San José, CA – On July 19, the Congressional Budget Office (CBO) said that the Republican plan to repeal the Affordable Care Act, or ACA (also known as Obamacare), without a replacement would leave 32 million more Americans without health insurance. The Republican Senate leadership put forward this bill, officially known as the “Obamacare Repeal Reconciliation Act of 2017” after their “Repeal and Replace” bill could not muster 50 Republican votes.

The Republican Senate repeal and replace, named the Better Care Reconciliation Act, only had support of 12% of Americans according to public opinion polls after the CBO said that it would leave 22 million more Americans without health insurance. It was opposed by a broad swath of establishment groups such as the American Medical Association, the AARP, hospital associations, and after the Cruz amendment was added, even major health insurance companies.

In addition to taking health insurance from 32 million more Americans after ten years, the Republican Senate repeal only bill would double premiums for individual health insurance policies. In ten years, 75% of the American population would not have any health insurance companies offering individual plans where they lived.

The Republican Senate repeal of the ACA would cut taxes on high income people and health insurance companies by $613 billion over ten years. In addition, large businesses would save over $100 billion that they now have to pay under the ACA if they don’t provide health insurance for their workers. To pay for these tax cuts for the rich and corporations, more than $800 billion would be cut from Medicaid, cutting 19 million people from health insurance. In addition, more than $600 billion of subsidies to buy health insurance would be cut, causing 23 million more Americans to lose their health insurance.

Altogether the repeal would save the federal government almost $500 billion over the next ten years, which Senate Republicans hope to use to cut taxes even more for the rich and big business.

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The ACA taxes include a 3.8% tax on investment income, which mainly goes to the top 1%. Investment income is not taxed to pay for Medicare or Social Security. There is also a 0.9% tax on individuals with very large salaries, which is also not taxed to pay for Social Security. Social Security taxes only tax the first $127,200 in earned income; any income above that or investment income is not taxed.

What this means is that eliminating the taxes for the ACA would provide the top one-tenth of one percent (0.1%) of Americans an average tax cut of almost $200,000 a year, which would be almost 75% of the total dollar tax cut.

These ACA taxes on households raise about $100 billion a year, which along with ACA taxes on health insurance companies, drug and medical equipment manufacturers, and others, pay for ACA. One cost of the ACA are the premium tax credit where the federal government will reimburse low and middle-income households that purchase health insurance through a government exchange for all or part of their health insurance premiums. Another cost is the expansion of Medicaid for low-income Americans.

The elimination of the ACA and the premium tax credits which subsidize the government insurance exchange would cause dramatic losses for about 4% of the population, who would lose insurance subsidies that average almost $5000 each year. While most the poorest 20% of American households, earning less than $25,000 per year, would not see much of a loss in subsidies, they are the ones who are most likely to lose insurance with the elimination of the ACA and its expansion of Medicaid. Eliminating the Medicaid expansion could cause almost 11 million to lose their insurance.

It is no wonder that the wealthiest businesspeople and Wall Street tycoons who are represented by billionaire President-elect Donald Trump are so keen to eliminate the ACA. But their gains would come at the cost of higher health insurance premiums and loss of health insurance for millions of workers and small business owners.

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One of the first things that Donald Trump said that he would do as president is repeal the Affordable Care Act (ACA) also known as Obamacare. The ACA has dramatically reduced the number of Americans without health insurance, from more than 41 million in 2013 to less than 29 million two years later, a drop of 13 million people. A repeal of the ACA would increase the number of uninsured by 20 million people, so the that number of uninsured would rise to record levels.

Hardest hit by repeal of the ACA would be poor and lower-income households earning less than twice the official poverty line, about $36,000 for a family of four, who would be cut from Medicaid and subsidies to buy private insurance. Latinos, who already have the highest percentage of people lacking health insurance, would also be hit the hardest among nationalities in the U.S. African and Asian Americans are likely to lose medical insurance at almost twice the rate of white Americans. There are more than 50 million people who have current health issues that could make them uninsurable if the ACA is repealed.

Repeal of the ACA would also increase the costs of Medicare and reduce tax revenues for Medicare. When the ACA was passed the date that the Medicare trust fund was expected to run out of money was pushed back by 11 years from 2017 to 2028. While the Medicare program uses ‘pay-as-you-go’ financing so that it would not be in any immediate danger, the revenue shortfall will mean higher Medicare premiums. Republicans in Congress would also use the exhaustion of the Medicare trust funds to push their plans to privatize Medicare, which could leave millions of seniors and disabled without health insurance and raise the costs of health insurance for millions more.

Despite being a major federal spending program, repealing the ACA would actually raise the federal budget deficit. The ACA has a number of taxes aimed at higher-income households and medical corporations, as well as rules to reduce spending on Medicare, which more than offset the costs of the Medicaid expansion and subsidies on the private insurance exchanges. Private health insurance, with overheads (profits and administrative costs) that average more than 12% of each premium dollar, are far more expensive than government health insurance such as Medicare, where overhead costs are less than 2%. The total number of federal workers serving more than 50 million Medicare and more than 70 million Medicaid patients is only 6000, or one worker for every 20,000 patients.

But to just fight the Republicans by defending the ACA will not go far enough. The ACA has left millions of people uninsured. Some of the insurance exchanges in states where Medicaid was not expanded have only one private insurer left. These states face a monopoly that can charge high premiums and they could even find themselves without a single private insurer. What is really needed is a national single-payer health insurance system, sometimes called Medicare for All, where the government would provide health insurance for everyone in America. By cutting out the high overhead of private health insurance and instituting strict cost controls, a single-payer system could cover everyone while expanding the program to cover long-term care and dentists, which Medicare does not cover now.

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But the reality is that the Republicans will block any legalization bill, while business interests will push the passage of expanding temporary worker and employment based visas. In the meantime immigrants are facing a wave of repression, with the Obama administration having deported a record 2 million undocumented people. So the piecemeal approach is most likely to end up being more of the same for the undocumented: more deportations, no legalization and a temporary reprieve for undocumented who came as children and qualify under the Deferred Action for Childhood Arrivals (DACA) program.

So why is Obama retreating in the face of Republican opposition to immigration reform? One reason may be a partisan consideration. By making this concession, Obama is trying to keep the immigration issue in the media, hoping to benefit in next year’s election by looking ‘reasonable’ in the face of Republican opposition to immigration reform, even if this means doing little to nothing to advance any immigration reform. But another factor is that many of Obama’s policies are, in fact, moderate Republican ones. Take a look at his Affordable Care Act (Obamacare). Two of the most controversial parts of the ACA, the insurance exchanges and the individual mandate, were both Republican ideas that were embodied in the Massachusetts health care reform under Republican governor Mitt Romney.

Fundamentally, this reflects the fact that both the Democratic and the Republican parties represent the 1%, the tiny minority who own half the total wealth in the U.S. and control the large corporations that dominate the economy. While the two parties have their differences, with the Republicans wanting more repression of immigrants with militarization at the border, and the Democrats are more interested in meeting the needs of business through expanding temporary and guest worker programs, they serve the same interests.

Up to now, there have been three views of immigration reform. On the one hand, there were advocates for the undocumented, family reunification and workers, who supported legalization and stopping deportations. They also opposed more militarization of the border, more workplace enforcement, more temporary and guest workers, cuts in family reunification and diversity visas and criminalization of the undocumented and expansion of using local police and sheriffs to crack down on immigrants. More and more of these forces are uniting behind a demand that the president issue a ‘Deferred Action For All’ that expands the DACA program to all the undocumented. This would allow the undocumented to come out of the shadows and be able to work and drive legally, while laying the basis for a stronger push for legalization in the future.

Then there were the right-wing Republicans in the House of Representatives, who opposed legalization, and wanted more militarization, more workplace enforcement, more temporary, guest and employment visas and supported criminalization of the undocumented and expansion of ICE-local police programs, as seen in the SAFE act that passed a House committee on a straight party line vote. The House Republicans also support a piecemeal approach so that they can pass what they want (more repression of immigrants) and block what they don’t want (legalization).

In between was the “Comprehensive Immigration Reform” or CIR approach, as seen in the Senate immigration reform bill. CIR tried to combine the other two opposing views on immigration reform, as a way of getting Republican support. But with the overall atmosphere of repression, the Senate bill got steadily worse, with a lot more militarization of the border. The House bipartisan bill was widely known to be even worse, but it never got off the ground as the House Republicans pulled support for any bill with legalization and rallied around a piecemeal approach in opposition to CIR. With Obama’s concession to the House Republicans, the CIR approach is basically dead for now.

Backers of the CIR approach have two choices: they can go along with the President’s approach, either openly or trying to hide behind the fiction that CIR is still possible in the House. This will end up with some pro-business changes, such as more temporary worker and employment-based visas, but no legalization and the continuing deportation of record numbers of the undocumented. Or they can join with advocates of legalization and stopping the deportations by backing the Deferred Action For All or DAFA, which would both benefit the undocumented and put pressure on the House to deal with legalization.

Masao Suzuki is a supporter of the Legalization for All network and a regular contributor to Fight Back! newspaper on the economy and the immigrant rights movement.

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The large demand for health insurance that overwhelmed the federal as well as many state exchanges comes from the large number of people in the U.S. who have no health insurance. About 15%, or more than 45 million people, had no health insurance for all of last year according the newly released report on Income, Poverty, and Health Insurance in 2012. Oppressed nationalities (African Americans, Asian Americans, Chicanos, Latinos and Native Americans) had even higher rates of going without health insurance, with the rate topping 30% for Chicanos and other Latinos.

The main reason for so many people going without health insurance is that businesses have been cutting health insurance benefits for their workers. In addition, the restructuring of the labor market to replace full-time, permanent jobs with more and more part-time and temporary jobs that intensified during the last recession also means fewer workers have health insurance. While young people have the highest rates of lacking health insurance, the biggest drop over the years have been among workers aged 25 to 64.

While the ACA promises to cover millions of Americans who lack health insurance, mainly through the expansion of Medicaid, which will be available in many, but not all, states to all low-income people. But millions more, including the 11 million undocumented in this country, will still not have health insurance even after the ACA is fully up and running.

The fundamental problem is that it is not profitable to insure everyone, and that for-profit health insurance spends about ten times as much for administration, profits for share-holders, huge salaries for CEOs, than government health insurance does. With the ACA based on forcing individuals to buy health insurance from private insurers through a combination of penalties (individual mandate) and subsidies, it actually expands this expensive and wasteful part of U.S. healthcare.

The example of Massachusetts, which pioneered a very similar plan to the ACA, shows both what this ACA can and can’t do. Massachusetts has the lowest rate of people without health insurance, at about 3%. On the other hand, Massachusetts is the most costly in terms of total health care spending, coming at 36% above the national average.

To both cover all Americans and lower costs, what is really needed is a single federal government health insurance, similar to Medicare, but available to everyone, also known as a single-payer system.

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Behind the partial shutdown of the federal government was the leadership of the House Republicans, who followed the lead of their right-wing Tea Party congress people. They needed to pass a bill to continue funding the government, since no budget for the 2014 Fiscal Year, which began Oct. 1, had passed. Instead, the House Republicans insisted on using the threat of a government shutdown to get what they wanted, which was to derail the Affordable Care Act, commonly known as Obamacare, even though the Senate, the president and the Supreme Court were against them.

The House Republicans’ willingness to seemingly burn down their own house to rid it of what they saw as vermin (Obamacare), is not only extremism, but also comes from their right-wing view of the government. It was under the Reagan presidency in the 1980s that the term “Starving the beast” arose, as right-wingers targeted the federal government as a “beast” for its social-welfare functions, wanting to pare down the role of the government to basically prisons to protect property rights of the rich and the military to maintain the empire.

Looking at a list of how agencies are being hit by the partial government shutdown, it is clear that many of the programs that the right wing hates will be hardest hit. Among the departments with the highest percentage of furloughed workers are the Department of Education (95%), Housing and Urban Development or HUD (95%), the Environmental Protection Agency or EPA (90%), and the Department of Labor (80%).

On the other hand, the Department of Homeland Security, which includes the Immigration and Customs Enforcement or ICE, has only 15% furloughs, so one can expect the record deportations to continue. The Department of Justice, which includes the FBI, also has only a 15% furlough, so no let-up in spying and harassments of Muslim Americans, Arab Americans and anti-war and international solidarity activists is in sight.

While the House Republicans say that they are targeting Obamacare, by and large the rollout of the Affordable Care Act set for October 1 was unaffected. While there were long waits for web sites to load and phones to get answered, this was largely because nearly 3 million people flocked to the U.S. government web site www.healthcare.gov and more went to state web sites such as www.coverca.gov in California.

In contrast, Senate Democrats and the Obama administration value the role of the government, both to subsidize big corporations (as Obamacare does with big health insurance companies) and to maintain social peace through social welfare programs such as Social Security and Medicare. But they also support the military and policing functions of the government, as seen in the Obama administration’s attempt to unleash a military attack on Syria and the FBI coordination of local police efforts to smash the Occupy movements.

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