DC Deciphered

It could end up being the biggest political scandal of our time.*  And no, I’m not talking about anything related to Russia. I’m talking about the Republican attempt to remake 1/6 of our economy, causing more than 20 million Americans to lose insurance, removing protections from tens of millions more, and doing so all under a strict shroud of secrecy while racing to the finish line, because they know – if they allowed any time or opportunity for public dissent – the blowback from the public would be staggering.

Despite the general plan having an approval rating of only 17%, despite it being opposed by a majority in every single state in the union, despite pleas from 120 patient organizations, despite appeals from doctors groups, hospital groups, the insurance industry and health economy experts, all warning about the devastating effects of the bill (or what we think is in the bill, since the contents still remains secret), the Republican Party seems determined to forge ahead, rushing to try get a bill through the Senate in the next 2 weeks.  And all of this is happening almost entirely below the radar of the public, as the media has barely covered it** and Democrats seem wholly unprepared to fight back.

So today, I’m going to do something a little bit different.  Regular readers of DC Deciphered know that every Friday I do a news roundup – called “What Did I Miss?” –  of some interesting and/or important stories that I think people might have missed during the week.  So today, DC Deciphered presents an all health care version of “What Did I Miss?”

1.  First, because this story hasn’t gotten a ton of mainstream media coverage, if you’re not someone who follows health care closely, you may not realize just how extraordinarily unusual the GOP’s rushed & secretive process here is.  So take it from Sarah Kliff, health care reporter for Vox.com.  Her recent piece is titled I’ve covered Obamacare since day one. I’ve never seen lying and obstruction like this:

Republicans do not want the country to know what is in their health care bill.

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 . . .

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.

Julie Rovner of Kaiser Health has been covering health care reform efforts much longer than Kliff has, and she makes a similar observation:

2.  Also from Vox, Dylan Scott explains why this secretive process means the Senate bill will be missing all of the scrutiny a major piece of legislation typically has to withstand:

Senate Republicans have decided their plan to repeal and replace Obamacare wouldn’t fare well in the sun, and so they have shielded it from any public scrutiny.

The bill — its contents still a mystery — could be voted on in the coming weeks without any committee hearings, expert testimony, or public debate . . .

Normally, when the Senate writes a major new bill, it holds public hearings where experts offer their opinions or insight on the issues at hand. Some draft legislation circulates for stakeholders and lobbyists to review. Committees get an opportunity to amend and vote on the bill before it goes to the floor. The process involves hours of public debate and weeks of work.

None of that is expected to happen in the Senate.

3.  In this great opinion piece from E.J. Dionne, Dionne shares a quote from a former Obama administration official who gets to the heart of it:

“I hate to think that looking back on this period, we’ll realize that the most regressive piece of social legislation in modern American history was passed, and no one was paying attention.”

4.  And Vox’s Sarah Kliff (yes, same one from #1, above) notes a funny pattern that’s developing, as the GOP’s secrecy is slowly starting to garner more attention from the media: a bunch of GOP Senators are complaining about the process, acting as if it’s just something that’s happening to them, not something they’re taking part in.

Call me cynical, but it kind of seems like they want to be able to vote for the bill, get credit with their base for repealing Obamacare, but then be able to wash their hands of responsibility once people start feeling all the bad stuff that happens as a result.  They think that putting their complaints about process on the record now will allow them to do this later.  Let’s not allow it

5.  And back in May, Senator Lindsey Graham criticized the hurried, opaque process the House used to pass its version of the health care bill.  But the process the Senate is using now is somehow even less transparent & deliberate than the process used by the House. I flagged Graham’s tweet at the time, because, sadly, it was entirely foreseeable that Senate Majority Leader Mitch McConnell would pull something like this, and that the rest of the GOP would go right along with him.

So does Sen. Graham have anything to say now about a rushed, secretive process?  And will this process stop him from voting for the Senate’s bill??  Sadly, I think we already know the answers to these questions.

6.  Since it has been a common refrain from Obamacare opponents to defend the repeal process by claiming that Obamacare itself was rushed through Congress in a secretive, closed process, let’s just get that out of the way – that’s entirely false. The process for passing the ACA was slow, deliberative and open, with numerous public hearings, input from outside experts and lengthy floor debates.

7.  Okay, so you get the point, the Republican process stinks. But maybe they’re doing it for a noble purpose??  Well, Vox asked 8 Republican Senators to explain what they’re hoping to achieve with their health care bill:  What’s the goal, and how will their bill help attain it??***  This is a must read . . .

With the bill’s text still not released for public view, Vox asked GOP senators to explain their hopes for it. Who will benefit from the legislation? What problems is this bill trying to solve?

“All of them,” Sen. John McCain said in an interview, not an uncharacteristic response of his Republican Senate colleagues . . .

Sometimes a senator could identify a desired outcome, like “lowering premiums” or “stabilizing marketplaces.” But they rarely could explain the mechanism through which they planned on achieving that outcome.

8.  And after the House passed its health care bill last month, there was a lot of talk about how that bill would never be able to pass the Senate, how it would have to be “softened up” to have any chance to get past the Senate moderates, and any bill coming out of the Senate would be completely different from the bill that just passed the House. It was always foolhardy to believe that (even if some of that talk came from Republicans themselves).

Now the Center on Budget and Policy Priorities has analyzed the differences between the House bill and the Senate bill (based on the leaks about what’s in the Senate bill).  Turns out the differences are slight and mostly cosmetic.

Here it is in chart form (for a larger image of the chart, see the linked article above):

9.  And the similarity between the bills is not great p.r. for Republicans, since word got out early last week that Trump told a group of Senators that the House bill was “mean, mean, mean” and that he wanted them to make the Senate bill “generous, kind (and) with heart.”

According the CNN’s Jim Acosta, Trump’s description of the House bill was even a little more colorful than that:

This was highly distressing for the GOP members of the House who had put their necks on the line to vote for this bill, after aggressive lobbying from Trump himself.  And it should be highly distressing to any members of the public who still put any stock in anything Trump says, since just last month he had gleefully celebrated this same bill’s passage in the White House Rose Garden and described it as “a great plan” that was “very, very incredibly well-crafted.”

10.  And now, just a bit on the actual substance of the bill: Republicans are going to claim that their bill retains Obamacare’s protections for people with preexisting conditions, because it will technically keep the provision that bans discrimination against those customers.

But don’t fall for it – for all practical purposes, those protections will be gone.  (Assuming the leaks coming out about the contents of the bill are correct).

Topher Spiro, VP of health policy at the Center for American Progress, explains:

[T]he Senate outline — like the House bill — still allows states to waive coverage of essential health benefits . . . [T]he Senate’s design would set in motion a downward spiral in benefits offered by insurers. If insurers couldn’t mark up premiums for people with preexisting conditions, the only tool they would have left to manage risk is their benefit packages. Insurers would be able to screen out sick people by excluding benefits they need — and would race to avoid being stuck with the sickest patients.

If you’re interested in keeping up with the GOP’s efforts to repeal & replace Obamacare, Spiro has been the absolute champ on keeping people informed on the topic, and he’s a great Twitter follow: @TopherSpiro.  Another highly recommended follow for the same topic is Andy Slavitt, who ran Medicare & Medicaid in the Obama administration: @ASlavitt.

11.  The preexisting condition issue can be a bit confusing if you haven’t been following it all along, so here’s another take on the explanation:

By allowing states to waive the ACA’s essential health benefits (EHB) requirements, it would enable insurers to effectively screen out sick people by excluding certain services.

As a result, people with pre-existing conditions in waiver states would face significantly higher costs and find it much harder to find insurance plans that actually covered treatment for even relatively common conditions such as mental health problems or diabetes.

12.  And finally since no one really knows for sure what’s in the Senate bill (aside from the anointed 13 member, all male working group of Senate Republicans), Mashable gives us its version of the GOP plan:

 

*****

Notes:

*For us post-Watergate peeps, I mean.

** More accurately, television news has given this topic almost no coverage.  And the major players in print news have been a bit better but not much. Toward the end of last week, they started focusing a little more attention that way.  However, there has been a lot of very good coverage among reporters who specialize in the health care beat at smaller and/or independent outlets.  So that’s where a lot of this reporting I include here comes from.

***Several Senators here mentioned that they want their bill to bring certainty or stability to the insurance markets or to keep insurers from leaving.  They neglect to mention that most of the uncertainty and instability in the Obamacare markets, and the reason so many insurers are leaving, is due to their own sabotage, and could easily be remedied without remaking the entire law.