The fist bumps com­ing from the GOP after pass­ing the Amer­i­can Health Care Act in the House were plen­ti­ful. Repub­li­cans around the coun­try were giv­ing each other high-​fives for hav­ing finally made the first real steps towards repeal­ing Oba­macare. Here’s the prob­lem. We haven’t seen the begin­ning of the repeal of Oba­macare. We’ve seen the seeds of Trump­care being planted. Per­haps the bet­ter name for it would be “Obamacarelite.”

This a repeal in name only. Con­gress­man Justin Amash revealed the truth about the AHCA in a Face­book post yes­ter­day (emphases are mine):

This is not the bill we promised the Amer­i­can peo­ple. For the past seven years, Repub­li­cans have run for Con­gress on a com­mit­ment to repeal Oba­macare. But it is increas­ingly clear that a bill to repeal Oba­macare will not come to the floor in this Con­gress or in the fore­see­able future.

When Repub­li­can lead­ers first unveiled the Amer­i­can Health Care Act, a Demo­c­ra­tic friend and col­league joked to me that the bill wasn’t a new health care pro­posal; it was pla­gia­rism. He was right.

The AHCA repeals fewer than 10 per­cent of the pro­vi­sions in the Afford­able Care Act. It is an amend­ment to the ACA that delib­er­ately main­tains Obamacare’s frame­work. It refor­mu­lates but keeps tax cred­its to sub­si­dize pre­mi­ums. Instead of an indi­vid­ual man­date to pur­chase insur­ance, it man­dates a pre­mium sur­charge of 30 per­cent for one year fol­low­ing a lapse of cov­er­age. And the bill con­tin­ues to pre­serve cov­er­age for depen­dents up to age 26 and peo­ple with pre-​existing conditions.

I want to empha­size that last point. The bill does not change the ACA’s fed­eral require­ments on guar­an­teed issue (pro­hi­bi­tion on pol­icy denial), essen­tial health ben­e­fits (min­i­mum cov­er­age), or com­mu­nity rat­ing (pro­hi­bi­tion on pric­ing based on health sta­tus). In short, Obamacare’s pre-​existing con­di­tions pro­vi­sions are retained.

The lat­est ver­sion of the AHCA does allow any state to seek a waiver from cer­tain insur­ance man­dates, but such waivers are lim­ited in scope. Guar­an­teed issue can­not be waived. Nobody can be treated dif­fer­ently based on gen­der. And any per­son who has con­tin­u­ous cov­er­age — no lapse for more than 62 days — can­not be charged more regard­less of health status.

Con­sider what this means: Even in a state that waives as much as pos­si­ble, a per­son with a pre-​existing con­di­tion can­not be pre­vented from pur­chas­ing insur­ance at the same rate as a healthy per­son. The only require­ment is that the per­son with the pre-​existing con­di­tion get cov­er­age — any insurer, any plan — within 62 days of los­ing any prior coverage.

If a per­son chooses not to get cov­er­age within 62 days, then that per­son can be charged more (or less) based on health sta­tus for up to one year, but only (1) in lieu of the 30 per­cent penalty (see above), (2) if the per­son lives in a state that has estab­lished a pro­gram to assist indi­vid­u­als with pre-​existing con­di­tions, and (3) if that state has sought and obtained the rel­e­vant waiver. Here in Michi­gan, our Repub­li­can gov­er­nor has already stated he won’t seek such a waiver, accord­ing to reports.

So why are both par­ties exag­ger­at­ing the effects of this bill? For Pres­i­dent Trump and con­gres­sional Repub­li­cans, the rea­son is obvi­ous: They have long vowed to repeal (and replace) Oba­macare, and their base expects them to get it done. For con­gres­sional Democ­rats, it’s an oppor­tu­nity to scare and ener­gize their base in antic­i­pa­tion of 2018. Nei­ther side wants to present the AHCA for what it is — a more lim­ited pro­posal to rework and reframe parts of the ACA, for bet­ter or for worse.

In March, when this bill was orig­i­nally sched­uled to come to the floor, it was cer­tainly “for worse.” The pre­vi­ous ver­sion pro­vided few clear advan­tages over the ACA, yet it hap­haz­ardly added pro­vi­sions to mod­ify essen­tial health ben­e­fits with­out mod­i­fy­ing com­mu­nity rat­ing — plac­ing the sick­est and most vul­ner­a­ble at greater risk.

Over the last month, sev­eral small but impor­tant changes were made to the bill. The cur­rent ver­sion aban­dons that fatally flawed approach to essen­tial health ben­e­fits (though the new approach includes new flaws), incor­po­rates an invis­i­ble risk shar­ing pro­gram, and per­mits lim­ited state waivers. These changes may slightly bring down (or at least slow down the increase in) pre­mi­ums for peo­ple who have seen rates go up. Even so, the AHCA becomes only mar­gin­ally bet­ter than the ACA.

Many have ques­tioned the process that led up to the vote on May 4. I have pub­licly expressed my dis­gust with it. The House again oper­ated in top-​down fash­ion rather than as a delib­er­a­tive body that respects the diver­sity of its mem­ber­ship. But it’s impor­tant to acknowl­edge that the bulk of this bill (123 pages) was released on March 6. Only about 15 pages were added after late March. Mem­bers of Con­gress were given suf­fi­cient time to read and under­stand the entire bill.

While an ear­lier ver­sion of the AHCA included a CBO score, the types of changes made to the AHCA in more recent stages ren­der an updated score highly spec­u­la­tive and prac­ti­cally mean­ing­less. For that score to be use­ful, the Con­gres­sional Bud­get Office would have to effec­tively pre­dict which states will seek waivers, which waivers they will seek, and when they will seek them. This com­plex analy­sis of the polit­i­cal processes and choices of every state is beyond anyone’s capa­bil­ity. I weighed the lack of an updated score accordingly.

When decid­ing whether to sup­port a bill, I ask myself whether the bill improves upon exist­ing law, not whether I would advo­cate for the pol­icy or pro­gram if I were start­ing with a blank slate. In other words, the proper analy­sis is not whether it makes the law good but rather whether it makes the law bet­ter. In this case, I felt com­fort­able advanc­ing the bill to the Sen­ate as a mar­ginal improve­ment to the ACA. The House has voted more than 30 times to amend (not just repeal) Oba­macare since I’ve been in Con­gress, and I have sup­ported much of that leg­is­la­tion, too, on the prin­ci­ple of incre­men­tal­ism. If it advances lib­erty even a lit­tle (on net), then I’m a yes.

Nonethe­less, the ACA will con­tinue to drive up the cost of health insur­ance — while bol­ster­ing the largest insur­ance com­pa­nies — and the mod­i­fi­ca­tions con­tained in the AHCA can­not save it. Many of the AHCA’s pro­vi­sions are poorly con­ceived or improp­erly imple­mented. At best, it will make Oba­macare less bad.

The Framers of the Con­sti­tu­tion under­stood that fed­er­al­ism — the divi­sion of pow­ers between the national and state gov­ern­ments — would max­i­mize the hap­pi­ness of Amer­i­cans. As long as Wash­ing­ton dic­tates health insur­ance pol­icy to the entire coun­try, there will be mas­sive ten­sion and dis­plea­sure with the sys­tem. I’ve always said, and I will con­tinue to say, we need to start over: Fully repeal Oba­macare, let the peo­ple of each state choose their own approach, and work together in a non­par­ti­san manner.