(Bloomberg) — The health care world is gearing up for a lobbying offensive to persuade Republican U.S. senators to address their problems with H.R. 1628, an Affordable Care Act change bill replacement that was conceived in the House in a virtual vacuum.
Insurers, doctors, patient groups and most health care experts are pinning their hopes on the Senate being more receptive after House Republicans — led by Speaker Paul Ryan — deliberately avoided discussing their plans for the American Health Care Act bill with the main groups that would be affected by changing the 2010 law. House GOP lawmakers say they kept the process closed out of concern that interest groups might try to shape the bill in their favor.
“Lord no!” said Rep. Phil Roe of Tennessee, co-chairman of the House Republican doctors’ caucus, making the case that some segments of the health industry benefited from the very regulations and paying customers created by the ACA. “They have a vested interest in keeping it around.”
Now, as GOP senators try to craft a repeal bill that can attract 50 votes, the industry won’t be left on the sidelines. Billions of dollars in U.S. health spending are at stake for hospitals, insurers and doctors who are worried by estimates that 24 million fewer Americans would be insured by 2026 under the House bill.
“I think initially there will be a lot more accessibility,” said Dick Woodruff, senior vice president of federal advocacy at the American Cancer Society’s lobbying arm, the Cancer Action Network. “I think the Senate process is going to be a lot more deliberative.”
‘No Formal Outreach’
Groups representing doctors also say that senators appear open to meeting with them.
“On the House side, there was no formal outreach, that I know of, by House leadership to sit down with us and hear our concerns or get our input before the bill was introduced,” said Bob Doherty, senior vice president of health policy and regulatory affairs at the American College of Physicians. “After, we did have repeated meetings with people in House leadership, the door was open and we expressed our concerns but it didn’t seem to do much good.”
“It is a little bit of a surprise to me,” Doherty added. “Health reform is so difficult. Getting people who take care of people engaged in the process and not actively opposed would seem to be smart policy as well as politically.”
The health care industry wants to protect coverage by preserving a Medicaid expansion instituted under the Affordable Care Act. Insurers have also called for increasing the financial help offered in the bill to Americans buying insurance in the individual market.
As chairman of the House Energy and Commerce Committee, Greg Walden of Oregon was one of the bill’s prime authors. He said he and his team regularly talk to industry players, but they didn’t want to rely on people who supported the ACA.
“I spent a lot of time with the hospital association people,” he said, offering one example. “You know, they got a different view. But obviously the Medicaid cuts, and all of that, we talk to them about.”
Roe said, “The whole idea was not to come up with Obamacare again.”
A lobbyist for hospitals, who asked to remain anonymous, confirmed meeting with Walden though not with House leaders. When the bill text came out in early March, the details were a surprise, the lobbyist added.
America’s Health Insurance Plans, the insurers’ main lobby group, had also been working for months to sway lawmakers on the Affordable Care Act change legislation, but it also didn’t see the bill before it was released to the public, a person familiar with the group’s strategy said.
Indeed, the bill was kept away from most Republican lawmakers before its release, prompting the spectacle of Sen. Rand Paul, a Republican skeptic of the House plan, searching Capitol rooms for the bill with a trail of reporters following him.
Leading House moderate Charlie Dent of Pennsylvania complained that the final House measure passed May 4 was “haphazardly constructed and hastily considered.”
He isn’t alone: Senate Republicans are already promising to carve it up and build a better version.
Sen. Dean Heller, R-Nev. (Photo: Heller)
Woodruff said his Cancer Action Network plans to meet with members of the task force Senate Majority Leader Mitch McConnell helped assemble to lead his party’s efforts on the health bill.
The American Medical Association said in a letter to Senate leaders Monday that it’s ready to work with Congress on the bill, and that the measure shouldn’t weaken health coverage.
Health insurers will make their case to senators as well, an insurance lobbyist said. Republican senators like Rob Portman, who represents Ohio where Obamacare’s Medicaid expansion is popular, and Dean Heller, who could face a contentious re-election in the swing state of Nevada, may prove helpful to their cause.
Many conservative groups — including the Heritage Foundation, Club for Growth, Tea Party Patriots and FreedomWorks — were also left out of the House deliberations.
President Donald Trump expressed surprise when leaders of several of these groups told him during a meeting in March that GOP leaders hadn’t consulted them, according to several participants. Many ended up backing the bill days before it was passed, after some last-minute changes.
Edmund Haislmaier, a senior health policy research fellow at the Heritage Foundation, said he wasn’t consulted in the crafting of the House health bill, and he didn’t know anyone else in the policy community who was. He added that while it’s important to guard against lobbyists writing legislation in the interest of their clients, lawmakers need to consult industry players like insurance companies.
Many big insurers have largely dropped out of the Affordable Care Act public exchange system after facing losses when premiums didn’t cover the cost of caring for consumers who signed up, and others that are still in the markets are proposing steep premium increases.
“You’re worried about people in that industry giving up and not participating, then it would be relevant to talk to them,” Haislmaier said.
A senior House GOP aide provided only one name of an expert consulted during the drafting of the measure: Doug Holtz-Eakin, a former director of the Congressional Budget Office and current president of the policy nonprofit American Action Forum.
‘Better Way’ Agenda
Holtz-Eakin said he and several others from his organization spoke “fairly regularly” with House leaders and members of the Energy and Commerce Committee, as well as the Ways and Means panel.
“How much of that shaped the bill? Well, I don’t know,” he said, adding that the eventual proposal seemed to him like a natural outgrowth of the “Better Way” agenda that Ryan and House leaders drafted last year.
“It’s pretty simple; I’m viewed as a resource that can tell them something about policy, and I don’t pretend I understand their politics all that well,” Holtz-Eakin said. “So I just try to help them when they ask.”
The senior House GOP aide said that leaders were mostly focused on trying to make sure the language in the bill, H.R. 1628, conformed with Senate rules and didn’t violate the expedited procedures being used to circumvent a Democratic filibuster.
While the Senate might be more accessible to industry and policy wonks, senators won’t exactly be deliberating out in the open.
There’s already talk of sending the new measure directly to a vote in the full Senate without committee hearings, if leaders can gather the 50 Republican votes — plus Vice President Mike Pence — needed to muscle it through. But the measure will be open to amendments on the Senate floor, giving lobbyists a chance to win changes.
House Republicans did widely consult with outside experts on one aspect of the bill: its tax cuts. These also happened to win more applause from conservatives.
The House Ways and Means Committee met with a number of conservative tax experts, as well as small business groups, the U.S. Chamber of Commerce and state leaders, according to a Republican aide.
“We were definitely consulted on specific ideas and input,” said Alex Hendrie, director of tax policy at the conservative Americans for Tax Reform. “I wouldn’t say ‘oh, we wrote this,’ but there was definitely a lot of great input back and forth.”
“The direction they wanted to go was out there, so I was surprised that people all of a sudden seemed to wake up and say ‘I can’t believe they want to do this,’ when it’s been out there for a year,” he added.
The House bill eliminates taxes on the wealthy, insurers and pharmaceutical companies that helped pay for the ACA. Health care industries may want to focus their attention on those tax cuts in the Senate where they aren’t a sure thing. Republican senators have said it’s unclear whether their chamber will keep all of the tax cuts because they might need some of the funds to provide more affordable coverage.
—With assistance from Shannon Pettypiece and Zachary Tracer
— Read GOP Seeks Way to Pay Insurers So More Don’t Drop ACA Plans on ThinkAdvisor.