Health bill secrecy alarms both parties
Democrats, some Republicans express distrust, concern.
As Senate leaders craft a rewrite of American health care behind closed doors, lawmakers object.
As they draft legislation to repeal the Affordable Care Act, Senate Republican leaders are aiming to transform large sections of the U.S. health care system without a single hearing on their bill and without a formal, open drafting session.
That has created an air of distrust and concern — on and off Capitol Hill, with Democrats and also with Republicans.
“I’ve said from Day 1, and I’ll say it again,” said Sen. Bob Corker, R-Tenn. “The process is better if you do it in public, and that people get buy-in along the way and understand what’s going on. Obviously, that’s not the route that is being taken.”
The secrecy surrounding the Senate measure to repeal and replace the Affordable Care Act appears to be remarkable — at least for a health care measure this consequential. In 1993, President Bill Clinton empowered the first lady, Hillary Clinton, to assemble health care legislation in private, with input from a panel of more than 500 experts.
That approach won scathing reviews from lawmakers in both parties. But it took place at the White House, not in Congress. Once the Clintons’ health plan reached Capitol Hill, it died in the public spotlight.
Republican leaders this week defended their actions.
“Look, we’ve been dealing with this issue for seven years,” Senate Majority Leader Mitch McConnell said. “It’s not a new thing.”
McConnell said there had been “gazillions of hearings on this subject” over the years — a less-than-precise tabulation that offered little comfort to Democrats who want hearings held now, in this particular year, on the contents of this particular bill.
In the summer of 2009, when Democratic members of Congress were defending their effort to remake the nation’s health care system, they were taunted by crowds chanting, “Read the bill, read the bill.”
Now Democrats say they would love to read the Republicans’ repeal bill, but cannot do so because Republicans have not exposed their handiwork to public inspection.
“They’re ashamed of the bill,” Senate Democratic leader Chuck Schumer said. “If they like the bill, they’d have brass bands marching down the middle of smalltown America saying what a great bill it is. But they know it isn’t.”
The stakes are formidable: Health care represents about one-sixth of the U.S. economy, and about 20 million people have gained insurance under the 2010 health law.
In theory, the bill-writing process is open to any of the 52 Republican senators, but few seem to have a clear, coherent picture of what will be in it.
Sen. Ron Johnson, R-Wis., offered a hint of the same frustration felt by Democrats seeking more information about the bill.
“I come from a manufacturing background,” Johnson said.
“I’ve solved a lot of problems. It starts with information. Seems like around here, the last step is getting information, which doesn’t seem to be necessarily the most effective process.”
At a Senate hearing Thursday, Tom Price, the secretary of health and human services, said that he, too, had not seen the elusive Senate bill.
Senate Republican leaders say the bill still is a work in progress, and they have not said exactly how their bill will differ from the one approved last month in the House. President Donald Trump raised the stakes on those changes when he told senators this week he thought the House version was “mean.”
The Senate bill is likely to phase out the Affordable Care Act’s Medicaid expansion more slowly than the House version.
It is also expected to provide larger tax credits for older Americans, who would see their costs rise dramatically under the House bill, to buy health insurance.
The legislation will be considered in the Senate under an expedited procedure that precludes a Democratic filibuster and allows passage by a simple majority.
But, Republicans say, Democrats will still be able to offer numerous amendments once the bill is on the Senate floor.
It is not unusual for lawmakers to draft major legislation in private, but they usually refine, debate and amend it in open committee sessions. The House bill to repeal the Affordable Care Act did not receive a hearing, where outside experts could testify. But lawmakers dissected its contents and were able to propose changes at three stages — in the Ways and Means, Energy and Commerce and Budget committees.
Senate Republican leaders evidently think their backroom approach gives them the best chance to devise a health care bill that can squeak through the Senate, given their narrow majority and the policy differences in their conference.
However Republicans feel about their forthcoming bill — and they are far more comfortable criticizing the Affordable Care Act than talking up the virtues of their still-incomplete replacement — the process playing out in the Senate is quite different from the way Democrats went about passing the Affordable Care Act.
The Senate health committee approved its version in July 2009 after considering hundreds of amendments over 13 days.
The Senate Finance Committee cleared its version in October 2009, after more than a year of hearings, round-table discussions and other spadework.
A group of Democrats and Republicans from the Finance Committee met for months behind closed doors, trying — but ultimately failing — to draft bipartisan legislation.
The full Senate passed the Affordable Care Act on Dec. 24, 2009, on the 25th consecutive day of floor debate.
While much of the Affordable Care Act was written in the open, some important provisions were hashed out in private, just before the Senate vote, by Sen. Harry Reid, the Nevada Democrat who was then the majority leader.
Republicans complained bitterly at the time, and Democrats threw those complaints back in their faces this week.
“This massive piece of legislation that seeks to restructure one-sixth of our economy is being written behind closed doors, without input from anyone, in an effort to jam it past not only the Senate but the American people,” McConnell said in December 2009.
Asked his level of comfort with the process, Sen. John McCain, R-Ariz., cut off a reporter before he could finish his sentence: “None,” he said.
“We’ve got a divided caucus,” McCain said.
“I listen avidly at lunch as we go over the same arguments over and over and over again.”