As we went to press, Trump and House Speaker Ryan announced they were pulling the AHCA legislation, declaring that the effort to repeal and replace Obamacare was over for the “foreseeable future.”

While this does not mean that Republicans will abandon their efforts to attack health care, the political reality is that they will not be able to bring forward comprehensive legislation on this issue for a whole period.

This is a major defeat for Trump and the Republicans and a major victory for working people. It puts other elements of their reactionary agenda in jeopardy and opens up a major crisis for the Republican Party.

Trumpcare was defeated because the Republicans were not able to keep the word from getting out, even in areas they control, about its awful consequences for millions of working people. A poll in the last few days showed the support for the AHCA at 17% with 56% opposed, including a majority of Republican voters. The thousands who came out to town halls to attack Republican representatives on this issue and the rallies organized by Bernie Sanders had a real effect. The other major reason the AHCA was defeated was because of intransigent opposition from the right wing of the Republicans in Congress, particularly the Freedom Caucus, who wanted to go even further in destroying health care for poor and older Americans.

After campaigning for years on repealing Obamacare, Republicans are faced with the stark reality of the impossibility of finding a market-based health insurance law that meets both the profit needs of the insurance companies, and provides quality, affordable coverage plans to consumers.

As Trump said in February: “Nobody knew that health care could be so complicated.” Well at least he didn’t!

What the AHCA Would Mean

The new Republican plan to replace Obamacare – the American Health Care Act (AHCA), would result in 24 million less people being insured by 2026, according to the Congressional Budget Office (CBO.) The CBO study also showed that insurance premiums would go up in the short term (15 to 20% in 2018 and 2019), and that premiums for some older, poorer people could go up by at least 750%!

The AHCA, already dubbed Trumpcare or Ryancare (after House Speaker Paul Ryan) would also end the individual mandate to carry coverage, replacing it with a penalty for a lapse in coverage of over two months, resulting in an increase in premiums of 30% for the first year upon re-enrolling. This would make it more difficult for people who already may have missed a premium payment for financial reasons to ever re-enroll.

Additionally, insurance companies would be able to charge older people up to five times as much for coverage as younger people. Currently, they can only charge three times the rate. Tax credits would be based primarily on age. Cost-sharing subsidies for low-income people would be repealed in 2020.

At the same time, the bill would mean that the richest 400 households in America would each receive an average annual tax cut of $7 million (Center on Budget and Policy Priorities). Those who will be hit hardest will be the poor working class, as up to 20 million will face a health care catastrophe. This is a massive upward redistribution of wealth to the 0.01% brought in under the guise of health care “reform.”

Brutal Attack on Poorer, Older Americans

At present, Medicaid, the health program for low-income people, is a mandate where the federal government is required to fund states for all “essential benefits,” including things like substance abuse and mental health care. The AHCA would end this mandate and slash federal subsidies,  resulting in some states discontinuing the recent expansion of eligibility. This is not to mention the devastating impact of defunding Planned Parenthood, particularly for poorer women.

Now the Republicans are talking about making work an eligibility requirement for Medicaid and turning Federal funding for Medicaid into block grants to the states which will almost inevitably be cut further over time. Degrading Medicaid is a precedent for privatizing Medicare and Social Security, a goal of right-wing Republicans.

Overall this is a brutal attack on the health care available to poor and working people. It is clear that many people in rural areas and white working class communities represented by the Republicans will be among those hardest hit. The Republican Party is apparently willing to take the calculated risk that most of these poor people don’t and won’t vote. But this could explode in their faces as even better off working-class people will know or be related to people who have benefited from the Medicaid expansion or other aspects of Obamacare. This is the beginning of many people realizing that they are going to be betrayed on every level by Trump.

Republican Contradictions

The Republican plan is receiving a backlash not only from physicians groups, nurses unions, and the AARP, but even from some hospitals as well, who would likely see more patients who are unable to pay!

Within the Republican party, there is far from unanimous support. Many Tea Party Republicans like Ted Cruz feel the bill doesn’t go far enough in cutting government spending by ending tax credits. More mainstream Republicans are concerned about anger from voters when it becomes clear that the plan isn’t really “improving” the ACA. Getting this through the Senate is by no means guaranteed.

Many Republicans fear that a backlash among working-class voters could lead many to desert the party in 2018 and 2020.

Build the Resistance!

The large meetings on health care organized by Our Revolution and the massive turnouts at Republican lawmakers’ town hall meetings where they have been relentlessly and correctly attacked show the widespread anger and fear of millions of people of losing their health insurance.

Bernie Sanders and others helped organize these protests, which are a great start and show the potential to defeat the Republicans. The protests need to continue and ramp up to even bigger mass protests, occupations of targeted lawmakers’ offices, etc. Unions need to play a key role in leading this up.

What Kind of Insurance Do We Need?

There are good reasons why the ACA was disliked by many. While it gave health insurance to millions who didn’t have access previously, those plans were often quite expensive and didn’t have great coverage. Not to mention the difficulty of signing up for plans online – a new career, ACA navigator, was born to help people through the process!

American health care is a disaster. But Trumpcare/Ryancare is not a solution; it will make things far worse. Many Republican voters will be some of the hardest hit. As much as possible, activists need to reach out to them, to convince them that the AHCA is not in their best interests. This is an issue that can force big cracks into the Republican coalition and help us push back Trump’s reactionary agenda.

In order to reach out to a broader audience and inspire millions more into action, it will be necessary to offer a real alternative to both the ACA and AHCA.

Expanding Medicare to cover everyone, regardless of age is that alternative. The problem is that the Democratic Party leadership is so wed to donations from the huge medical corporations that they refuse to put it forward. This also reflects that even the liberal wing of the establishment is not today pretending to offer real progress in the standard of living and quality of life of ordinary people. Capitalism has less and less to offer and health care is under attack in many countries.

But resistance will grow. In Britain, 250,000 recently came on the streets of London to oppose the privatization of the National Health Service. If this disastrous plan passes, it will give new momentum to the push for single payer, Medicare for All, at state level. As Seattle Socialist city Councilmember Kshama Sawant recently pointed out:

“Many Democratic Governors have been denouncing Trump’s attacks on the Affordable Care Act. But why don’t these Democratic Governors immediately move to implement single-payer systems in their own states?

“California is already discussing such a plan. Our own state of Washington, along with Oregon, could come together in this effort. Along this “blue” West Coast we can develop a joint, single-payer alternative to the dysfunctional private health insurance system.”

This is the type of bold approach needed in the coming months and years that would begin to lay the basis for real national reform of health care in the interests of working people. But this will only be achieved if we build a mass movement fighting all along the line in the interests of working people and the poor.

Katie Quarles, RN, Member of Board of Directors, Minnesota Nurses Association (personal capacity)

Updated 3/27/2017