The GOP Senate’s alternative to Obamacare — a first look

Senate Republicans today unveiled their health care bill. It’s 142 pages long. I have not yet read it.

According to New York Times reporters Robert Pear and Thomas Kaplan, the Senate bill maintains the structure of its House counterpart, but is more “moderate.” For example, it offers “more financial assistance to some lower-income people to help them defray the rapidly rising cost of private health insurance.”

In addition, according to Daniel Horowitz, the Senate version of the bill strips away regulatory reforms or state waivers contained in the House version. Instead, it “merely loosens existing waiver authority up to the discretion of HHS for a few regulations.”

My sense is that Majority Leader McConnell faces an uphill battle to get 50 votes. Because the bill preserves so many Obamacare requirements, discontent among conservatives is palpable.

Indeed, Sens. Cruz, Johnson, Lee, and Paul have just issued a statement saying they are “not ready to vote for this bill,” but “are open to negotiation and obtaining more information before it is brought to the floor.” I think you have to assume that McConnell anticipated this reaction and is prepared to negotiate with the conservative Senators.

Meanwhile, though, moderates like Susan Collins and Lisa Murkowski may balk over the bill’s deep cuts to Medicaid. In fact, Dean Heller, who is up for reelection next year, has already released a statement expressing “serious concerns” about the bill’s Medicaid provisions.

For me, the two big questions for any Obamacare replacement legislation are: (1) is it a substantial improvement over Obamacare and (2) how will it affect premiums and deductibles.

I’m not going to attempt answers to these questions until I knew more about the Senate bill. However, because the Senate bill eliminates the mandate to buy insurance without (as I understand it) reducing coverage requirements, the bill is susceptible to the argument that it’s worse — from the standpoint of viability — than Obamacare. To the extent that this problem is papered over with subsidies ($25 billion, reportedly) that should be problematic for conservatives.

Similarly, as to the second question, I’ve always thought the key to lower premiums and deductibles is doing away with the Obamacare regulations.

The House bill at least provides states with that option. If, as Horowitz says, the Senate bill’s loosening of existing waiver authority for a few regulations isn’t sufficient to signal to insurers enough flexibility to cause them to reduce premiums, then the Senate bill is problematic on that account.