(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.
