Senate Majority Leader Mitch McConnell announced Tuesday afternoon that Republicans would be delaying a vote on their legislation to “repeal and replace” Obamacare until after the traditional July 4 recess.
The decision to hold off a vote on the “Better Care Reconciliation Act” came after the Congressional Budget Office (CBO) released its score on the measure, showing that there would be 22 million fewer Americans with health insurance by 2026 under the plan, bringing the total number of uninsured to 49 million people.
The Senate Republican leadership acknowledged that it did not have the votes of 50 Republican senators to ensure its passage. The Republicans, with 52 seats to 48 for the Democrats, control the upper legislative house. With the Democrats poised to vote as a block against the bill, the Republicans can afford only two defectors. But at least nine Republican senators, some far-right conservatives and some “moderates,” have indicated that they will not support the bill in its present form. McConnell said he would work on changes to the legislation and get a new scoring from the CBO before proceeding after the break.
The Senate bill, like its House counterpart passed last month, is extremely unpopular. A recent Kaiser Family Foundation poll showed that 55 percent of the public holds an unfavorable view of the Senate plan, with 38 percent having a “very unfavorable” view.
The American Medical Association on Monday joined a long list of medical organizations and health care advocacy groups opposing the bill, including the American Academy of Family Physicians, the American Academy of Pediatrics and the American Heart Association, to name just a few.
Both the Senate and House versions of the Trump administration plan effectively end Medicaid, the government health care program for the poor and the disabled, as well as for millions of elderly people, as a guaranteed program based on need. They do so by capping funding, and at rates that fall far short of medical costs, resulting in enrollees having their benefits cut or eliminated outright. Both plans in the first instance phase out and eventually end the expansion of Medicaid under the Obama administration’s Affordable Care Act, better known as Obamacare.
The misnamed “Better Care” legislation slashes Medicaid spending by a total of $772 billion over 10 years. The government insurance program currently serves some 75 million people, including 30 percent of all adults with disabilities, 60 percent of children with disabilities and 64 percent of all nursing home residents.
Beyond the cuts to Medicaid, the bill calls for a total cut in spending for health care of $1.02 trillion over 10 years, including $408 billion in subsidies for people who purchase insurance from private insurers on the Obamacare exchanges. These massive reductions in health care spending for ordinary Americans will largely be used to finance $700 billion in tax cuts that will overwhelmingly go to wealthy individuals and corporations, including insurance companies, medical device makers and pharmaceutical firms.
The House and Senate bills constitute a savage attack on the health care of working people. Whatever the precise form of the law that eventually emerges from internal horse-trading among Republicans and back-door negotiations with the Democrats will mark a milestone in the ruling elite’s drive to destroy the social reforms of the 1930s and 1960s, including Medicare and Social Security.
The Trump administration health care “reform” proposals build upon the pro-corporate, anti-working class health care overhaul carried out by the Obama administration. Obamacare, which includes a $700 billion cut in Medicare spending, further subordinates the health care system to the insurance companies, pharmaceutical giants and hospital chains, slashing costs for corporations and the government by raising premiums and reducing benefits for tens of millions of working people. It provides bare-bones coverage for some 20 million previously uninsured people—leaving 28 million with no coverage—by rationing health care for the working class as a whole.
The Republican plan goes further, faster in attacking what remains of health care provision for working people.
On Tuesday, commenting on Fox News on the CBO estimate that 22 million people would lose insurance coverage under the Senate bill, Republican House Speaker Paul Ryan portrayed people losing coverage because of cuts in subsidies and massive increases in deductibles and co-pays as a matter of personal preference. “So, it’s not that people are getting pushed off a plan,” he said, “it’s that people will choose not to buy something they don’t like or want.”
This neatly sums up the contempt of the American corporate elite and its bribed politicians for the American people.
In reality, 15 million of the 22 million people projected to lose coverage are among those currently enrolled in Medicaid. Many millions more will not purchase insurance because it is either too expensive or worthless.
The Kaiser Family Foundation reports that under the Senate’s “Better Care” bill, a 64-year-old earning $26,000 a year would see a $4,800 increase in premiums by 2020; a 64-year-old earning $68,200 would see a $5,200 increase. Deductibles are predicted to soar to $6,000 and above.
This targeted attack on the preretirement population is by design. The insurance companies, employers and government see this group as an intolerable drain on profits, since they will soon be out of the labor market and collecting Social Security and Medicare benefits (to which they have contributed their entire working lives). As far as the ruling class is concerned, the sooner they die, the better!
Another group of people who stand to lose coverage are those with preexisting medical conditions such as cancer, diabetes, asthma, pregnancy, etc. While the Republicans claim that the Senate bill protects these people, it actually makes an end run around its nominal ban on insurance companies discriminating against those with preexisting conditions by permitting states to obtain waivers allowing insurance policies that do not include Obamacare-mandated “essential benefits.”
An insurance plan might be affordable, but if you are a pregnant woman and the plan does not cover prenatal care, it is useless. If you are a cancer sufferer and your plan does not cover the expensive drug you need to fight the disease, it will do you little good.
While it is not possible to predict precisely how the negotiations will play out, it is clear that there is bipartisan agreement that the current health care system needs to be “fixed,” and that this requires slashing health care spending, including for Medicaid and other “entitlements.”
After announcing the delay in the vote on the Senate bill, McConnell told reporters, “Either Republicans will agree and change the status quo, or the markets will continue to collapse and we’ll have to sit down with Senator Schumer.” The Democrats have gone out of their way to make clear they are anxious to negotiate with the Republicans. They talk of working out a bipartisan plan to “strengthen” Obamacare. This is a euphemism for incorporating the demands of the insurance industry for further reductions in benefits and the removal of all restraints on their ability to maximize profits.
The draconian cuts proposed in both the House and Senate health bills have evoked anger and disgust among wide layers of the population. But the choice between maintaining Obamacare or adopting some form of Trumpcare is no choice at all for the working class.
The working class must advance its own independent program, against Trump, the Republicans and the Democrats, based on a socialist program. Ownership of the health care industry must be taken out of private hands and placed under public ownership and the democratic control of the working class. This is the only basis for guaranteeing quality health care for all.