White House and Republicans fail on “repeal and replace” of Obamacare

Senate Majority leader Mitch McConnell, Republican of Kentucky, announced Tuesday morning on the Senate floor that the Republicans’ effort to repeal and replace Obamacare had failed.

This turn of events marks a stunning defeat for President Trump, who has made a “repeal and replace” of the Affordable Care Act (ACA) one of his central policy goals. Although he has issued executive orders on immigration, deregulation, and taken other reactionary initiatives, no major legislation has been moved through Congress for him to sign.

McConnell was unable to bring the latest version of Senate Republicans’ Better Care Reconciliation Act (BCRA) to a vote after two Republican senators, Mike Lee of Utah and Jerry Moran of Kansas, came out in opposition to the bill, leaving the Senate leadership at least two votes short of the number needed to begin debate on the measure.

Two other Republicans, Senators Rand Paul of Kentucky and Susan Collins of Maine, had already signaled their opposition. With a slim 52-48 majority in the Senate, the measure could only lose the support of two Republicans, with Vice President Mike Pence brought in to break a tie.

Senate Republicans then pivoted to “Plan B,” described by McConnell as legislation that would include a “repeal of Obamacare combined with a stable two-year transition period.” This measure was scuttled almost as soon as it was advanced, as three Republican senators indicated that they would not vote to bring it to the Senate floor.

McConnell told the press, however, that he would still bring the bill to a vote “soon,” perhaps this week. This is presumably an effort to definitely put this round of the Republicans’ health legislation effort to rest and move on to tax cuts for the wealthy, military appropriations and other budget-cutting.

Such an action, simply repealing the ACA with nothing in its place, would in swift order strip millions of people of their health care. It would undoubtedly enrage a population already fed up with the deplorable state of health care for ordinary Americans. But the Trump administration is inherently hostile and indifferent to the millions of people who would stand to suffer under such a scenario.

After the failure of “repeal and delay,” Trump seemed unhinged as he spoke to a White House press pool Thursday. First blaming the Republicans for the defeat of any Senate measure to repeal Obamacare, he said, “We’re not going to own it. I’m not going to own it. I can tell you the Republicans are not going to own it. We’ll let Obamacare fail and then the Democrats are going to come to us.”

A recent Kaiser Family Foundation poll found that only 26 percent of Americans were in favor of the “repeal and delay” approach, while 61 percent opposed “repeal and replace.” More importantly, nearly two-thirds of those polled, 65 percent, oppose major reductions in federal funding for Medicaid, the social insurance program for the poor and disabled, jointly funded by the federal government and the states. More than 70 million people are currently covered by Medicaid.

Both the BCRA and similar legislation passed in the House would gut Medicaid, slashing federal funding for the program by more than $770 billion over 10 years. Both bills would terminate it as an open-ended entitlement program with guaranteed benefits by instituting per-capita caps or block grants in funding to the states.

The legislation would also phase out Medicaid expansion in the 31 states that adopted it. The Congressional Budget Office estimated that an earlier version of the BCRA would leave 22 million more uninsured by 2026 than under current law.

The Democrats were quick to capitalize on the Republicans’ legislative failure. Their comments, however, did not center on the draconian cuts to Medicaid posed in the Senate plan. Rather, they repeated their offer to work with the Republicans to “fix” Obamacare.

Senate Minority Leader Chuck Schumer made clear at a press conference Tuesday afternoon precisely what the Democrats mean by “fixing” the ACA. “By continuing to deny the insurance markets the certainty they need to function, the president is playing a dangerous game with health care,” he said.

Schumer said the Republicans “can start today working with the Democrats. We can work together to lower premiums, we can work together to stabilize the markets, we can work together to improve the quality of health care.” In other words, the Democrats are proposing to “fix” Obamacare by making it even more beholden to the private insurers and the entire health care industry, which is wed to the capitalist system of health delivery in the US.

Senator Bernie Sanders, an independent who caucuses with the Democrats, wrote in a statement, “I am delighted to see that the disastrous Republican health care plan will not succeed.” He marked the occasion as “a great victory for the millions of Americans who stood up and fought back against this dangerous legislation.”

Sanders’ and Schumer’s statements serve to blind workers and young people to the social reality they face, and the type of struggle that is required to fight for quality, affordable health care and all of their democratic and social rights. That fight must take as its starting point the political mobilization of the working class, independent of the Democrats and their supposedly "left" allies, who inevitably come forward to promote illusions that this right-wing party will defend the interests of working people.

The gutting of Medicaid proposed in the failed Republican plans marked a new point of departure in the decades-long attack on health care and working class living standards. Starting with Medicaid, the aim is to privatize and ultimately dismantle the basic social reform programs dating from the 1930s and 1960s, including Medicare and Social Security.

The ACA, signed into law by Obama in 2010, marked a milestone in this effort, imposing massive cuts to Medicare, the health insurance program for the elderly. Obamacare, built on the foundation of the for-profit health care industry in the US, further subordinated the health delivery system to the private market, cutting costs for the government and corporations while rationing care and raising costs for the vast majority of Americans.

A recent study revealed that the US has the poorest health care, and the widest gap between rich and poor in the care they receive, of 10 other high-income countries. The US is in the midst of an opioid epidemic claiming the lives of tens of thousands of Americans every year. Some areas of the US have rates of infant and maternal mortality rivaling the world’s poorest nations.

But any “compromise” on health care worked out by the two big-business parties will not be based on confronting what can only be described as a health care emergency in America. It will not lower premiums or out-of-pocket expenses for working families, or improve the access to health care.

This latest episode in the health care “debate” must serve as both a warning and a wake-up call to workers and youth. Profit must be taken out of health care and the health care industry placed under public ownership and the democratic control of the working class. The working class must advance its own program, independent of both Trump and the Democrats, based on the fight for socialism.