The health-care law that will affect millions of Americans is being actively concealed from them

Into the back room!
Into the back room!
Image: AP Photo/Pablo Martinez Monsivais
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Senate Republicans are currently revising the proposed new law that would overhaul the American health care system, equivalent to about a sixth of US economic production. They won’t tell anyone what’s in it.

Hypothetically, bills in Congress go through an open process of discussion and amendment in committees, and then another period of debate and amendment on the floor of the legislature. These norms have been watered down and abused over the years, but especially for major legislation, they are often an important way to build public understanding and support of the law.

Republicans were pretty mad about the process that produced the Affordable Care Act (ACA) in 2010, under president Barack Obama. At the time, Republican Senate leader Mitch McConnell warned Obama that Democrats would lose elections if they tried to “jam” a bill through Congress.

What did jamming look like? Starting in March 2009, Obama held a White House summit with lawmakers and stakeholders to talk about health-care reform. The House released its 1,000-page bill that July and went through months of committee mark-ups before passing it in November. Then the bill went to the Senate, where both the Senate Health, Education, Labor and Pension Committee and the Senate Finance Committee held weeks of hearings on the text. Republicans were able to propose and debate hundreds of amendments, though few made it into the final bill.

Needless to say, this made for a political mess for the Democrats, who were attacked by the insurance industry and Republicans alike for some of the ideas in the bill. This was when representative Joe Wilson screamed “You lie!” at the president in a joint session of Congress. But the long debate also put the basic mechanics of the bill out in front of the public, and gradually drew in enough members to vote it through.

Were there back-room deals in the ACA? Definitely. The final Senate bill was ultimately revised by the office of the Senate majority leader, the Democrats’ Harry Reid, before it went to the floor. Still, there was no mystery about its provisions when it came to the vote, as it arrived on the floor with a full analysis from the Congressional Budget Office (CBO) for nearly a month of debate before passing on a party-line vote.

The biggest irony of all, though, is that the ACA’s passage was delayed by weeks when Democrats held closed hearings with Republicans, designed to give them to cover to find a compromise.

Here’s what the Republicans learned from that experience: Don’t wait on the opposition. Skip all the hearings and go straight to the back room. They hope to do in six months what the Democrats did in 14.

One of Trump’s main election promises was to repeal and replace the ACA. But after his inauguration, the White House didn’t release any principles about what should be in the new health-care bill. In the House, lawmakers began with a rushed mark-up process, introducing the bill and revising it in committees over a compressed two-day schedule.

After the CBO score came out, showing a remarkably punitive piece of legislation, Republicans decided not to vote on the bill. A month later, after back-room negotiations and another amendment, they brought out a new bill and passed it in the House by one vote, without waiting for any new analysis of its effects. When the CBO scored the second bill, it found it to be virtually the same as the previous version.

Even Trump called the bill “mean.”

Now that bill is in the Senate, and senators have said they’ll re-write it almost entirely. Is that what they are doing? We don’t know.

There have been no mark-ups of the bill in either of the relevant Senate committees, and Democrats are not part of the talks. Nor, apparently, will there be any talks. McConnell and his team—13 senators, all of them white men—have been finalizing a new bill behind closed doors. Leaks suggest it will be similar to what the House passed, but how similar we don’t know. The key divide is once again between Republican moderates who wish to delay cuts to low-income health insurance, and conservatives who want to do away with public health-care subsidies entirely.

The bill is reportedly in its final stages, and Republicans expect to vote on it before the July 4th holiday recess. That’s vanishingly little time for the public to know what is in this law and influence their representatives. Now, the question is whether lawmakers will be willing to walk out on a wire to back the bill without knowing how the public will receive it but with good reason to suspect they will hate it.

The GOP line is that the party’s lawmakers held many hearings over the last seven years on how to repeal the Affordable Care Act. Yet if those hearings are driving the content of the bill, there should be no reason not to make the legislation public.