The bill is bad in both obvious and subtle ways. Its passage was premised on the claim that it would protect people with preexisting conditions, even though states could allow insurers to price sick people out of the market. Rep. Tom Cole (R-Okla.) said on Thursday that states would have to meet “stringent conditions” before they could rip up Obamacare’s protections. But experts who have gone through the bill’s language have found the requirements to be minimal.

Once insurers could rate premiums according to people’s health status, the Brookings Institution’s Matthew Fiedler explains, options for people with preexisting conditions would dry up, even if they did the responsible thing and kept continuous coverage. Not a problem, according to House Majority Whip Steve Scalise (R-La.): The bill offers “multiple layers of protection.” But, unlike what much of the reporting has indicated, states would not have to establish high-risk pools for people who fall through the cracks. And even if they did, the bill does not specify whom or what high-risk pools would have to cover, or what premiums could be for people in them.

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The last-minute $8 billion amendment that swayed Rep. Fred Upton (R-Mich.) and other GOP lawmakers to support the bill is embarrassingly poor. The University of Michigan’s Nicholas Bagley observes that states will be tempted to take the money, but the more who do, the less there will be to go around. The result would be little help for people with preexisting conditions. A study that Avalere Health released Thursday found that the bill’s funding levels could cover only 110,000 to 600,000 of 2.2 million people in individual insurance markets who have preexisting conditions.

The preexisting conditions mess is only the beginning of the bill’s defects. Shoddy legislative language could undo cost protections for most Americans in employer-sponsored health plans. Subsidies currently based on income, region and premium costs would be reduced in size and rated only weakly by age, potentially harming older, low-income people, particularly in rural areas. Much of the bill remains the same as the one the Congressional Budget Office projected would result in 24 million fewer people with health-care coverage, in part due to its hard-hearted rollback of the Medicaid program for the poor and near-poor.

For many of these reasons, the bill could die in the Senate. So, some Democrats calculate, House Republicans just walked the plank for a bill that will go nowhere. Democrats challenging vulnerable Republicans now have a potent attack line, and Obamacare will probably remain the law of the land.

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Perhaps this sort of cynicism softens the blow. But cynicism is a low sentiment, an abdication of conscience when a key legislative body in the world’s greatest democracy just endorsed a cruel bill that would hurt millions of people. It also ignores the damage that Republicans are doing to the health system right now. The damage will continue as long as the GOP is quixotically bent on repealing and replacing Obamacare.

The health-care system relies on insurers voluntarily selling coverage on highly regulated and carefully subsidized markets. Uncertainty about the regulations or the subsidies repels insurance companies that need assurances that new policy under a new administration will not cause them to lose vast amounts of money. Republicans have cultivated such uncertainty at a crucial time, when insurers are deciding whether to participate in Obamacare markets next year, and what they would charge people if they did.

While hopes of repeal and replace have remained alive, President Trump has refused to offer insurers confidence that a crucial subsidy program will continue. When asked, the White House insists that the solution to the system’s problems is the American Health Care Act. For his part, House Speaker Paul Ryan (R-Wis.) has ducked responsibility and kicked the can back toward a White House that had provided nothing but volatility. Even if that issue is resolved, insurers unsure of where health-care policy is heading will be wary of continuing to invest in markets that may not exist in a few years.

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