(Bloomberg) — Republican senators pushing anotherattempt at an Obamacare repeal made tweaks to their bill thisweekend to try to sway a few GOP holdouts whose votes theyneed.

The changes would steer money to Alaska and Maine, the homes ofsenators Lisa Murkowski and Susan Collins. States would also getmore flexibility to make changes to insurance rules, a measuremeant to entice conservatives. At its heart, though, the bill isthe same — it would reduce future spending on Medicaidand private insurance subsidies by billions of dollars, and letstates set the rules for what insurers can charge and what theyhave to cover.

“This version is much starker than prior bills, in that it’s allabout buying Republican votes,” said Leighton Ku, a health policyprofessor at George Washington University.

The bill, backed by Senators Bill Cassidy of Louisiana andLindsey Graham of South Carolina, will be discussed by the SenateFinance Committee on Monday afternoon. It’s opposed by doctors,hospitals and health insurers.

Here’s how the new changes work:

State dollars: Alaska’s vote

The Graham-Cassidy bill redirects Obamacare’s billions ofdollars in funding to the states to use how they want. The changesmade over the weekend move some of those dollars around.

“They’ve made some minor changes to the funding formula, andthey appear to have added some targeted pots of money for a fewstates, but the big picture of this legislation is the same as lastweek,” said Matthew Fiedler, a fellow at the BrookingsInstitution.

The bill has a contingency fund worth $6 billion in 2020 and $5billion in 2021, and a new breakdown of how the money would begiven out sends more money to Alaska. It uses a new mechanism toreward low-population-density states — Alaska fits thecriteria — even if they already expanded Medicaid under the law, which not allstates did. Without the low-density provision, all Medicaidexpansion states would get less funding than others.

There’s another $3 billion pot of money to be doled out from2023 to 2026, this one for states that expanded Medicaid after2015. Only Louisiana, Cassidy’s home state, and Montana expandedthe program that late, according to the Kaiser Family Foundation.

“Expansion states that stood to lose significant amounts of ACAfunds will get to that point more slowly, so that would benefitexpansion states like Alaska, Arizona, Kentucky,” said RobinRudowitz, associate director of the Kaiser Family Foundation’sProgram on Medicaid and the Uninsured.

In the end, states are still expected to face large cuts becausethe Graham-Cassidy bill changes Medicaid funding to a fixed,per-enrollee amount from a set percentage of states’ costs. Themove would reduce federal spending on traditional Medicaid by anestimated $175 billion over 10 years, according to the Center onBudget and Policy Priorities.

Insurance rules: GOP conservatives

Changes meant to win over Senate conservatives such as TexasRepublican Ted Cruz and Utah’s Mike Lee would permit states toallow insurance companies to provide plans with fewer benefits,while charging higher premiums to the sick or old.

Under the proposal, states could let insurers:

Impose deductibles that are higher than the limits set by theACA, or remove the health law’s limits on the costs that anindividual or family can have to pay in a year. Offer coverage thatlacks some of the ACA’s benefits, such as maternity care,prescription drug or mental health coverage. Remove requirementsthat insurers cover preventive-health treatments and immunizationswithout cost to the customers.

States can also waive protections that bar insurers fromcharging more to people with pre-existing medical conditions,though the new bill toughens up the policy somewhat.

The revised bill says states will have to describe how theirhealth plans “shall” maintain affordable, adequate insurancecoverage for those people. That’s a change from the past version,in which a state had to say how it “intends” to make sure peoplewith pre-existing conditions have access.

“The prior language was fairly toothless,” said Brookings’Fiedler. “They have tightened up half the problem with the switchfrom ‘intends’ to ‘shall,’ but the standard that they have toachieve is incredibly vague, so I’m not convinced that this imposesmeaningful constraints in practice.”

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