The Trump administration and the Republican leadership of the House of Representatives abruptly canceled a scheduled vote on their bill to repeal and replace Obamacare on Thursday after failing to obtain the required votes from the Republican caucus to secure passage.
Trump held a last ditch meeting Thursday morning with members of the far-right “Freedom Caucus” and offered more concessions, making the bill even more reactionary and punitive, but still failed to obtain their support. At the same time, previous concessions made to the group of some 30 Tea Party zealots alienated members of the nominally “moderate” Tuesday Group within the Republican caucus, leading at least eight of them to declare their opposition on the grounds that the bill was too harsh.
With all 193 House Democrats pledged to vote against the bill, the White House and House Speaker Paul Ryan could afford no more than 22 “no” votes from the 237 Republicans if the bill was to avoid going down to defeat. As of mid-afternoon on Thursday, the media was reporting that some 37 Republicans were planning to oppose the measure, titled the American Health Care Act (AHCA).
Ryan, who had already canceled a press conference scheduled for the morning and rescheduled it for 3:30 pm, suddenly canceled again, after which the media began to report that the vote would be postponed, without at first indicating when it might be held.
The disarray in the Trump administration and the Republican House leadership was evident. Only a few hours before, Trump had met with trucking industry executives and affirmed that the vote would be held later in the day and the measure would pass. His press secretary, Sean Spicer, insisted at a press briefing shortly before Ryan canceled his afternoon press conference that the bill would get the needed votes.
Following the postponement of the vote, it was announced that Trump would meet with the Tuesday Group at 5 pm and the entire Republican caucus would meet in the early evening. The administration said debate on the House floor would begin Thursday evening and the vote would be rescheduled for early Friday. The debate did, in fact, get underway as promised, but as of this writing it remains unclear when or if an up-or-down vote will be held.
Even if the measure, as amended to conciliate the most right-wing holdouts, does pass the House, it faces an uphill struggle in the Senate, where 8 of the 52 Republican senators have said they plan to vote against it.
The AHCA is a vicious attack on health care for ordinary working and retired Americans. As reactionary as Obamacare is, the Trump bill goes significantly further in stripping tens of millions of people of health coverage, gutting Medicaid, the federal-state program for the poor, and ending it as an entitlement program, removing virtually all restraints on profit-gouging by the insurance monopolies, and providing massive tax cuts for wealthy individuals and medical firms.
The Congressional Budget Office estimates that “Trump care” will leave 14 million more people uninsured in its first year and 24 million over a decade.
Obamacare was devised largely by the insurance and health care corporations to decrease their costs and those of the government and impose a greater burden for health care on the backs of workers by increasing their premiums, co-pays and deductibles. It brought some 20 million previously uninsured people into the system by expanding Medicaid coverage and requiring people not insured by their employer or a government program such as Medicare, which covers people 65 and older, to purchase plans from private insurers on government-run exchanges. It still left some 20 million people completely uninsured and encouraged the rationing of health care for ordinary people who were insured by withholding more expensive tests, drugs and treatments.
Far from reining in the insurance giants, drug monopolies and hospital chains, it weakened the system of employer-paid insurance and strengthened the grip of the market on health care.
The Trump bill escalates the health care counterrevolution begun under Obama. Since the bill was first released on March 6, it has been made progressively more brutal as negotiations within the Republican caucus have been held in an attempt to win over the most diehard opponents of health care for poor and moderate-income people and seniors. Earlier this week, the White House agreed to amend its initial bill to allow states to impose work requirements on Medicaid recipients and receive federal funding in the form of a block grant, rather than on the basis of a cap on outlays per recipient.
Health and Human Services Secretary Tom Price and Seema Verna, the administrator of the Centers for Medicare and Medicaid Services, sent a letter to state governments last week saying they were open to granting waivers to allow states not only to add work requirements, but also to require recipients to pay premiums and co-pays for Medicaid care.
Both per-capita spending caps and block grants effectively end Medicaid, which currently covers 74 million people, as an open-ended federal entitlement program, but the block grant scheme will hasten the dismantling of the program.
In its current form, the Trump bill ends the expansion of Medicaid under Obamacare, which provided some level of health coverage to 11 million previously uninsured people, in 2020. It slashes funding for the program by 25 percent by 2026 and reduces the number of beneficiaries by 17 percent, or 14 million people. By 2026, according to the Congressional Budget Office, federal spending on Medicaid will have fallen by a cumulative total of $880 billion.
The Trump bill also slashes health care subsidies for low-income people, most onerously for elderly workers not yet eligible for Medicare, eliminates requirements for large corporations to provide coverage to their employees, cuts taxes for the wealthy and medical corporations by $600 billion, strips Planned Parenthood of federal funding for one year and imposes other abortion restrictions, and retains Obamacare’s excise tax on supposedly overly generous employer-sponsored health plans—those covering millions of unionized active and retired workers. This provision is specifically designed to hasten the demise of employer-sponsored coverage and force millions of workers to purchase insurance on the private market as individuals.
On Wednesday, in a further attempt to win over the Freedom Caucus holdouts, the White House offered to strip its bill of an Obamacare mandate requiring insurance firms to provide essential benefits in ten areas: doctor’s visits, emergency services (such as ambulances), hospitalization, maternity care, pediatric care, mental health and substance abuse treatment, prescription drugs, lab tests, rehabilitation, and preventive services.
“I’m afraid if they get rid of the essential benefits,” commented Dr. John S. Meigs, Jr., president of the American Academy of Family Physicians, “you’ll have meaningless insurance.”
This, however, did not go far enough for the Tea Party crowd. They are reportedly demanding even further windfalls for the insurance companies, including the elimination of language that bars companies from setting insurance rates based on a person’s sex, medical condition, genetic condition or other factors. They are also demanding caps on the amount of money insurers have to pay out on health claims, limits on the number of years a beneficiary can be covered, and drug testing of beneficiaries.
Reports differ on whether the “Freedom Caucus” is prepared to accept the current bill’s ban on insurers denying coverage based on preexisting conditions and its provision allowing children to stay on their parents’ plans until age 26, measures that have been carried over from Obamacare.
Whatever the immediate fate of the American Health Care Act, one thing is certain. The ultimate outcome of the health care “reform” hashed out between the two parties of the US corporate-financial ruling elite will be a catastrophic decline in health care and a further fall in life expectancy and quality of life for tens of millions of American workers.