(Bloomberg) — Senate Republican leaders drafting a measure to revamp U.S. health care policy appear to be following the same path as their House counterparts — writing a bill behind closed doors before springing it on other lawmakers and the public close to a vote.
Rank-and-file Republicans, including Lindsey Graham of South Carolina and Jeff Flake of Arizona, say they don’t know what’s in an emerging Affordable Care Act change bill that’s been under negotiation since the House passed its version in early May. Even lawmakers who have attended small-group sessions to help draft it say they aren’t sure how Senate Majority Leader Mitch McConnell may be resolving areas of disagreement.
Some who will help determine whether the GOP can pass a bill without any Democratic support say they’re missing a chance to guide and shape it.
“Until I see the language, I don’t know what’s there,” said Sen. Bill Cassidy, a Louisiana Republican. “And so I would like to see language. If you don’t have language, sure you have a sense but your sense could be wrong.”
Senate Republican leaders say text will be available to everyone later and that they’ve given every GOP senator ample opportunity to weigh in at caucus meetings that continue Tuesday. McConnell provided an outline of ideas under consideration last week at a closed-door GOP lunch as leaders seek to craft a more modest proposal than the House approved.
“Nobody’s hiding the ball here,” McConnell told reporters Tuesday. “You’re free to ask anybody anything.”
About a dozen Senate Republicans met Tuesday with President Donald Trump at the White House to discuss efforts to change the Affordable Care Act. Afterward, third-ranking Republican John Thune of South Dakota said the president “wants us to get moving on it” and urged the GOP senators to work through their differences.
The senator said Trump didn’t state many policy preferences but said people with pre-existing conditions should be protected and spoke about making tax credits apply to lower-income people rather than allocated solely by age as the House bill did.
“I think he realizes our bill is going to move probably from where the House is, and he seems fine with that,” Thune said.
Senate Finance Chairman Orrin Hatch said, “I think we’re a ways away” from an agreement. The Utah Republican said he would like to see a floor vote before the July 4 recess but couldn’t say if that is possible.
The nonpartisan Congressional Budget Office says the House measure would leave 23 million more Americans without health insurance in a decade because of its deep cuts to health care spending including Medicaid for low-income Americans.
‘Ashamed of the Bill’
Democrats say the process is blatantly hypocritical because Republicans complained before the Affordable Care Act passed in 2010 that it was largely written behind closed doors. Democrats point out the landmark health law was debated and voted upon by three House committees and two in the Senate, with opportunities to amend it. This time, neither chamber has held even one hearing.
“They’re ashamed of the bill,” Senate Minority Leader Chuck Schumer said on the Senate floor Monday. “They know they have the hard right on their backs, saying you gotta do something. But at least have the decency, honor, a little bit of courage. Put the bill out there and let us debate it and let us amend it.”
In taking the secretive tack, Senate Republican leaders risk hitting the same wall that confronted House Speaker Paul Ryan in March, when his chamber initially failed to pass a measure because it lacked enough support among the GOP. Ryan had tried to push the bill through only 17 days after revealing the legislative text to fellow Republicans.
Insurers and Doctors
The bill — and a revised version that passed May 4 on a narrow 217-213 vote — was crafted far away from groups representing insurers, doctors, and patients who then came out in opposition.
Senate Republicans face tougher challenges to pass a measure that has no Democratic support in either chamber. Senate Republicans hold a razor-thin 52-48 majority and plan to use an expedited procedure to pass a health plan with as few as 50 votes, plus a tie-breaker from Vice President Mike Pence. That would bypass the usual 60-vote threshold and keep Democrats from blocking the measure.
That leaves little margin for error, and many of the policies Republicans are looking at could lose support of moderates or conservatives. The GOP also has a tight timeline with leaders including Majority Whip John Cornyn calling for action before an August recess to provide time for other priorities later.
Sen. Susan Collins, R-Maine (Photo: Collins)
“I just think there’s too much at stake, including the agenda when we get back in the fall — do another budget resolution and do tax reform — and we can’t get to that until we get this done,” Cornyn said.
At a Senate health committee hearing Tuesday that was supposed to focus on high prescription-drug prices, Democrats criticized Republican efforts to develop their health bill in secret.
Sen. Patty Murray of Washington, the top Democrat on the panel, asked Chairman Lamar Alexander of Tennessee whether he would hold a hearing on the bill, saying that members of her party have no idea what is in it.
“I have none planned,” Alexander said. He called the committee “a group of grown-up adults who are able to do more than one thing at a time. I don’t know why I should call bipartisan hearings requested by the Democrats when you won’t focus on the hearing.”
Cuts to Medicaid
The House American Health Care Act bill, H.R. 1628, would cut Medicaid by $834 billion over 10 years, repeal $664 billion of the Affordable Care Act tax increases on the wealthy and the health care industry, and end requirements that individuals get health insurance and that most employers provide it. The measure would replace the Affordable Care Act subsidies with tax credits based primarily on age, and let states get waivers from some of the Affordable Care Act’s consumer protection rules.
Many Republicans say the closed-door negotiating process is necessary to find the right balance to get the needed votes. Republicans are weighing changes to the House plan that include a slower phase-out of the Affordable Care Act Medicaid expansion, better protection for people with pre-existing conditions, and tax credits based on income as well as age.
“I think the leader is trying very hard to get ideas and get kind of a starting draft,” said Sen. John Hoeven, a North Dakota Republican taking part in the negotiations. “And then I think there will be more opportunities for those ideas to be out there in a transparent way and for people to have feedback.”
Others say the process is hard to defend, but they have no choice if they want to keep their campaign promise to replace Obamacare.
‘Not the Best Way’
“We wrote a bill in the House, which nobody could amend,” said Graham. “That’s not good. We’re trying to do it from a one-party perspective because no Democrat is willing to help us. But no, this is not the best way to do health care. But it’s the way we’re having to do it.”
Others say they fear senators and the public will have little time to understand a final proposal when and if it is released.
“I think we have to really take a look at this, and I think the American people need to take a look at it,” said Sen. Ron Johnson, a Wisconsin Republican.
Some Republicans who have largely been left outside the deliberations say they can’t predict what they’ll do.
“The emerging bill is considerably better than the House bill,” said Sen. Susan Collins, a moderate Republican from Maine who’s seen as a tough vote to get. “But saying that it’s better doesn’t mean that it’s acceptable to me.”
—With assistance from Sahil Kapur, Anna Edney and Erik Wasson.
— Read New HealthCare.gov Verification Effort to Start June 23 on ThinkAdvisor.