An early poster from the 1930s promoting the new Social Security system. | Public domain

When the Republicans withdrew their latest attempt to “repeal and replace Obamacare”, some breathed a sigh of relief that this cruel plan to strip health care from some 20 million Americans was stopped. But they won’t give up, as Trump’s latest act—terminating subsidies to help cover low-income peoples’ insurance premiums—shows. To understand why they won’t stop, it is informative to look back to 1935 when the Social Security Act was passed by FDR and the Democratic Congress.

The ruling class at the time saw Social Security as a devastating defeat because it established a legal right for the elderly, the infirm, and the unemployed to be supported by the federal government when they had no other option. Most importantly, these programs were financed by federal taxes. Despite all the gimmicks and loopholes that their high-paid accountants manipulate, the top 10 percent end up paying a lot of money to support these programs. From that day to this, the 10 percent have never stopped trying kill these programs.

As the legislation was originally proposed by Roosevelt, it included a national health care system for all Americans. The latter was a step too far for the medical industry and the rich. Roosevelt and the Democrats were forced to back down, and the best chance of establishing health care as a universal right was blocked for some thirty years.

Then, with the support of labor, the civil rights movement, and the still progressive base of the Democratic Party, Lyndon Johnson was able to amend the Social Security Act to create Medicare and Medicaid as part of the War on Poverty. This provided healthcare for the elderly (most of whom were poor) and the impoverished. Again, the right wing and the ruling class saw this as a devastating blow that they would never accept.

They opposed these healthcare programs for two reasons. First, they strengthened the Federal government (something the right wing and the super-rich couldn’t stand). Second, and most importantly, Medicaid and Medicare were both entitlement programs open to anyone who needed them and paid for through taxes. Reagan tried to get rid of Medicaid and failed. George W. Bush tried to get rid of Medicare and failed.

Then, President Obama and Congress passed the Affordable Care Act, the ACA.

The ACA forced insurance companies to cover millions of people and most of their health care needs, including pre-existing conditions. It also made it possible for states to expand Medicaid to make that happen. Medicaid is now the largest healthcare program in the country.

With the seizure of all three branches of the federal government in the 2016 elections, the ruling class saw a golden opportunity to win the battle they lost in 1965 when the Social Security Act was amended to establish those two programs.

There is yet another reason behind all their excitement. They want to lay the basis for tax cuts for the rich.

The Republicans’ main funders, led by the Koch brothers, want to get rid of Medicaid in order to fund a massive tax cut for the richest among them. The $2 trillion, 10-year cut in health care funding in the original “repeal and replace” bill would have let them pass massive tax cuts without noticeably increasing the deficit.

Partisan politics are also at play. Trump and the Republicans want to eliminate any vestige of Obama’s presidency and “cut the government down to size.”

The ruling class has not hidden their agenda. They have publicly put Trump and the Republican Party on notice that they will no longer fund Senators and members of Congress who cannot get what they want done. If only for this reason, the “repeal and replace” effort will continue.

The Graham-Cassidy Bill attacked the Medicaid expansion and put traditional Medicaid on a budget by creating block grants to the states (which will put a ceiling on who is eligible and what it will cover) that will be reduced over time, no matter what happens to the economy.

It also eliminated tax credits for premiums (which will price many out of private insurance) and got rid of the federal subsidies which enable poor people to cover deductibles and co-pays. It left up to the states what they want to cover. Annual and lifetime benefit caps would have been instituted, and states would have been able to decide whether insurers can charge more for older people, or women.

In total, some 20 to 30 million people would have lost their healthcare.

This was the third time the Republicans failed to kill Obamacare. They failed because the people stood up. After 3-4 years’ experience with the ACA, it became clear that the horror stories spread by the Republicans were false. Some 16 million people have gained health insurance for the first time, and they do not want to give it up.

When the Republicans were forced to pretend that they were actually legislating, they held a public hearing in a room too small for the public to attend. Even reporters and cameramen were removed. Special recognition should be given to ADAPT and other disability rights groups who put their bodies and wheelchairs on the line to draw public attention to this farce.

The people have won this battle, but the war is far from over. Even though they have not repealed the ACA, Trump is still trying to sabotage it.

Labor was adamant that the Graham-Cassidy Bill be stopped. The Democrats are united for now. But, it is not time to take the pressure off. The Kochs may give their orders, but the people are pretty determined not to let them have their way.

Defeating Graham-Cassidy was a great defensive victory for the working class, but it is only the first round in this fight. Trump has already landed a punch in the next one.

There are problems with the ACA that need to be fixed, for sure. But we have to see its defense as part of the fight to secure Roosevelt’s original idea, that full Social Security has to recognize health care for everyone as a human right.