The most recent version of the Senate Republican bill to repeal and replace ObamaCare would result in 22 million additional people without insurance over the next decade, the Congressional Budget Office (CBO) reported Thursday.

The number of uninsured is essentially unchanged from the original draft of the legislation released last month.

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A Health and Human Services analysis of Sen. Ted Cruz’s proposal to let insurers sell plans that don’t comply with Obamacare regulations appears to back up the Texas Republican’s claim that the idea would lower premiums across the individual insurance market. The analysis purports that the amendment offered to the Senate’s Obamacare repeal bill would slash premiums for certain Obamacare enrollees by 2020, and save even more for consumers who opt for cheaper, no frills products. HHS also found the amendment would boost enrollment by as much as as 16.1 million people by 2024, more than the nearly 14 million topline projected under Obamacare.

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How do we fix health care? The conservative policy world has offered a number of ideas, but elected Republicans have failed to coalesce around any particular strategy. J.D. Vance argues that this is because they’re unable to accept that the government must play a role in paying to solve this problem. This is where the Republican Party hits an ideological barrier that it simply must power through before meaningful reform can happen. Yes, solving problems can be expensive, and yes, that money always comes from taxpayers. Devising a vision is impossible when we refuse to accept that the government bears some financial responsibility in solving a problem it helped create.

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Senate Republicans, scrambling to win support for their health-care bill, pushed a measure Thursday that they said could ease the impact of the bill’s Medicaid cuts on low-income people.

Advocating for the new direction is a little-known health official who is now at the center of the health-care fight: Seema Verma, head of the Centers for Medicare and Medicaid Services, which oversees the two federal medical programs.

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It is a sign of Republican desperation that some think their best hope is to repeal ObamaCare and then pray something comes together in the next two years to replace it. President Trump even seems to expect that Democrats will help. Good luck with that.

Still, the repeal-only maneuver might provoke a fresh start, perhaps with a new bill drafted by some ad hoc group of legislators. Maybe failing to pass anything now will prompt wavering Republican senators to start supporting incremental, if imperfect, progress. A defeat of repeal on a procedural motion to take up the bill could cause Congress to drop health care now but return to it later, after Republicans make progress on tax reform, infrastructure, the debt ceiling and the budget.

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President Trump now suggests he may just let Obamacare collapse and blame Democrats since they did nothing to solve the problem. Grace-Marie Turner, President of the Galen Institute, said that strategy won’t work. “They are going to be blamed for the millions of people that would lose coverage if nothing is done because these exchanges are failing, insurance companies are signing up to provide coverage next year because they are losing so much money providing so-called insurance under Obamacare rules that don’t work,” she said. “Republicans own it. How can you have the White House and both houses of Congress and say that you don’t own this problem?” Turner asked.

But Turner is also slamming Democrats for asserting that premiums and deductibles are skyrocketing because Republican promises to repeal Obamacare are creating uncertainty among insurers. “That is just so completely beyond the realm of reality,” she said. “The reason that costs are going up under Obamacare is because of the flawed structure of the bill that, for one thing, encourages people to wait until they’re sick to sign up for coverage and that provides all sorts of opportunities for people to drop coverage and game the system.”

“Washington-centralized solutions are not the answer, whether Republicans are developing them or Democrats are developing them,” Turner said.

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Despite the surge in enrollment and spending—or perhaps because of it—Medi-Cal, California’s Medicaid program, has failed to fulfill its stated goal of improving health-care access for the indigent and disabled. A recent report from the Santa Clara County Civil Grand Jury highlighted the conundrum many of the state’s Medicaid enrollees face: “You’ve Got Medi-Cal, but Can You Get Medical Care?” By extending Medi-Cal to younger, healthier people—many of whom could be better served by the kind of bare-bones private insurance that ObamaCare outlawed—California has made it harder for those who most need low-cost care to get it.

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Republicans seem to be able to achieve near-unity on ending the individual mandate, allowing insurers to offer discounts for younger people, protecting taxpayers from having to subsidize abortion coverage, and giving states some freedom to relax regulations. They should work for legislation that achieves these goals and includes as much Medicaid reform as 50 senators are prepared to tolerate. Republicans should not claim that such legislation would repeal and replace Obamacare, since it would not, and should make it clear that additional legislation will be needed in the future.

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Senate Republicans killed their own health-care bill on Monday evening. This self-inflicted fiasco is one of the great political failures in recent U.S. history, and the damage will echo for years. This wasn’t the inevitable result of some tide of progressive history, but choices made by individuals to put their narrow political and ideological preferences ahead of practical legislative progress. The “ObamaCare Republicans” come from both the conservative and moderate wings, but all of these Senators campaigned for nearly a decade on repealing and replacing ObamaCare. Now they finally have a President willing to sign literally any bill that lands on his desk, but in the clutch they choked. The ObamaCare Republicans ran on fiscal discipline but they rejected the best chance for entitlement reform in a generation.

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The Trump administration and Republicans in Congress find themselves in a position there never wanted to be in: heading into the August recess having failed to repeal and replace the Affordable Care Act (ACA), and also without any significant legislative accomplishments since the November 2016 election.

Before charting a new course, the GOP needs to understand how they drove themselves into this political ditch.

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