The Republican House failed to pass its first effort to replace Obamacare because it was not supported by a handful of ultra conservative Republicans. It made some changes in the bill to appease Freedom Caucus members and it passed a bill that it sent to the Senate. The CBO just scored to new bill and it found that 23 million Americans would lose coverage under the new bill. The Speaker of the House, Paul Ryan praised the bill for two reasons: He said that it would lower premiums and that Obamacare was failing on its own. The most important things we need to know about the Republican plan is that it cuts Medicaid spending by around $800 billion. The cuts in Medicaid were necessary to fund the tax cuts in the plan for citizens with high incomes. There is no way that a less costly healthcare plan can be produced without reducing access to healthcare and/or reducing benefits. The Republican Senate will make an effort to fix some of the flaws in the House bill. They have an impossible task. They can't fill the holes in the House plan without increasing federal funding. Its all about money. Any plan that reduces funding will provide less access and fewer benefits.
Paul Ryan and Trump both claim that Obamacare is failing on its own. That is wrong. Ever since the Obama administration passed the Affordable Care Act. Republicans have undermined the bill. It was not a perfect bill but it was the best bill that Obama could get out of Congress. If Republicans really wanted to increase access to healthcare it would be easy. They could do that by reversing the steps that they have taken to sabotage the ACA. They can't do that for a couple of reasons. In the first place, they promised their base that they would repeal the ACA and they renamed Obamacare. It was renamed because a large part the Republican base did not like Obama's skin color. Moreover, they resented the fact that many of the needy Americans who benefited from ACA had the same skin color. They have also hated Medicaid since it was passed by the Johnson administration in 1965. The ACA is totally dependent upon Medicaid. Its impossible to cut Medicaid by $800 billion and produce a plan that does not reduce coverage and benefits. Donald Trump's proposed budget plan makes things even worse. It cuts Medicaid by an additional $650 billion. Again the cuts in Medicaid are necessary to provide more tax cuts for high income Americans.
The battle over healthcare reflects fundamental values in our society. The Republican Party is driven to reduce the non-defense side of the federal budget because the bulk of that side of the budget is consumed by public welfare programs. Paul Ryan also would like to cut taxes and balance the federal budget. Its pretty clear that this can't be done without defunding public welfare programs. Healthcare, education and social security will always be at risk from the Republican Party.