The Kansas City Star Dave Helling column

June 27--The U.S. Senate is expected to debate a health care reform package this week, part of the Republican Party's promise to "repeal and replace" the Affordable Care Act, known as Obamacare.

Do not be deceived. The measure has very little to do with Obamacare.

The bill doesn't repeal the ACA. It reduces subsidies and credits for the purchase of insurance on the private market and gives states the right to reduce minimum standards for policies, but the fundamental structure of the ACA remains relatively intact.

Some conservative senators oppose it for just that reason, deriding the measure as Obamacare lite.

The Senate bill phases out Obamacare's Medicaid expansion, which provided protection for lower-income Americans. That doesn't matter in Kansas or Missouri, which refused to expand Medicaid, but it does matter in states like Ohio and Nevada.

But by far the biggest reductions in the Senate bill deal with regular Medicaid, which has almost nothing to do with Obamacare. Medicaid, a federal-state partnership, began in 1965, when Barack Obama was 4 years old.

Monday, the Congressional Budget Office said the Senate bill would reduce Medicaid spending by $772 billion from current law through 2026 by phasing out expanded Medicaid and cutting the regular program.

That projection may be artificially low. The cuts are phased in, so their full impact won't be felt until after 2026, which is beyond the timeframe of the CBO's analysis.

But by 2026, CBO says, 15 million fewer Americans will be able to obtain Medicaid coverage than under current law. That's about 30 percent of the 49 million uninsured Americans predicted for that year.

Will cutting Medicaid help the federal deficit? To a point. But the cuts are in the Senate bill largely to pay for tax reductions, which will cost the government $541 billion through 2026, according to CBO.

The tax cuts in the Senate bill are aimed primarily at high-income earners and investors.

This might not mean much to most Americans who aren't on Medicaid and aren't high-income earners.

But for Americans of a certain age, the Senate bill should be pretty scary because Medicare and Social Security are probably next.

This fiscal year, the U.S. will spend roughly $1.6 trillion on Medicare and Social Security, more than one-third of the entire budget. By common agreement, the trajectory of both programs is unsustainable without tax increases or benefit cuts or both.

The current Congress shows no appetite for raising anyone's taxes. But the push to cut benefits continues: President Donald Trump's budget reduces the Social Security Disability Program. House Speaker Paul Ryan wants to privatize Medicare. And so on.

In this context, it's hard to see the Senate health bill as anything other than a dress rehearsal for the coming political Armageddon over entitlements.

I know -- Trump promised not to touch Social Security or Medicare. Does anyone believe him?

Broad conservative resistance to public social programs such as Social Security, Medicare and Medicaid is an old story in the United States.

In that sense, the Senate debate won't make history. It will be a continuation of it.

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