This has become more evident each day, as the Senate plots out a secretive path toward Obamacare repeal — and top White House officials (including the president) consistently lie about what the House bill actually does.
There was even a brief moment Tuesday where Senate Republicans flirted with the idea of banning on-camera interviews in congressional hallways, a plan quickly reversed after outcry from the press.
“The extreme secrecy is a situation without precedent, at least in creating health care law,” writes Julie Rovner, who has covered health care politics since 1986 and is arguably the dean of the DC health care press corps.
I don’t have quite as long a tenure as Rovner, but I have been covering health care politics since Democrats began debating the Affordable Care Act in 2009. It’s become obvious to me, particularly this week, that Republicans plan to move more quickly and less deliberatively than Democrats did in drafting the Affordable Care Act. They intend to do this despite repeatedly and angrily criticizing the Affordable Care Act for being moved too quickly and with too little deliberation.
My biggest concern isn’t the hypocrisy; there is plenty of that in Washington. It’s that the process will lead to devastating results for millions of Americans who won’t know to speak up until after the damage is done. So far, the few details that have leaked out paint a picture of a bill sure to cover millions fewer people and raise costs on those with preexisting conditions.
The plan is expected to be far-reaching, potentially bringing lifetime limits back to employer-sponsored coverage, which could mean a death sentence for some chronically ill patients who exhaust their insurance benefits.
Senate Republicans do not appear to be focused on carefully crafting policy that reflects a more conservative, free market attempt at achieving President Donald Trump’s goals of covering every American at lower cost. They’re focused on passing something, by whatever means necessary. That may come back to haunt them electorally, but not until millions suffer the consequences.
Congress is hiding the health care bill
My professional life in 2009 and 2010 was an endless string of Affordable Care Act hearings aired on C-SPAN. I lived in New York at the time. It became a regular ritual to sit down in my cubicle, plug my headphones into my laptop, and listen to an entire day of Senate debate.
“There were hundreds of hearings and markups that lasted days — or in the case of the Senate Health, Education, Labor and Pensions Committee, months,” Rovner recalls in her piece.
Senators wanted to talk about the Affordable Care Act and why they believed they needed to pass it. They gave floor speech and after floor speech defending its provisions. Patients had months to lobby their legislators on particular issues that they thought were important. A few months ago I interviewed one woman, for example, who successfully lobbied former Sen. Kent Conrad (D-ND) to add a ban on lifetime limits in health insurance.
I remember Christmas Eve 2009 in particular, when I lived in New York and my roommate’s family came to visit for the holiday. They opened presents in our living room. I was holed up in my bedroom watching the Senate vote on the ACA, the culmination of a 25-day floor debate.
There isn’t much C-SPAN to watch these days because the Senate is running a remarkably closed process. There are no committee hearings. There are no floor speeches defending the policy provisions of the bill. Senate Majority Leader Mitch McConnell instead has assembled an ad hoc working group to hash out the details of Obamacare repeal in private meetings.
The biggest priority seems to be just passing a bill, regardless of what the bill actually looks like. Tierney Sneed, a reporter for Talking Points Memo, recently asked Sen. Orrin Hatch, who chairs the Senate Finance Committee, whether it was important to get the bill out a few days before the vote, so the public could review its provisions.
His response was telling. “Well, I think we’re not worried so much about that as we are getting it together so we can get a majority to vote for it,” he said.
The White House is lying about the health care bill
Vice President Mike Pence visited the Health and Human Services Department on Tuesday and delivered a speech to the agency’s employees.
“Now, I know this room is filled with men and women who care deeply about bringing high-quality health care to every American,” Pence said. “Rest assured, Donald Trump wants the exact same thing.”
Trump is not acting that way, though. He held a Rose Garden ceremony last month to laud a bill that would cause 23 million Americans to lose coverage — a bill he praised as “incredibly well-crafted.”
This is now a consistent pattern from top Trump officials, who have decided that their strategy to hide the Republican health care plan will be to not tell the truth about what it actually does.
Health and Human Services Secretary Tom Price has appeared on national television and claimed that Americans will “absolutely not” lose Medicaid coverage under the House-passed bill. Two separate, independent analyses of the AHCA find this isn’t true. Millions of Medicaid enrollees would lose coverage under that bill.
Trump himself gave an interview to CBS in April where he said that people with preexisting conditions would be protected under the AHCA. They won’t be: At the time he gave that interview, the bill had been amended to allow states to opt out of the requirement to charge people with preexisting conditions the same prices as healthy enrollees, a move that will almost certainly price some patients out of coverage.
Trump said that deductibles will go down under the Republican plan. Nonpartisan analysis expects deductibles will go up.
The White House has decided to deal with an unpopular bill by refusing to acknowledge the parts of it that the public doesn’t like. When asked in interviews about the expected loss in coverage or cuts to Medicaid, administration officials simply act as if they don’t exist.
This will all catch up to them — after the damage is done
At some point, of course, this strategy will catch up with Republicans. Promises that “every American” will receive “high-quality health care” will ring false when millions lose their health insurance. Once a law passes, it’s awfully hard to hide the consequences.
Republicans might lose elections if they pass the American Health Care Act. But that will only happen after people suffer the consequences of a rushed bill considered quickly with little public debate.
These are people like 62-year-old Cliff Hoskins, a retired coal miner who lives in rural Kentucky. He used to be on Medicaid expansion — he described it as the best insurance he ever had — and now has coverage through the ACA marketplace.
His out-of-pocket premium would likely triple under key Republican health care provisions.
“It’s going to at least take half, if not all, of my Social Security,” Hoskins says. “If I had to pay the full amount, that would not be good. That would put you back in poverty.”
These are people like 6-year-old Timmy Morrison, who lives in a city halfway between Washington and Baltimore. He was born premature with a rare genetic condition and has racked up $3 million in medical bills during his short life. If the Senate follows the House’s path, it would pass a bill allowing companies to once again place lifetime limits on health benefits — which would mean Timmy could run out of care.
His parents don’t know what they would do if that happens. “We don’t really know what to do right now,” his mother, Michelle Morrison, told me in February. “Should we start pressuring his doctors to do a surgery now so he can get it in time? That doesn’t feel right. Insurance is supposed to cover things that you can’t anticipate — and for us, this is one of them.”
Voters can oust Republicans in the 2018 midterm elections if they don’t like the health care plan. But for people like Cliff and Timmy, the damage will already be done. The election is secondary to their ability to get health insurance coverage.
This is the most damaging part of the lack of public discourse around the Republican repeal efforts: There are millions of real lives at stake that could be hurt. These people would suffer the consequences that will happen much faster and matter much more than any election.
Author: Sarah Kliff