A coterie of Republicans is planning to have the Senate vote before July 4 on a bill that could take health insurance away from up to 23 million people and make changes to the coverage of millions of others. And they are coming up with the legislation behind closed doors without holding hearings, without consulting lawmakers who disagree with them and without engaging in any meaningful public debate.
There is no mystery why the Senate majority leader, Mitch McConnell, is trying to push this bill through quickly. The legislation would repeal major provisions of the Affordable Care Act. Opening it to scrutiny before a vote would be the congressional equivalent of exposing a vampire to sunlight.
That is one mistake Mr. McConnell, a master of the Senate’s dark arts, is not about to make. As one Republican aide put it to Axios on Monday, “We aren’t stupid.” Better to pass a terrible bill in the cover of darkness just as the House did with its version, the American Health Care Act, in the hopes that critics do not have much time to raise a stink. And then there is President Trump, who is standing ready to applaud whatever turkey the Senate produces as long as it gives him a chance to claim a win.
Mr. McConnell’s strategy belies the disingenuous Republican complaint that Democrats jammed the A.C.A., or Obamacare, into law in 2010 without sufficient analysis or discussion. The Republican effort to undo the A.C.A. bears no resemblance whatsoever to that much more thorough exercise.
Congress and the Obama administration spent a year on health care reform from March 2009 to March 2010. The House and Senate came up with several competing bills, held dozens of hearings, accepted Republican amendments and spent countless hours soliciting feedback from public interests groups and the health care industry. The Congressional Budget Office produced several reports to analyze the various proposals and the legislation that ultimately became law.
By contrast, instead of public drafts and hearings, we now have to settle for a series of leaks from Capitol Hill about what is or isn’t in the bill. On one day, news organizations might be told that Mr. McConnell’s health care working group (which happens to be composed entirely of men) has found ways to win over more moderate senators like Rob Portman of Ohio by agreeing to phase out the expansion of Medicaid more slowly than the House bill would. Such a policy would mean that millions would still lose coverage but not as quickly as in the House version.
But on another day, the public might learn that conservatives like Rand Paul of Kentucky are furious because the draft does not do enough to turn the American health care system into a facsimile of “The Hunger Games.”
In other words, the country is getting only glimpses of half-formed policies and mere hints of the back-room deals offered to win support for them. The Washington Post recently reported, for instance, that Mr. McConnell might cobble together a slim majority for his bill by offering senators from Appalachian states a fund for the opioid epidemic. He might also have to come up with something to accommodate Lisa Murkowski of Alaska because her state has high health care costs and stands to lose a lot if Congress reduces spending on health care by $1.1 trillion over 10 years to give the wealthiest American families a fat tax cut.
It would be tempting to find all this negotiating a purposeless charade if it didn’t have the potential to hurt millions of people and wasn’t already taking a toll. In recent weeks, health insurers have ended coverage in some parts of the country for next year and proposed raising premiums substantially elsewhere. The companies say they are trying to protect themselves from the uncertainty around the A.C.A. Blame for that rests with Congress and Mr. Trump, who has threatened to destroy Obamacare through administrative changes.
Republican leaders seem to think they will gain a tactical legislative advantage if they can negotiate a deal behind the scenes and then suddenly spring it on the full Senate. Those gains will quickly evaporate when voters learn what they have done.
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