Last week, President Trump intervened in the final stages of legislative passage of a $1.4 trillion spending package, funding the federal government for the rest of the fiscal year, to further slash the impoverished island of Puerto Rico of billions of dollars of Medicaid funding.

The initial spending bill would have sent about $12 billion in Medicaid funding to Puerto Rico over four years, but Trump demanded this be slashed to $5.7 billion over two years, according to a Politico report. In a bipartisan vote, the Democratic-controlled House overwhelmingly passed the spending package last Tuesday and it was approved Thursday by the Senate. Trump signed the bill into law on Friday, ahead of the December 20 deadline.

A spokesperson for the White House Office of Management and Budget told Politico that “additional funding was not needed” for the impoverished island. Another said the new deal was a “win for President Trump and the American people.”

While social services such as health care are being cut by the billions, the two budget bills passed by Congress and signed into law by Trump include a massive $738 billion for the military and national security spending. The package includes $1.4 billion in spending for Trump’s border wall.

Hurricane Maria, which hit the island in 2017 and destroyed essential infrastructure and thousands of homes, led to a mass exodus to the mainland US. Those who remain on the island are elderly or impoverished, and many doctors and medical professionals have left the island in search of better working conditions and better pay. Medicare reimbursement rates for doctors are 40 percent lower than in the mainland US. More than 60 percent of people on the island receive either Medicare or Medicaid, and 1.6 million are on the island’s Medicaid program, called “Mi Salud.”

Just as the Trump administration used the social devastation after Hurricane Maria to secure debt repayments to Wall Street creditors and crystallize the austerity programs imposed by the Obama administration through the Puerto Rico Oversight, Management, and Economic Stability Act (PROMESA), Trump’s response to the funding of medical care on the island expresses the complete indifference and criminality of the entire ruling elite toward the working class.

Puerto Rico’s health care crisis began in 1968, when Congress imposed a cap on Medicaid spending in US territories, limiting the federal contribution. Puerto Rico receives significantly less from the federal government than US states, which means the Puerto Rican government has to pay billions to cover needed medical care.

Puerto Rico has been in a profound political and social crisis for over a decade. Social inequality and austerity have become a central feature of Puerto Rican life for the vast majority of the population, which is overwhelmingly working class and poor. Hundreds of public schools have been looted, shut down, or turned into charter schools, hospitals have been closed, and many jobs have disappeared.

This led to a mass movement in July of this year of Puerto Rican workers, students, and small business owners against the governor of Puerto Rico and the Financial Oversight Board, which led to the ouster of Governor Ricardo Rossello and his replacement by Wanda Vázquez Garced.

The protests were sparked by 900 pages of private chat messages between the governor and top officials in his administration. The chats confirmed what many on the island already knew, that the governor and the entire political establishment were corrupt and had only contempt toward the island’s 3.2 million residents.

The protests were part of a global resurgence of class struggle against the same social conditions that plague Puerto Rico. After decades of social counter-revolution, the working class has come onto the international stage to fight for social equality and their democratic rights.

The struggle for high-quality health care, decent wages, and the struggle against the dictatorship of capitalism in Puerto Rico can only be taken forward by appealing to workers on the mainland and around the world in a common struggle for socialism and against the whole capitalist system.