GOP urged to lift veil on health bill

Repub­li­can sen­a­tors face grow­ing crit­i­cism from pa­tients groups and doc­tors over closed-door ap­proach.

Los Angeles Times - - FRONT PAGE - By Noam N. Levey and Lisa Mas­caro

WASH­ING­TON — Se­nate Repub­li­cans are fac­ing in­creas­ing crit­i­cism for duck­ing pub­lic scru­tiny as they craft leg­is­la­tion to roll back the Af­ford­able Care Act with lit­tle in­put from out­side ex­perts, pa­tients, physi­cians and oth­ers most af­fected by health­care leg­is­la­tion.

The GOP’s se­cre­tive process marks a sharp de­par­ture from the tra­di­tional way the Se­nate has de­vel­oped large, com­plex bills, which are of­ten de­bated for years with mul­ti­ple com­mit­tee hear­ings to en­sure broad in­put and care­ful anal­y­sis.

The closed-door ap­proach, which is even more opaque than the process used ear­lier this year in the House, is all the more re­mark­able given the bill’s likely im­pact on tens of mil­lions of Amer­i­cans, many of whom could see their health in­sur­ance pro­tec­tions sub­stan­tially scaled back or elim­i­nated al­to­gether.

“It is deeply dis­turb­ing,” said Erika Sward, as­sis­tant vice pres­i­dent of the Amer­i­can Lung Assn. “Pa­tients groups like ours need to make sure that our pa­tients’ needs for health­care will be met .... We can’t do that if we can’t see what is be­ing pro­posed.”

The lung as­so­ci­a­tion is among 120 pa­tient groups that last week sent a let­ter to se­nior Repub­li­can sen­a­tors ex­press­ing deep con­cerns about GOP pro­pos­als to fun­da­men­tally re­struc­ture Med­i­caid, which pro­vides health cov­er­age to more than 70 mil­lion poor Amer­i­cans.

Al­though Se­nate Ma­jor­ity Leader Mitch McCon­nell (R-Ky.) has in­di­cated he

wants a vote on a bill in the next two weeks, Se­nate Repub­li­cans haven’t dis­closed de­tails of their Med­i­caid plans, or any other part of their health­care leg­is­la­tion.

The Oba­macare re­peal bill passed by the House in May, which has helped guide the Se­nate dis­cus­sions, would slash fed­eral health­care as­sis­tance to low- and mod­er­ate-in­come Amer­i­cans by nearly $1 tril­lion and in­crease the num­ber of unin­sured by 23 mil­lion over the next decade, ac­cord­ing to the non­par­ti­san Con­gres­sional Bud­get Of­fice.

Speak­ing to re­porters at the Capi­tol last week, McCon­nell — who had pre­vi­ously vowed a much more open leg­isla­tive process for the health­care bill — de­nied there was any ef­fort to con­ceal the Se­nate leg­is­la­tion.

“We’ll let you see the bill when we fi­nally re­lease it,” he said. “No­body’s hid­ing the ball here. You’re free to ask any­body any­thing.”

But even some GOP sen­a­tors have voiced in­creas­ing frus­tra­tion about the lack of pub­lic de­bate about the specifics of how Repub­li­cans plan to re­place Oba­macare, as the cur­rent health­care law is fre­quently called.

Sen. Lisa Murkowski (RAlaska) lamented in an in­ter­view with on­line news site Vox last week that she couldn’t even an­swer ba­sic ques­tions about the bill.

“None of us have ac­tu­ally seen lan­guage,” she said. “My con­stituents ex­pect me to know, and if we had uti­lized the process that goes through a com­mit­tee, I would be able to an­swer … my con­stituents’ ques­tions.”

It re­mains un­clear whether any GOP law­mak­ers will try to hold up the health­care leg­is­la­tion, how­ever, as no Repub­li­can se­na­tor has de­manded pub­licly that McCon­nell slow down or hold hear­ings on it.

Be­fore vot­ing, the Se­nate, un­like the House, will have to wait for an in­de­pen­dent anal­y­sis from the Con­gres­sional Bud­get Of­fice.

The lack of pub­lic de­bate ap­pears to be a de­lib­er­ate strat­egy by McCon­nell and his lieu­tenants to min­i­mize op­por­tu­ni­ties for crit­i­cal eval­u­a­tion of their bill, which is likely to be highly con­tro­ver­sial.

Se­nate Fi­nance Com­mit­tee Chair­man Or­rin G. Hatch (R-Utah) said hold­ing pub­lic hear­ings about the leg­is­la­tion would only give Democrats more op­por­tu­nity to at­tack it.

“We have zero co­op­er­a­tion from the Democrats,” he said. “So get­ting it in pub­lic gives them a chance to get up and scream.”

But in­ter­est in the GOP health­care leg­is­la­tion ex­tends far be­yond Demo­cratic politi­cians on Capi­tol Hill.

Ma­jor physi­cian groups, hos­pi­tals, con­sumer ad­vo­cates and or­ga­ni­za­tions rep­re­sent­ing mil­lions of pa­tients with can­cer, di­a­betes, heart dis­ease and other se­ri­ous ill­nesses have been plead­ing with Repub­li­can lead­ers for months to open up the process and lis­ten to their con­cerns.

Last week, more than 15 pa­tients groups — in­clud­ing the Amer­i­can Heart Assn., the March of Dimes, the Amer­i­can Lung Assn. and the Amer­i­can Di­a­betes Assn. — asked McCon­nell’s of­fice to meet with them next week, propos­ing any time be­tween Fri­day and June 22.

A spokesper­son from McCon­nell’s of­fice told them staff sched­ules were too busy, said rep­re­sen­ta­tives of sev­eral or­ga­ni­za­tions.

McCon­nell spokesman Don Ste­wart said the ma­jor­ity leader’s sched­ule is full. “Nu­mer­ous meet­ings are al­ready booked well in ad­vance,” he said.

Dick Woodruff, vice pres­i­dent of the Amer­i­can Can­cer So­ci­ety’s ad­vo­cacy arm, said even when he and oth­ers have sat down with Repub­li­can con­gres­sional aides, it of­ten has been fruit­less.

“The Se­nate staff gen­er­ally don’t know any­thing,” Woodruff said. “There are so few peo­ple who un­der­stand what is go­ing on that hav­ing meet­ings isn’t par­tic­u­larly pro­duc­tive .... This is such a closed process.”

An­other rep­re­sen­ta­tive of a lead­ing pa­tient group likened the ex­pe­ri­ence to “talk­ing to a wall.”

The con­cerns about the health­care leg­is­la­tion ex­tend to the broader pub­lic as well, polls sug­gest.

The House bill is ex­tremely un­pop­u­lar, with vot­ers dis­ap­prov­ing of the leg­is­la­tion by nearly 4 to 1.

Just 17% of reg­is­tered vot­ers in a re­cent na­tion­wide poll backed the House bill, com­pared with 62% who dis­ap­prove of the leg­is­la­tion. Last week, Pres­i­dent Trump re­port­edly called that leg­is­la­tion, which he cel­e­brated in May in a Rose Gar­den cer­e­mony, “mean.”

Rut­gers Univer­sity pro­fes­sor Ross Baker, who has spent decades study­ing Congress, said law­mak­ers have tra­di­tion­ally used com­mit­tee hear­ings and pub­lic de­bate over leg­is­la­tion to help ed­u­cate vot­ers and build sup­port for com­plex and con­tro­ver­sial leg­is­la­tion such as the civil rights bills of the 1960s.

He said that is what makes the cur­rent GOP ef­fort so re­mark­able, adding, “I can’t think of an­other piece of leg­is­la­tion of this scope and mag­ni­tude that af­fects so many peo­ple that has been drawn up behind such a dense veil of secrecy.”

Don Ritchie, his­to­rian emer­i­tus of the Se­nate, said not since the years be­fore World War I has the Se­nate taken such a par­ti­san, closed-door ap­proach to ma­jor leg­is­la­tion.

A cen­tury ago, Se­nate Democrats, at the urg­ing of Pres­i­dent Wilson, drew up ma­jor tar­iff re­forms while shut­ting out Repub­li­cans. But when Demo­cratic lead­ers tried that again when they had large ma­jori­ties dur­ing the Great De­pres­sion, rank-and-file sen­a­tors re­volted. It hasn’t hap­pened since, he said.

Even the deeply par­ti­san de­bate over the de­vel­op­ment of the Af­ford­able Care Act, which ended with Democrats alone vot­ing for the bill, had Repub­li­cans at the ta­ble for much of the process.

That in­cluded 53 hear­ings and meet­ings about health­care in the Se­nate Fi­nance Com­mit­tee, ac­cord­ing to a tally as­sem­bled by the com­mit­tee.

The com­mit­tee — a group of Demo­cratic and Repub­li­can sen­a­tors who spent months in 2009 try­ing un­suc­cess­fully to de­velop a bi­par­ti­san com­pro­mise — then spent seven days mark­ing up fi­nal leg­is­la­tion, the long­est markup of a bill in more than two decades.

In the end, the Se­nate spent nearly 15 months de­vel­op­ing the Af­ford­able Care Act be­fore it was fi­nally en­acted in March 2010.

Zach Gib­son Getty Images

SE­NATE Ma­jor­ity Leader Mitch McCon­nell de­nied there was an ef­fort to hide the health­care leg­is­la­tion.

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