This month it will prove if Mitch McConnell, Senate’s Republican leader, qualifies as the Master of the Senate with the replacement of Obamacare. That was the title given by biographer Robert Caro Lyndon B. Johnson, who, for his presidency, led as leader of the majority of legislation for an abolition of racial divorce by the Senate.
McConnell has another theme: replacement of health insurance through Obamacare, the US public health insurance. But how? If the Republican representatives in Washington do not succeed, they can expect hell and damnation at home.
For seven years, Republicans promised to replace Obamacare with something “much better”. President Donald Trump took over that. But now they stand for the bridge, they appear hopelessly divided.
The Democrats lost, through Obamacare’s involvement, the House of Representatives in 2010, the Senate in 2014 and the presidency two years later. Now the Republicans are with it. The Democrats are watching with sorrow.
Actually, Obamacare is only a small part of the US care sector, which accounts for more than 17 percent of the gross domestic product. In Europe, this is 10.5 percent, like in France and Germany.
Most Americans (55 percent) are insured through their employer. The federal government helps to ensure: for 65 people there is Medicare, for the disabled and the poor Medicaid. In addition, there are specific insurance policies, such as those for veterans.
Nevertheless, some of the population don’t qualify, especially the poorer people and the unemployed. Obamacare helps this group. The Budget Bureau of Congress expected in 2013 that 26 million Americans would insure themselves through Obamacare. That struck: there were 11 million. The number of uninsured citizens decreased from 16.5 percent to around 11 percent of the population, but it was less spectacular than expected. Too few young people wrote in. They would rather pay the penalty for unsecured.
That had consequences. Insurers received too many subscriptions from older, care-demanding Americans. The premiums, as well as their own risk, increased to more than 5,000 dollars. Insurers refused to work with Obamacare in many states. The system shrunk.
The lifetime of Obamacare was the expansion of Medicaid. The Obama Government extended the accessibility of the poverty line to 138 percent of the poverty line. Of the subscriptions via Obamacare, 70 percent was financed by Medicaid. The federal government offered the States additional money.
Here is the core of the split between Republican Senators, who occupy 52 of the 100 Senate seats. 32 States accepted extra money from Washington DC, especially in the Midwest and Northeast; 19 states refused, such as Texas, Florida and, for the most part, the Deep South.
Hard vs. Moderate
Ohio was very excited. The state has an industrial past and an elderly population. Texas has another profile and refused resolute. However, both states are controlled by Republicans. For example, Senators from those states face each other. ‘Hardliners’ want to abolish Obamacare and undo the expansion of Medicaid.
For example, ‘moderators’ want Obamacare light and insurers to accept people with chronic illnesses. Insurance requirements differ by state. Especially in the poorer, economically weak states there is an epidemic of addiction to opiates – heavy painkillers or even heroin. An overdose can be fatal. This year, more than 60,000 deaths are taken into account.
In between two fires
Republican Senate leader McConnell puzzles. He can give more freedom of choice in the insurance system – especially Medicaid states. A special budget for opiate epidemics is unavoidable. Republican Senator Ted Cruz has a compromise amendment: Obamacare remains an insurance option, but insurers may also offer other packages. Each Senator makes the calculation according to the needs of its own state. Certainly with the Midterm elections of 2018 in front of the door.
In the background is President Trump. He wants to force the Republican senators to reach an agreement. If necessary at the expense of their beloved summer vacation. The alternative is the total voters’ greed. It remains uncertain whether McConnell ever becomes a Master of the Senate.