Public opinion about the Affordable Care Act is consistently favorable and on an upswing.
Faced with the prospect of repeal, crowds of constituents are confronting lawmakers across the country to express their anguish in town halls. But still, Republicans are rushing to rip apart the health insurance coverage that millions of people depend on.
That rush is a particularly bitter irony for anyone who, like me, worked on writing the ACA originally. Republicans accused Democrats eight years ago of drafting the health-care law in secret, despite dozens of public hearings and work sessions. But now it’s their own process that is highly secretive, with U.S. Capitol Police guarding a basement room where the draft legislation is kept hidden from voters, the news media and even members of Congress.
The GOP tried to use one quote in particular to drive its message back then. In 2010, then-House Speaker Nancy Pelosi, D-Calif., said that “we have to pass the bill so that you can find out what is in it, away from the fog of the controversy.”
What Pelosi meant was that people would realize the benefits of the law once they became tangible — which is exactly what polling shows has happened. But Republicans spun and truncated the quote to suggest that Democrats were hiding something.
In fact, the process to enact the Affordable Care Act was thorough and transparent. I was there for the whole thing, as a Democratic staffer for the Senate Health, Education, Labor and Pensions (HELP) Committee.
In the House, Democrats held a series of public hearings before introducing a public discussion draft in June 2009. The House then held more public hearings before introducing new legislative text in July.
All three relevant committees held “markups” — committee work sessions to amend the legislation — and the full House vote on the amended legislation did not take place until November.
In the Senate, the HELP Committee held 14 bipartisan roundtables and 13 public hearings in 2008 and 2009. During the committee’s markup in June 2009, Democrats accepted more than 160 Republican amendments to the bill.
Beginning in May 2008 — 20 months before the Senate vote and six months before Barack Obama, who would later sign the bill into law, was even elected president — the Senate Finance Committee held 17 public roundtables, summits and hearings.
In 2009, Democrats met and negotiated with three Republicans for several months before the tea party protests caused the GOP to back away from negotiations. The Finance Committee held its markup in September, and the full Senate vote did not take place until December.
In both the House and the Senate, “scores” by the independent Congressional Budget Office were available before each vote at each stage of the process. These scores are estimates of the effects of legislation on the budget and on the number of people who would be covered by health insurance.
That’s not remotely like what’s happening in Washington now.
It’s Republicans who are rushing to jam through their legislation to repeal the law in a highly secretive process. House Speaker Paul D. Ryan (R-Wis.) said this week on NBC’s “Today” show, “We’re not hatching some bill in a back room and plopping it on the American people’s front door.”
In fact, that’s exactly what they’re doing.
Only Republicans can see the bill text before the markup next week, and it’s only on view in a basement next to the Capitol. Sen. Rand Paul (R-Ky.) was denied entry into the room Thursday when he tried to go read the bill.
Worse, Republicans plan to mark up the proposal and take a vote without having a score from the CBO — which means no one will know what repealing the law will do to people who are covered under the ACA until after the committee votes on it.
Republicans have held no public hearings on their restructuring ideas. They do not plan to have any committee markups in the Senate. Legislation is still not public — one month from the planned vote in the Senate. And needless to say, Republicans made no attempt to conduct a bipartisan discussion about improving the Affordable Care Act instead of abolishing it.
Democrats used a special budget procedure known as “reconciliation” — which can be used to avoid a filibuster — to make tweaks to the Affordable Care Act after final passage. Now Republicans are using that very same procedure — but right away, at the beginning of the legislative process, and to make radical changes.
It’s true that some behind-the-scenes negotiation, discussion and drafting is part of every legislative process — including the process to enact the ACA. But in that case, versions of bill text and their CBO scores were publicly available for many months before the final vote. An extended public debate took place for more than a year. What’s truly remarkable now is that the entire process has been behind closed doors.
There’s a reason, of course, why Republicans want to hide their bill and its effects: Under every iteration of their plan, deep cuts to Medicaid and much lower tax credits for private insurance would cause millions of people to lose their coverage.
Republicans are making their members walk the plank with blindfolds on because they have no other choice.
They promised, over and over again, to repeal the ACA, and now they’re going to try to do it no matter how. Their internal divisions are rampant and grow by the day. This is no way in a democracy to consider and shape legislation affecting tens of millions of people with many lives hanging in the balance.
And ultimately, what was false about the Affordable Care Act is true about the secret basement bill: They have to pass the bill to find out what’s in it.
Spiro is the vice president for health policy at the Center for American Progress and a former staffer to Sen. Edward M. Kennedy, D-Mass.