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Not since the rollout of the flawed HealthCare.gov site has a health-care measure drawn such utter scorn. The Senate’s health-care effort was so widely panned that one wonders what the 13 members of the working group had been doing behind closed doors all this time. The bill contains multiple, serious deficiencies — but also a few opportunities.

First, the bill in no way, shape or form repeals Obamacare. For a couple of years, Republicans’ bill would prop up the system as is with subsidies to insurers, precisely what Sen. Marco Rubio (R-Fla.) and others have fought to prevent for a few years now. This belies the notion that Obamacare is unfixable. We’ll get back to this below.

Second, the bill then makes the newly stabilized exchanges unstable once again by repealing the individual mandate. Only the sickest will sign up; the premium costs will skyrocket, and we’ll be back to bailing out insurance companies or closing the exchanges. <a href="https://reason.com/blog/2017/06/22/the-senate-gops-new-health-care-bill-is">Peter Suderman explains:</a>

Like the House plan, the Senate plan retains Obamacare’s major insurance regulations, including the requirement to cover pre-existing conditions, at the federal level. Unlike the House plan, it does not allow states to apply for a waiver to opt out of those rules. It also eliminates Obamacare’s health insurance mandate.

Every state that has attempted this combination of coverage regulations without a mandate has seen a swift meltdown in the individual market. There is every reason to expect that the same would happen under the Senate plan, especially since Obamacare’s exchanges were struggling with a too-small, too-sick enrollee pool even with the mandate in place.

Peter Stevenson

Third, although the Senate bill keeps the exchanges and the Affordable Care Act’s protection for preexisting conditions, it gives out stingier support to lower- and middle-income Americans and lowers the threshold from 400 percent to 350 percent of the poverty line for phasing out subsidies. More cost is shifted back to the sickest patients. Insurers could offer alternative plans without the minimum list of benefits, but that would entail higher out-of-pocket costs and/or less coverage. It is as if someone asked the Senate to come up with a less generous version of Obamacare.

Fourth, the Medicaid cutback sets up a situation like the “doc fix,” an annual ritual by which Congress had to increase payments to providers to keep them in the business of offering care to Medicare patients. In both cases, Congress announces big cost reductions — but then delays them so that future presidents and lawmakers have the task of either pulling the trigger or coming up with more money. The changes in the Senate bill to Medicaid are so substantial (both in rolling back the pool of eligible people and in implementing a slower formula for keeping up with inflation) that there is a good chance that House Speaker Paul Ryan’s dream of ending the Medicaid entitlement and shipping it back to the states won’t ever come to pass.

Fifth, the premise of this repeal effort was that the exchanges were failing. If so, there’s little to no justification for cutting back Medicaid — except to give very big tax cuts to the rich. Why not keep the taxes in place and use the funds to, say, give Medicaid patients private coverage? Instead of tax cuts for the richest, Congress could improve health-care access in rural areas or through the Department of Veterans Affairs, or it could increase rather than cut back on drug addiction treatment. (Aren’t the rich already getting a tax cut from the GOP’s tax reform plan?)

Sixth, there is a tremendous opening here for Senate moderates to end this fiasco and try to work with Democrats on a shortlist of reforms. Republicans are willing, it seems, to support the exchanges as is for a couple of years. Democrats should put forth their own suggestions for bolstering the exchanges. Rather than do away with the individual mandate, the lawmakers could seek to prevent young, healthy people from gaming the system (i.e. going into the system only when they get sick or injured). They could even agree to keep or — gasp! — increase the pool of people covered by Medicaid in exchange for some reforms. (Why not a work or school requirement for able-bodied adults with no children?) They should bring the governors into the discussion and get buy-in from both Republicans and Democrats who have actually run their state’s Medicaid systems.

Instead of getting run over by the right wing of their party, as their House counterparts did, Senate moderates have the chance to strike out on their own and come up with reforms that bolster the exchanges and that improve Medicaid. They can test Democrats’ promise to work constructively across the aisle. Conservatives, meanwhile, should understand that the bill is nothing more than a repudiation of their seven-year fight to repeal the ACA. They will leave a legacy that amounts to: Obamacare, but worse!

University of California at Berkeley, BA in history

University of California at Berkeley, JD

Jennifer Rubin writes reported opinion for The Washington Post. She is the author of “Resistance: How Women Saved Democracy from Donald Trump” and is host of the podcast Jen Rubin's "Green Room."

Jennifer Rubin

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The Washington Post Opinions section features opinion articles, op-eds, editorials by the Editorial Board, global opinions and letters to the editor on the issues of the day. Offerings include columns by Washington Post opinion writers, political cartoons by editorial cartoonists Ann Telnaes and Michael de Adder and podcasts by James Hohmann and Jonathan Capehart.