Sen. Dean Heller (R-Nev.) said Friday that he cannot support Senate Majority Leader Mitch McConnell’s health-care bill without changes to it, becoming the fifth GOP senator to take that position since the bill was released on Thursday.

Heller, who is up for reelection in 2018, has expressed concerns about the way the measure addresses the future of Medicaid. The proposal would impose long-term federal spending cuts on the program.

“I cannot support a piece of legislation that takes away insurance from tens of millions of Americans and hundreds of thousands of Nevadans,” Heller said in a news conference held in his home state.

Nevada, like most states, expanded Medicaid under the Affordable Care Act.

Heller’s comments came the day after four conservative senators issued a joint statement saying they cannot support the bill unless it is changed. Three of them said they worried it does not go far enough in repealing the ACA, known as Obamacare. A fourth said he worried the process was rushed.

Those senators are Ted Cruz of Texas; Ron Johnson of Wisconsin; Rand Paul of Kentucky; and Mike Lee of Utah.

McConnell (R-Ky.) cannot pass the bill if he loses more than two Republican votes. The GOP holds a 52-48 advantage over Democrats in the Senate, with Vice President Pence standing ready to break ties in the GOP’s favor.

Sen. Dean Heller (R-Nev.) announced on June 23 that he would not support the Republican Senate health-care bill. (Reuters)