Collins and Sen. Lisa Murkowski, R-Alaska — are strong supporters of the group and have consistently opposed efforts to defund it.

“I, for one, do not believe that Planned Parenthood has any place in our deliberations on the Affordable Care Act,” Murkowski said in an address to Alaska state lawmakers earlier this year. “Taxpayer dollars should not be used to pay for abortions, but I will not vote to deny Alaskans access to the health services that Planned Parenthood provides.” 5 TWO GOP SENATORS ARE OFFERING A POTENTIALLY ATTRACTIVE ALTERNATIVE Sens. Lindsey Graham, R- S.C., and Bill Cassidy, R-La., offered an alternative Thursday that they said could attract more support than the bill introduced by GOP leaders.

Their plan would send the current federal funding for Obamacare, estimated at about $110 billion last year, to the states in the form of block grants that governors could use however they want.

Graham said states could keep Obamacare in place or replace it with a new system.

“Instead of having a one-sizefits-all solution from Washington, we should return dollars back to the states to address each individual state’s health care needs,” Graham said.