The long-awaited Senate Obamacare replacement plan

I spent some time today reading through the new Senate healthcare bill, lovingly called the "Better Care Reconciliation Act of 2017". Compared to the House bill (which I did not read), this seems to leave a good chunk of Obamacare alone. I think I have to agree with Rand Paul that this truly is "Obamacare lite". It tweaks some things, repeals most of the new taxes associated with the Patient Protection and Affordable Care Act, and adds a few new programs ostensibly designed to constrain Medicaid and other healthcare costs. But it doesn't really take any new direction, and it seems to do little in the way of reducing our nations huge healthcare costs.

These are the biggest changes I see in the bill compared with current law:

• Households below 350% of the poverty level are eligible for refundable health insurance tax credits, compared with the old requirements that households must be between 100% and 400% of the poverty level. The tax credit is also scaled as a function of income AND age.
• The Medicaid expansion is being eliminated (with all additional funding for states that have expanded Medicaid to end at the end of 2023). 
• This may not be the end of the world, because those previously covered by Medicaid can get coverage on the individual market.
• The plan cost used to determine subsidies is now the median priced 58% actuarial value plan. Previously, it was the 2nd lowest cost Silver plan (silver plans basically corresponding to 70% actuarial value). 
• Under Obamacare, if your employer offered insurance that is too expensive or of poor quality, you can elect to get insurance in the individual market and you still can receive the refundable tax credits (provided you are below the income limits of course). Under the BCRA (can I call it the BeCaRAct?) you are still not eligible for the tax credits, no matter how expensive or terrible your employer provided insurance is. 
• "Qualified health plans" now can only include coverage for abortions that are to save the mother's life or in the cases of rape or incest. 
• Elimination of the individual and employee mandates. 
• Increased HSA limits up to max OOP for high deductible health plans. 
• 1 year defunding of Planned Parenthood.
• Repeal of cost-sharing subsidies. Under Obamacare, low income households would pay less for out of pocket health expenses. This is eliminated.
• States can apply for waivers from the requirements to provide comprehensive, affordable coverage. These waivers could lead to fewer people covered by health insurance. The waivers must be granted unless they increase the federal deficit.

Overall, the bill seems to cut a good chunk of taxes in order to reduce expenditures on healthcare. This reduction in healthcare spending will largely target the poor, while the tax cuts will primarily benefit high-earning individuals and large corporations. This is an objective statement and really can't be denied if one is being truthful.

While we could potentially see more people obtain health insurance due to everyone under 350% of the poverty level being eligible for tax credits, I think in actuality the poor are going to have a hard time affording health care. Even though they can get insurance coverage for a measly 2% of their income, these are going to be high deductible, high out-of-pocket maximum plans, which for a poor household will still likely be far out of reach of what their income can provide.

Of note, the bill didn't touch the most popular parts of Obamacare: People can't be denied coverage based on pre-existing conditions, nor can they be charged more, and children can remain on their parents' insurance up to age 26. However, without the individual mandate, it's not clear to me what will keep people in the health insurance market when they are healthy. Not that I like the mandate or anything, but it's a bit disappointing to see that there is NOTHING to replace it to incentivize people to stay covered.

Below is a more comprehensive summary of what I understood to be in the bill. Bulleted items are generally editorializing done by me.