Senate Republicans are working feverishly to pass their version of a bill to “repeal and replace” the Affordable Care Act (ACA), having set themselves an arbitrary deadline of securing its passage before the July 4 congressional recess. Early last month, House Republicans passed the American Health Care Act (AHCA), celebrating in the White House Rose Garden with President Trump, who said of the bill, “It’s a great plan, and I believe it’s going to get better.”
A group of 13 Republicans senators is working behind closed doors on the Senate version of the legislation. Senate Majority Leader Mitch McConnell plans to push the legislation—which concerns one-sixth of the US economy, and which will affect the health and lives of tens of millions of Americans—with no committee hearings, no public mark-up (drafting and editing) of the bill, and only limited debate.
It is no secret that the clandestine nature of the Senate “working group’s” negotiations is due to the AHCA’s wide unpopularity, with a recent poll showing that only 20 percent of Americans approve of it while 57 percent disapprove. The broad opposition is due to its draconian features, particularly the gutting of Medicaid, the social insurance program for the poor jointly funded by the federal government and the states. The AHCA would effectively end Medicaid as a guaranteed benefit based on need by placing a per-capita cap on overall spending.
The AHCA would slash $824 billion from Medicaid and would end the ACA’s expansion of Medicaid to low-income adults, causing 14 million newly insured people to lose their benefits over a decade. All told, the Congressional Budget Office estimates that 23 million people would become uninsured in 10 years under the AHCA. At the same time, the bill would slash taxes for corporations and wealthy individuals, while boosting the already multibillion-dollar profits of the health care industry.
McConnell has an additional reason for secrecy, since any divisions within the Republican caucus threaten passage of the bill, and concessions made to far-right senators like Ted Cruz and Rand Paul could provoke opposition from a group of “moderates” from states with large Medicaid populations, and vice versa.
Under the “reconciliation” process chosen for the health care legislation, the Republican leadership can push through the bill despite holding only a narrow 52-48 majority, providing they lose no more than two Republicans, with Vice President Mike Pence casting a tie-breaking vote.
Senate Democrats profess outrage over the closed-door nature of the Republicans’ deliberations. They staged a talk-a-thon on the Senate floor Monday night, stalling chamber proceedings through a series of parliamentary maneuvers. A few senators live-streamed their “search” for the elusive legislation, driving around the capital. All of these stunts amount to so much hot air. The Democrats are incapable of mounting a true opposition to the Republicans’ vicious assault on the health care of ordinary Americans because they share their class objectives.
Numerous media commentaries have pointed to the Democrats’ “powerless” position to oppose the Republicans’ plan, due to the Republicans’ 52-48 Senate majority. This is only valid in terms of parliamentary arithmetic: the vast majority of the American people oppose the House bill and will oppose the Senate bill once they learn its provisions. But the Democratic Party is unwilling and unable to mobilize this popular opposition.
Every Senate Democrat, including so-called independent and self-professed “democratic socialist” Bernie Sanders, portrays Obamacare as a progressive social reform, or at least a “step in the right direction,” concealing the reactionary and anti-working-class character of the Affordable Care Act.
Obamacare was aimed from the start at cutting costs for the government and corporations while rationing health care for the vast majority. In that sense, the Republicans have invented nothing new. Whatever version of “Trumpcare” eventually passes the Senate will only take the tendencies already present in Obamacare and make them worse: imposing more and more of the cost of health care on individual workers and their families.
The logic of this process, under both Democrats and Republicans, is the development of an openly two-class health care system: the best health care money can buy for the super-rich and a privileged upper-middle-class layer; and for the vast majority of the population, a cut-rate system, starved for funds and personnel, offering inadequate and overpriced care, if any at all.
In response to Trump and the Republicans’ howls that the ACA is “failing” and “imploding”—through rising premiums and deductibles and dwindling networks of insurers—the Democrats beg for a seat at the table to “fix” Obamacare. This is a euphemism for making further concessions to the demands of the insurance companies and other corporate interests by further restricting subsidies for low-income purchasers of insurance plans, cutting business taxes and implementing other regressive measures.
Any health care overhaul hatched in Washington will be based on the for-profit health care system, enriching the insurance companies, drug companies, hospital chains and medical device companies and the CEOs that run them.
Looking beyond the Democrats’ bluster, working people need to actually take stock of what is at stake in the Republicans’ plan. The most fundamental attack is the gutting of Medicaid, one of the last social reforms wrested from the ruling elite through working-class struggle. While limited in nature, Medicaid guaranteed the right to health insurance and medical services for the poor and for children and disabled people, and provided funding for nursing care for the elderly based on need. Medicaid emerged as part of the “Great Society” and “War on Poverty” under the Johnson administration, alongside landmark legislation such as the Civil Rights Act and the Food Stamp Act, both in 1964, and the Voting Rights Act of 1965.
The assault on health care exemplified by the Republicans’ reactionary legislation is of a piece with the ruling elite’s attack on all the social rights of the working class—the right to a job, education, decent housing, a secure retirement, access to the arts and culture, and a healthy and safe environment.
Congressional Democrats have chosen to oppose the Trump administration not over the destruction of social conditions, but over Trump’s alleged “softness” toward Russia. They are working in alliance with the dominant factions of the intelligence apparatus to whip up a war fever against Russia in an attempt to condition the public for an escalation of the wars in the Middle East as well as a military confrontation with Iran and nuclear-armed Russia. Incapable of opposing the most reactionary presidency in US history on anything resembling a progressive or democratic basis, they have positioned themselves to the right of Trump on issues of imperialist foreign policy.
Whatever form it takes, the health care legislation that the Republicans are able to pass through Congress and place on the president’s desk to sign will be one of the most reactionary pieces of legislation in modern history. The ruling elite sees the attack on Medicaid as the first shot in their war on Medicare and Social Security and wants to see all of these social programs privatized or ended outright. In the final analysis, both big-business parties agree that health care must be limited to what is compatible with the profit interests of corporate America.
The working class must fight for its own class interests. The crisis in health care requires a socialist solution, which takes as its point of departure the needs of working people and society as a whole, not the wealth and profits of a tiny minority.
The establishment of a system of universal, free health care for all requires placing the entire health care system—the private insurers, pharmaceuticals, giant health care chains—under public ownership, managed democratically to serve human needs, not profit. Such a fight requires the mobilization of the working class as a revolutionary force, independent of and opposed to both the Democratic and Republican parties.