This Republican bill is a turkey. Passed or not, it won't end the death spiral.
The fundamental difficulty at the core of Obamacare is the "guaranteed issue" part, which covers pre-existing conditions. Neither party has balls enough to repeal it because it will "hurt people". The problem is that by covering pre-existing conditions at the same rate as the healthy, the private insurance market is essentially destroyed. There is no amount of cost-shifting or subsidies that can be obtained to make this work. The result is that Healthcare exchanges still exist, government has to keep providing medicaid in areas where private insurers have pulled out, and the death spiral continues.
My suggestion would be to remove these people entirely from the insurance market. If for example, your insurance plan is scheduled to cost more than 30% of your gross income, then you would be eligible to be put in a separate high-risk pool subsidized (unfortunately) by a fund in each state. Likely it would only comprised < 10% of people who get private insurance. I would of course remove any mandate or tax penalty for not buying insurance.
That's not a bad idea, although it sounds pretty similar for Medicaid for those who can't afford full insurance (with pre-existing conditions making it unaffordable)
I say scrap the whole damn thing:
1) repeal EMTALA,
2) abolish Stark law prohibition of physician-owned hospitals
3) eliminate certificate of need
4) nationwide Medicare-light, which gets seen at nationwide system of teaching hospitals/county hospitals.
--make a new 6 year program from college which makes someone a primary doctor, give free/reduced tuition in exchange for 10 year primary care service (sim. to what military does)
--more subsidies/free tuition if you commit 10 year to work at US-version of NIH (aka British system)
--there will be no malpractice, and there will be rationing of care at the Nationwide US-NIH
--if 2 doctors decide end-of-life, you are on hook for artificially prolonging life of grandma
--in event of malpractice, go to no-fault system
5) Get rid of non-profit hospitals, allow private hospitals which take insurance (or payment) but not bound by CMS regulations (but still subject to intermittent inspections for safety, quality of care)
--full "free-market" hospitals
--Allow malpractice at for-profit centers
--allow multiple hospitals to compete for care of insured patients, including physician owned-centers
--not much different than what we have now w/ insured patients (essentially a two-tier system)
--no govt funding for private hospitals (sim. to Australia)
Let's stop this weird socialized-"free" market hybrid that can't be one or the other b/c of regulations and laws