Senate health plan is a little Obamacare with a lot of pain

The Observer editorial board

Senate Minority Leader Chuck Schumer responds to the Republicans’ health care bill.
Senate Minority Leader Chuck Schumer responds to the Republicans’ health care bill. AP

If you squint a little and tilt your head just the right way, the health care plan Republican senators introduced Thursday has a familiar look to it:

It’s Obamacare-lite. Or at least Obamacare-ish.

The Affordable Care Act subsidies that allow low-income people to afford policies? They’re in the Senate plan, although at slightly lower levels than Obamacare.

The protections for people with pre-existing conditions? They’re in there, too. As with Obamacare, insurers would be barred from increasing someone’s premiums or denying coverage because they were ill.

Both provisions were lost in the unpopular American Health Care Act, which House Republicans passed last month. Both provisions are back – a concession to moderate senators and an American public that reacted harshly to the act.

But make no mistake: The Senate’s plan, called the Better Care Reconciliation Act, is an awful bill. It shares broad and troubling similarities to the AHCA, trading less coverage and higher premiums for the poor in exchange for tax cuts that primarily benefit the wealthy. Like the AHCA, it will surely result in millions of Americans losing their health insurance; the Congressional Budget Office will assess how bad that damage is next week.

The Senate bill eliminates the individual mandate penalty – which will result in higher premiums – and it calls for Medicaid reductions that are about as deep as the AHCA’s. Also, like the House plan, states can change what “essential benefits” insurers will be required to cover, including hospital visits and mental health care.

Still, the Senate plan looks a lot more like Obamacare than the free-market approach that Republicans promised they would return to in repealing Obamacare – and it keeps some of the key ACA benefits that Americans don’t want to lose. Even the proposed Medicaid reductions are targeted for years down the road, another concession to moderates who know how much could change politically before then.

All of which is an acknowledgment that Obamacare gets more right than it doesn’t. That’s why conservatives are already objecting to the Senate plan, which Senate leader Mitch McConnell has tellingly called a “draft.” Expect the same kind of pendulum that Obamacare repeal faced in the House, with harsher proposals being floated to get conservatives on board.

In the Senate, however, only three Republicans need to defect to kill the health care plan, and some moderates already are queasy about having their name on a bill that results in higher premiums, higher deductibles and less coverage for their constituents. (N.C.’s Thom Tillis, who talks a good game about being a moderate, will likely be in lockstep as usual with conservatives in supporting the plan. So will fellow N.C. Sen. Richard Burr. )

There’s a simpler path, of course. Republicans can make fixes to Obamacare, calm insurers, and keep the health care plan and benefits an overwhelming majority of Americans favor. That would be far better for Americans than any substitute they’ve proposed thus far.