If Senate Majority Leader Mitch McConnell believes it when he says "Obamacare is collapsing under its own weight," he should not give it a lick of fresh paint but should tear it down and rebuild it.
His bill, crafted in back rooms by a handful of anonymous committee staffers, leaves in place Obamacare's basic infrastructure whiling tinkering with a few details and bailing out insurers.
The Better Care Reconciliation Act isn't a bill to reform healthcare. This is a bill to notionally repeal Obamacare while propping the insurance market up through the next election. It's an exercise in political box-checking and ass-covering.
Under the BCRA, which was first revealed to the public, including to senators, on Thursday, the healthcare system would operate roughly the same way it does under Obamacare, just with slightly looser regulations and slightly lower costs. The individual market would still be heavily regulated by Washington, with insurers limited in their ability to price plans according to risk.
The Republican bill would also preserve and expand subsidies for the insurance industry, which the GOP used to attack. A central feature of Obamacare was the premium support for middle-class people buying insurance on the individual market. The Senate bill preserves this.
"At a fundamental level," libertarian healthcare expert Peter Suderman argued aptly in Reason magazine, "the Senate plan accepts Obamacare's premises about the nature of health insurance and the individual market. It works from the assumption that the only way to make expensive health insurance cheaper is to subsidize it through the federal government."
Conservatives and libertarians believe there are other ways to make healthcare affordable. Market forces can exert downward pressure on the price of both insurance and healthcare. These forces were suppressed before 2010, and Obamacare didn't make things better. But this Senate bill doesn't do much either.
Republicans don't do anything to take away the privileges of employer-sponsored health insurance, even though that system dampens competition among insurers. And the bill doesn't empower consumers to buy insurance across state lines.
Nothing in this legislation reverses Obamacare's policy of pushing consolidation among physician practices and hospitals. The bill doesn't try to pick apart unneeded and costly regulation on the scope of practice. Nothing in the Better Care bill reduces prescription drug prices, which are kept high through government policy.
Instead of using market forces to lower prices, the GOP bill just subsidizes health insurance and health insurers. Just a few months ago, Republicans in Congress were suing former President Barack Obama for trying to funnel unappropriated money to insurers through an Obamacare program called Cost-Sharing Reductions, or CSRs. (In short, insurers waive the copays and deductibles for lower-income customers, and taxpayers cover the cost.) The Republican bill would pay back insurers for the Obama-era payments blocked by the GOP suit and would pay the CSR payments in future. This isn't repeal of Obamacare. This is codification of Obamacare.
One innovation by Republicans in this bill is a brand-new fund to subsidize insurers, a "stabilization fund" to the tune of $50 billion over the next four years. This is a straightforward bailout, intended to keep insurers from leaving the marketplace during the next three years — that is, through the next presidential election.
There's a reasonable argument for a stabilization fund that would smooth the path from Obamacare's broken exchanges to a new, workable system. But this bill doesn't head toward or build a workable system. It neither provides significant structural support to Obamacare's individual market nor tears down Obama's edifice and replaces it with something better.
If Republicans believe the bridge is collapsing, this bill suggests they're happy to let it crumble, as long as it stays standing until they can get across it.