Republican senators returning to Washington from the July 4 holiday recess face internal divisions over legislation to repeal and replace the Affordable Care Act (ACA), better known as Obamacare. Senate Majority Leader Mitch McConnell was unable to bring legislation to the floor that could gain the required 50 votes before the recess.
Protests against the Republican proposals took place Monday in more than a dozen locations in House and Senate office buildings. As of Monday afternoon, police had arrested 80 protesters, 21 in House office buildings and 59 in Senate buildings, and charged them with misdemeanor offenses.
Returning Republican senators, including Ted Cruz of Texas, Jeff Flake of Arizona, Rob Portman of Ohio and Lamar Alexander of Tennessee, were greeted by protesters in or around their offices. Some of those outside Cruz’s office lay down on the floor, blocking foot traffic and leading Capitol police to carry them down the hall. Cruz, Flake and Portman also faced protests in their home states over the recess, with 15 protesters arrested in Columbus and Cincinnati, Ohio.
The Better Care Reconciliation Act (BCRA), the Senate version of the House’s American Health Care Act (AHCA) passed in May, is massively unpopular. A new NPR/PBS NewsHour/Marist Poll shows that only 17 percent of US adults approve of the BCRA, while 55 percent disapprove. (Another 7 percent either haven’t heard enough about it or have no opinion.)
While Republican Senate leaders are seeking to tweak the bill to satisfy ultra-conservatives and “moderates” in their ranks who disagree with the bill, it is clear that any changes they make will not alter the fundamentally reactionary character of the legislation. With 50 votes needed to pass the bill, at least 10 Republican senators are presently opposed and no Democrats are expected to support it.
The Republicans hold a 52-48 majority in the Senate and can afford to lose only two Republican votes. If a floor vote were to end in a 50-50 tie, Vice President Mike Pence would be allowed to cast a tie-breaking vote to pass the bill.
Passage of the bill would mark the end of Medicaid, the government health insurance program for the poor, as a guaranteed social benefit based on need, establishing either a per-capita spending cap or limiting funding, benefits and eligibility by means of block grants to the states. It would also phase out the expansion of Medicaid under Obamacare in the 31 states and the District of Columbia that adopted it. The result would be brutal cuts or the outright elimination of health care for tens of millions of families with children, seniors and people with disabilities. Medicaid currently covers over 70 million Americans.
Senator Cruz has authored a “Consumer Freedom Option” amendment to the Senate bill, under which private insurers would be able to vary premiums based on health history or deny coverage outright to people with expensive preexisting conditions. This would be allowed as long as states offered at least one “community-rated” plan, in which premiums would not vary based on health status.
The effect of such a change would be to eliminate ACA protections against discrimination based on pre-existing conditions and requirements that all plans offer a set of “essential” medical services, such as maternity care, prescription drugs, doctor visits, emergency care, substance abuse, mental health and other vital services.
The Kaiser Family Foundation (KFF) has analyzed other changes to the Senate bill under consideration and their long-term effects, which it says would have “little impact” on the bill’s “five core features.”
Ending the ACA Medicaid expansion: One change under discussion would slow or delay the phase-out of federal funding for Medicaid expansion. KFF says that states’ costs would still increase three- to five-fold in the long run, leading most or all states to end their expansions. A proposal to add $45 billion for treating opioid drug disorders would be offset by opioid-addicted people presently covered by the Medicaid expansion losing access to other mental and physical health care.
Capping and cutting federal Medicaid funding: A proposal to return to the House bill’s slightly less draconian growth rates for per-enrollee funding would still shift large costs to the states, “leading to deep cuts to eligibility, benefits, and provider payments,” according to KFF.
Increasing marketplace premiums and deductibles: Allowing the use of health savings accounts to pay premiums for individual coverage would be mostly a tax break for the rich, as low- and middle-income people have little or no income to set aside for such accounts.
Changes to the ACA’s individual market: The “Cruz amendment,” mentioned above, would sharply raise premiums and deductibles for people with preexisting conditions, making coverage unaffordable for many.
Cutting taxes for the wealthy and corporations: One proposal is to not repeal the ACA’s 3.8 percent tax on high-income households, which is presently repealed in both the House and Senate bills. KFF estimates this change would still leave in place tax cuts of $457 billion, almost exclusively benefiting corporations and the rich.
The Senate leadership has sent two versions of the bill with these changes, one with Cruz’s amendment and one without, to the Congressional Budget Office for analysis. The CBO predicted that the initial Senate bill would result in an additional 22 million Americans becoming uninsured over 10 years.
Several Republicans have predicted that the bill will not pass. Speaking on CBS’s “Face the Nation” on Sunday, Senator John McCain of Arizona said, “My view is it’s probably going to be dead.” Asked about the bill’s odds on “Fox News Sunday,” Senator Bill Cassidy of Louisiana said, “I would probably put that at 50-50.”
Majority Leader McConnell has acknowledged that if the Republicans and President Trump fall short on their pledge to “repeal and replace” Obamacare, they will be forced to negotiate with the Democrats. Any such negotiations would involve discussions on further concessions to the profit demands of the insurance companies.
Minority Leader Charles Schumer and Senate Democrats have continued to campaign against the BRCA and said they will negotiate only if the Republicans give up on repealing the ACA. Senator Ben Sasse, Republican of Nebraska, suggested another scenario, in which Republicans could repeal most of the ACA, forcing Democrats to the table to work on a replacement.
However this plays out, the Democrats have made clear that they are willing to work with the Republicans to “fix” Obamacare. This has nothing to do with making the ACA better—lowering soaring premiums and deductibles, widening the networks of hospitals and providers, further expanding Medicaid and its federal funding, and taxing the wealthy.
The entire framework of the official health care “debate” is reactionary. Obamacare itself is a regressive restructuring of the health care system designed to cut costs for corporations and the government, undermine the system of employer-provided health insurance, and force uninsured workers to purchase health plans from insurance companies with huge premiums and absurdly high deductibles and co-pays. It still leaves some 28 million people completely uninsured.
The basic premise of the Republican plans as well as Obamacare is the capitalist market and the profitability of the gigantic insurance and pharmaceutical firms and hospital chains. The health and well-being of the working population is completely subordinated to the profit drive of the corporate elite.
While the Democrats pose as the defenders of workers and their families who are struggling under the weight of rising health costs and rationed services, they are in full agreement with the Republicans that there is “no money” for health care and other basic social services, and “realistic” sacrifices must be made. This is a brazen lie in a country where 20 individuals have as much wealth as the bottom 175 million people.
Senator Bernie Sanders of Vermont, the advocate of “Medicare for all,” spent Sunday rallying voters in West Virginia and Kentucky to call on their Republican senators to vote against the bill. He would have people believe that pressuring these reactionary politicians will make any difference in the lives of workers and youth who stand to lose under whichever plan emerges from either the Republicans or some sordid deal between them and the Democrats.
Millions of Americans are outraged by the attack on health care being hatched in Washington, as demonstrated by the plunging poll numbers for both Republican plans and the growing protests. But in taking forward this fight, the working class cannot allow itself to be drawn behind any section of the political establishment and must proceed with its own methods of class struggle.
A socialist solution to the health care crisis requires a break with the Democratic Party—and all those who promote illusions in this big business party—and a fight for the independent mobilization of the working class. Only the expropriation of the health care industry and the establishment of socialized medicine can secure health care as a social right.