Way cleared for bipartisan attack on Medicaid

US Senate votes to open debate on Republican health care legislation

The US Senate voted 51–50 Tuesday to open discussion on Republican legislation to repeal and replace Obamacare. The procedural vote to bring to the floor the House bill passed in May, the American Health Care Act (AHCA), will allow debate to begin and amendments to be put forward on a bill that calls for draconian cuts to Medicaid, the government insurance program for the poor and disabled, and the effective termination of the program as an “entitlement” with guaranteed benefits to all enrollees. The measure also includes huge tax cuts for corporations and the wealthy.

Although the vote is procedural, it is a clear signal that leading Republicans and Democrats are prepared to work together to “fix” the Affordable Care Act (ACA), popularly known as Obamacare, by making it even more profitable for the insurance industry and corporate America and more onerous for working people.

Workers must take the vote as a warning that there is a bipartisan conspiracy to undermine the health and wellbeing of working families in the interests of Wall Street.

Although the Republican legislation faces an uncertain future in Congress, the financial markets responded positively to the vote, interpreting it as reassurance that the drive to slash corporate and government health care costs will move forward and the eventual outcome will be the gutting of Medicaid and slashing of taxes. The Dow Jones Industrial Average rose 100 points on the news and the S&P 500 and NASDAQ notched record highs. At a White House press conference, President Trump hailed “the motion to proceed on health care.”

The Republicans’ one-vote majority was secured when John McCain made a dramatic return to the Senate after his diagnosis of brain cancer. Vice President Mike Pence cast the tie-breaking vote. Two Senate Republicans, Susan Collins of Maine and Lisa Murkowski of Alaska, voted against the measure, along with all 48 Democrats.

As a result of arm-twisting and promises by Senate Majority Leader Mitch McConnell, a number of Republicans, including Dean Heller (Nevada), Rob Portman (Ohio) and Shelley Moore Capito (West Virginia), voted in favor after previously declaring themselves either undecided or opposed. Senator Rand Paul of Kentucky, who had up to now been a firm “no,” voted in favor after being told by McCain that the Senate would vote immediately on a repeal of Obamacare without a replacement plan. This, however, is expected to fail.

The vote to begin debate follows failed attempts by the McConnell leadership to secure the 50 senatorial votes it needs to pass its Better Care Reconciliation Act (BCRA). The various iterations of the BCRA all include cuts to Medicaid totaling at least $770 billion over ten years. The Congressional Budget Office estimated that the legislation would leave 22 to 32 million more people uninsured over the next decade.

All versions of the BCRA would mark the end of Medicaid as a guaranteed federal entitlement program based on need. They would do so by imposing per-capita spending caps or block-granting funding to the states, resulting either way in the removal of millions from Medicaid rolls and cutting the benefits of those who remain.

The Senate will now begin debate on amendments, including a measure to repeal Obamacare with no replacement, a repeal and replacement bill, and a narrower bill that revokes the ACA’s individual mandate and other lesser provisions. None of these approaches presently appears to have the votes needed to pass.

John McCain’s return to the Senate to cast a decisive vote in favor of opening debate was as notable for the political theater it provided as for the content of his remarks. The senator was recently diagnosed with glioblastoma, a particularly aggressive form of brain cancer. He had not been expected to make a Senate appearance for the health care vote.

McCain condemned the process that had brought the Republicans’ to the procedural vote after failing to pass any versions of the BCRA. “We try to do this by coming up with a proposal behind closed doors in consultation with the administration,” he said, “then springing it on skeptic members, trying to convince them that it’s better than nothing.”

He said he would not vote for the bill in its present form and went on to predict that the Republicans’ go-it-alone strategy would “likely fail.” He urged the Senate to “return to regular order”—a process that would involve committee hearings and collaboration with the Democrats.

McCain urged the Health, Education, Labor and Pensions committee to “try to report a bill out of committee with contributions from both sides.” He continued: “Then bring it to the floor for amendment and debate, and see if we can pass something that will be imperfect, full of compromises, and not very pleasing to implacable partisans on either side, but that might provide workable solutions to problems Americans are struggling with today.”

Despite the senator’s sporting a scar over his left eye from his recent surgery, his claims of sympathy for ordinary Americans lacked any credibility. Secure in the knowledge that he has unlimited access to the best available medical care, he flew to Washington to make sure that debate would proceed on various measures to strip tens of millions of any access to decent care, ensuing untold suffering and many thousands of premature deaths.

McCain and the rest of the Senate are keenly aware of the broad and intense popular opposition to the Republican proposals. But as head of the Senate Armed Services Committee, his concern is advancing the predatory interests of US imperialism, in part by starving what remains of social programs in order to boost military spending. The Democrats are in basic agreement with this agenda.

In the lead-up to Tuesday’s vote, Senate Minority Leader Chuck Schumer stressed that the Democrats were willing to “compromise” and “work together” with the Republicans on health care and other economic issues. After the vote, he said the Democrats would not block efforts by Republicans to vote Tuesday night on amendments to repeal and replace Obamacare. “We’ll have to see what they propose,” he said, “but we don’t mind having a few votes tonight.”

Schumer’s statements follow his comments Monday to CNN that the Democrats’ primary concerns are health care and “the economic well-being of the working family”—not investigations into alleged Russian meddling in the 2016 election. This is cynical blather.

As Trump’s reactionary policies—on immigration, economic nationalism, the environment, health care and other social issues—have been moving forward, the Democrats have been focused on Russia and engaged in a struggle with the president on foreign policy. This has served to distract public attention from Trump’s assault on social programs and his gutting of regulations on big business.

It is significant that in all the demagogy attacking the Republicans’ health care legislation—including comments by Bernie Sanders on Monday calling it the “cruelest, most destructive and irresponsible piece of legislation ever brought to the United States Senate in the modern history of this country”—there have been no statements condemning proposals in the BCRA that would effectively end Medicaid as a guaranteed entitlement.

It is clear that any bipartisan deal that emerges on health care will make massive inroads into Medicaid and build on the pro-corporate content of the ACA. From the start, Obamacare has been based on making the for-profit delivery of health care in America even more heavily class-based, cutting costs for the government and corporations while rationing health care for the working class.

The attack on Medicaid—along with the other social reforms wrested from the ruling class in bitter struggles—began under Obamacare, which cut hundreds of billions from Medicare, the social insurance program for the elderly. The ultimate aim of health care “reform” is not only the destruction of Medicaid and Medicare, but the Social Security retirement program as well.

Schumer, Sanders and the Democrats defend the for-profit health care system. Their strategy of “fighting” the Republicans has been to call on workers and young people currently suffering under the health care system to pressure the Republicans to vote “no” on repealing and replacing Obamacare. The last thing the Democrats want is the mobilization of popular opposition to “Trumpcare” and the Trump administration

The only basis for halting the destruction of medical care for tens of millions of working people is the independent mass mobilization of the working class in opposition not only to Trump, but to the entire two-party system and all of the political representatives of the ruling class. All attempts to channel opposition behind the Democratic Party must be rejected.

This fight must be based on a socialist program, including the expropriation of the insurance conglomerates, the pharmaceutical corporations and the giant hospital chains and the replacement of health care for profit to health care geared to social need. This means transforming the health care corporations into publicly owned and democratically controlled utilities.