Vice President Pence speaks to a group of grass-roots organizations calling on the Senate to take action on health-care legislation, during a meeting in Washington on Friday, July 21, 2017. (Alex Brandon/AP)

The Senate parliamentarian signaled Friday that Democrats could block several key elements of the Senate GOP health-care bill, including abortion coverage restrictions, a one-year ban on funding for Planned Parenthood and changes to Medicaid coverage requirements, if the legislation comes up for a vote next week.

While not a final ruling, Senate Parliamentarian Elizabeth MacDonough’s assessment threatens to further anger conservatives such as Sens. Mike Lee (R-Utah) and Rand Paul (R-Ky.) who say the GOP health-care bill does not go far enough in repealing the Affordable Care Act.

Democrats released the guidance Friday after weeks of consultations with GOP leaders and MacDonough, who determines whether legislation is in line with complex Senate rules. MacDonough advised party leaders that roughly a dozen provisions in the bill may not meet the requirements and would need 60 votes to pass, meaning the 52 Senate Republicans could not pass the measures on their own.

Senate Republican leaders plan to hold a vote next week on some version of the health-care bill but it is unclear what that legislation will include. Senate Majority Leader Mitch McConnell (R-Ky.) has struggled to convince his badly divided party to coalesce around a single option for repealing the ACA.

Leaders planned to vote on a version of a repeal measure that passed the Senate in 2015 before being vetoed by then-President Barack Obama. Under heavy pressure from President Trump, McConnell reopened negotiations over a version of the plan to repeal and replace the Affordable Care Act similar to the one that was the subject of MacDonough’s assessment.

Sen. Bernie Sanders (I-Vt.), the top Democrat on the Budget Committee, celebrated the guidance as a potentially fatal blow to the Republicans’ already troubled attempt to gut the Affordable Care act.

“The parliamentarian’s decision today proves once again that the process Republicans have undertaken to repeal the Affordable Care Act and throw 22 million Americans off health insurance is a disaster,” Sanders said. “It is time for the Republican leadership to junk this bill and work with the American people on legislation which improves the Affordable Care Act, not destroys it.”

Republicans sought to downplay the guidance as a preliminary review that was based on an earlier version of the legislation. Leaders could still amend the troubled measures before a vote next week.

“This is just guidance on an earlier draft of the bill to help inform action on the legislation going forward,” said Joe Brenckle, a spokesman for Senate Budget Committee Republicans.

A spokesman for McConnell declined to comment on the parlimentarian’s deliberations.

Republican leaders chose to use the budget process to pass the health-care rewrite because Senate rules allow budget legislation to pass with 51 votes rather than the 60 votes necessary to pass most other bills. That would allow the 52 Senate Republicans to pass the bill without the help of Democrats. But budget rules also require that the legislation be limited to matters dealing with taxes, spending and the deficit.

MacDonough advised Friday that Republicans’ long-sought restrictions on abortion funding and a one-year freeze in Medicaid payments to Planned Parenthood did not meet those standards. The decision came as a surprise to many Republicans after MacDonough allowed the abortion-related cuts to be included in a 2015 ACA repeal.

But a new estimate from the Congressional Budget Office showed that the measures violated Senate rules by directly targeting a single health provider, according to a Democrat familiar with the deliberations who was granted anonymity to discuss the confidential session.

Planned Parenthood Federation of America hailed the parliamentarian’s guidance, saying it showed Republicans were singling their group out for punishment.

“No amount of legislative sleight of hand will change the fact that the primary motivation here is to pursue a social agenda by targeting Planned Parenthood,” said Dana Singiser, the group’s vice president for public policy and government affairs, in a statement.

MacDonough also suggested she would block plans to allow states to spend unused Medicaid funds on nonhealth projects like road construction or schools. She signaled similar objections to a proposal that would require people who have gaps in their health coverage to wait six months before buying a plan on the individual market and plans to allow states to drop some coverage requirements in 2020.

The guidance could complicate GOP attempts to convince conservatives to voice their support for the legislation.

On Friday, Vice President Pence hosted representatives from organizations such as the Concerned Women for America, the National Taxpayers Union, American Conservative Union, Club for Growth, the U.S. Chamber of Commerce and the National Federation of Independent Businesses in his ceremonial office.

“Every one of the groups that are gathered here today — the millions that you represent — are here to speak with one voice to say to the Congress: It’s time to vote. It’s time to act,” Pence told the assembled group. “It’s time to get on with a debate to repeal and replace Obamacare.”

Democrats also believe that guidance suggests MacDonough would strike down a slew of state-specific provisions intended to win support from reticent Republicans like Alaska’s Lisa Murkowski. The assessment cast doubt on a measure that would limit New York state’s local Medicaid contribution requirements.

Senate Minority Leader Charles E. Schumer (D-N.Y.) called it a rebuke of all state-targeted measures.

“This will greatly tie the majority leader’s hands as he tries to win over reluctant Republicans with state-specific provisions,” Schumer said in a statement. “We will challenge every one of them.”

Mike DeBonis contributed to this report.