Michael McBrayer of St. Paul, Minn., needs to pay a lot attention to his health.

“I give myself shots multiple times a day, as well as controlling my diet and exercise,” he says.

Ten years ago, McBrayer learned he has Type 1 diabetes. Now he knows he faces dire consequences if he fails to control his blood sugar.

“Kidney failure, blindness, heart disease — all those things are looming out there,” he says.

McBrayer has health insurance through his wife’s employer, the state of Minnesota. It’s a HealthPartners health insurance plan that charges extra to employers — in this case, the state — to cover diabetes care. So for the past several years, McBrayer’s plan has paid for everything he needs to keep his diabetes in check. He doesn’t spend a dime on supplies.

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The program that pays for McBrayer’s diabetes management supplies has saved the state of Minnesota more than $1 million in medical services over 10 years.

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Diabetes, high blood pressure and other chronic conditions account for the vast majority of health spending in the U.S., according to the Centers for Disease Control and Prevention. Almost half of American adults have one or more chronic physical or mental health conditions, and spending on them adds up to some $2.3 trillion a year.

Some health plans are beginning to offer free maintenance care for people with chronic health problems, hoping that spending a little more early on will save a lot money in the long run.

“We’ve been trying change the health care conversation in the United States from how much we spend to how well we spend,” says Dr. Mark Fendrick, head of the University of Michigan’s Center for Value-Based Insurance Design.

He says it makes both medical and economic sense to make properly managing chronic conditions affordable.

“I want the health insurance plan my patients have to charge my patients the least for the services that are going to make them healthier,” he says. “Let’s allow those to be covered on a pre-deductible basis; you’re not leaving the patients paying 100 percent of the cost.”

That may seem like common sense, but health plans have been running hard in the opposite direction. Consumers are on the hook for a rapidly increasing amount of their health costs — in large part to try to curb health costs.

But corporate buyers of health insurance are starting to realize that people may be putting off necessary care, says Mike Thompson, who runs the National Alliance of Healthcare Purchaser Coalitions. The organization advises around 12,000 organizations that buy health plans for tens of millions of Americans. He says those who provide insurance need to take a thoughtful look at what they pay for and what consumers should pay for.

“So that people are more prudent on discretionary care but are more compliant with the care they need and certainly the case they need to stay healthy,” Thompson says.

If people have to pay out-of-pocket for care they might not need, they may think twice, but their day-to-day health needs are taken care of.

One major obstacle to this approach, known as “value-based health insurance,” is an IRS rule that does not allow free maintenance care for chronic conditions for the 20 million Americans with health savings account-qualified, high-deductible insurance.

The enhanced insurance benefit that pays for all McBrayer’s Type 1 diabetes maintenance is paying off for state taxpayers, according to HealthPartners, his provider.

That program has helped quadruple the number of diabetes patients with optimal care, saving the state about $1 million on medical services since its inception almost 10 years ago, says Dan Rehrauer, a program manager at HealthPartners.

“We’ve shown that we’ve reduced hospitalization and emergency department utilization, which is exactly what we want to see,” Rehrauer says. “You’ve got a healthy employee and that results in not ending up in the hospital and saving money.”

This story is part of a reporting partnership with NPR, Minnesota Public Radio and Kaiser Health News.

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Senate Majority Leader Mitch McConnell, R-Ky., plans to release an updated Republican health care bill on Thursday and is delaying the body’s annual August recess by two weeks in an effort to generate momentum for the beleaguered legislation.

“In order to provide more time to complete action on important legislative items and process nominees that have been stalled by a lack of cooperation from our friends across the aisle, the Senate will delay the start of the August recess until the third week of August,” McConnell said in a statement. Originally senators were supposed to head home at the end of July.

The GOP will also release an updated version of their Better Care Reconciliation Act, which so far has drawn opposition from both moderate Republicans who say it goes too far in reducing Medicaid funding and conservatives who argued the bill doesn’t go far enough to fully repeal regulations and subsidies in the Affordable Care Act, or Obamacare.

McConnell had wanted to have a vote on the bill before the July 4th recess, but he didn’t have the votes he needed to pass it after at least five GOP lawmakers came out against the current version. There are currently 52 Republicans in the Senate and 50 need to support it to pass.

A revised Congressional Budget Office score, showing the costs and impact on coverage of the new version of the bill, is expected on Monday or Tuesday of next week. The CBO score of the first version found that the BCRA would leave 22 million more people uninsured by 2026.

A vote on a motion to proceed on the revised bill is expected by the end of next week. If that preliminary procedural measure passes, there will be debate on the bill that could go on for days.

Some Senators have already begun offering alternatives which could make it into the revised bill. Sens. Ted Cruz, R-Texas, and Mike Lee, R-Utah, have an amendment which would let insurance companies sell any health insurance plan they wish as long as they also offer at least one plan that is compliant with all of the coverage mandates outlined in Obamacare.

That would allow insurers to offer plans that do not comply with ACA regulations, like providing so-called “essential health benefits,” and would therefore provide less robust coverage and cost less. Critics say it will cause costs for people with pre-existing conditions who need more services to rise sharply, undermining protections in place for them.

The White House supports the amendment, and Cruz told reporters on Tuesday that he believes that plan is the key to a deal.

“I think the reason is that it is the necessary ingredient to getting the votes that we have to have to follow through on our commitment to repeal Obamacare,” Cruz said. “I believe we can get there. It remains challenging. More work remains to be done. But there is a path forward.”

GOP senators are already warning that failure to uphold their seven-year campaign promise to repeal and replace Obamacare could have reverberations with their base.

“We should not be surprised if people are irritated with the Republican majority when we have been promising, and we do not deliver,” Sen. Chuck Grassley, R-Iowa, said on Fox News Tuesday. “I am very pessimistic.”

However, the bill overall has little support with the American public. An NPR/PBS NewsHour/Marist poll earlier this month found just 17 percent support the Senate GOP bill, and that even GOP support for it is soft.

Ultimately, if this doesn’t work, Republicans may need to find a way to bring Democrats to the table, and Sen. Lindsey Graham, R-S.C., has hinted he’s working on a way to do just that in the coming days.

“We’re not there yet, but we’re working with governors, and we may be taking some of the critics of the current bill and converting them to supporters,” Graham told reporters on Tuesday.

NPR’s Susan Davis contributed to this report.

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