Republicans Are Keeping Their Health Care Bill Secret Because They Can't Defend It On the Merits

The Senate GOP is relying on the same opaque process they accused Democrats of using to pass Obamacare.


Tom Williams/CQ Roll Call/Newscom

One measure of the strength of a piece of legislation is how enthusiastic its backers are about defending it at length in public. This may not always account for the full merit of a bill, but at the very least, it provides a sense of whether or not its own supporters believe it is worthwhile, and are willing and able to make the case for its value.

By this metric, the Senate's health care bill is almost entirely indefensible. Although the bill, an update of the American Health Care Act (AHCA) that passed the House in May, is reportedly almost finished, the handful of Senate Republicans charged with drawing up the legislation have declined to share details with the public, and have repeatedly indicated that they have been ordered to keep quiet about the basic framework.

Senate Republicans are so intent on keeping the contents of the bill secret that they have not even revealed specifics to some of their fellow Republican lawmakers. "I want to know exactly what's in the Senate bill. I don't know yet," Sen. Ron Johnson told Bloomberg News.

Nearly everyone, in other words, is being kept in the dark, and although the legislation will eventually have to be made public, the current plan is to vote on it as quickly as possible after the text is revealed—possibly before the July 4 holiday recess.

The reason for this is that Republicans believe that a combination of speed and secrecy is the only way the bill will pass. They have so little confidence in their bill that they don't want anyone to see it.

The first draft may be finished as soon as tomorrow, but Republicans do not plan to make it available for scrutiny even after it is complete. "We aren't stupid," one anonymous Republican aide told Axios. The aide's defense is that the contents of the bill might change even after it is complete, because GOP lawmakers might continue to discuss it amongst themselves. The general public, notably, will not be part of this discussion. It is a defense that merely highlights the GOP's unwillingness to subject their health care ideas to public debate.

In one sense, this is not surprising. The few rumors that have emerged suggest that the Senate bill will look a lot like the House bill, except perhaps a little more expensive. It will, in other words, keep the essential framework of Obamacare—subsidies for individual market insurance, federal regulations for insurers, and a penalty (assessed by insurers rather than the government) for those who go without coverage—while rolling back the current health law's Medicaid expansion over a longer period of time. That plan was supported by less than 20 percent of the public, which is to say that it was even less popular than Obamacare was when it passed.

The AHCA relies on a framework that, regardless of how it is tweaked, is designed to please approximately no one. Critics of Obamacare can argue, correctly, that it keeps Obamacare's core structure in place, rewriting the health care law rather than repealing it. Supporters of the health law can argue, also correctly, that it dramatically reduces the benefits and coverage associated with Obamacare. And health policy experts on all sides of the aisle can argue, again correctly, that it is fundamentally incoherent as health policy, that it would lock the nation into a poorly designed system that serves no substantive ideological or health policy goal. Its chief virtues appear to be that it allows Republicans to claim they repealed Obamacare, and that it paves the way for an overhaul of the tax code that would cut tax rates.

When Republicans do attempt to discuss the AHCA in terms of health policy, they tend to frame it as a response to the failures of Obamacare. It is an argument that, like the bill itself, does not make much sense.

Republicans like to point out that Obamacare's insurance markets are struggling. It is certainly true that the individual insurance markets set up by the health care law are not faring well. Insurers are dropping out, citing massive losses and fundamental structural flaws in the program. Next year, some 45 counties in the nation could have no participating insurer in the exchanges set up under the health law, according to The New York Times. Many states have seen significant rate hikes under the law, and early reports indicate that further hikes are likely this year.

Republicans even have a partial point when they argue that some of this uncertainty is built into the health care law: One of the reasons for the instability in the exchanges is that it is unclear whether the Trump administration will continue to pay subsidies to health insurers. The Obama administration made those payments, but after House Republicans sued, a federal judge ruled that they were illegal.

Republicans sometimes argue that the health coverage offered through the law is not worth much because it is either unavailable or unaffordable.

But "Obamacare isn't working" isn't an argument that the AHCA would. The House version of the AHCA is structured in a way that would create higher premiums and more instability in the individual health insurance market rather than less.

Under the AHCA, premiums would rise faster, on average, through the end of the decade, according to the Congressional Budget Office, and would continue to rise through the next decade, albeit at a slower rate. Meanwhile, the CBO predicts that 14 million fewer people would have coverage next year. The CBO's predictions are unlikely to be precisely accurate, but they are almost certainly directionally correct, so even if the agency's estimates are off by a significant margin, the result would still be premium hikes and coverage disruption for millions. None of the tweaks that the Senate has reportedly discussed would significantly alter those short-term effects.

Republicans, in other words, want to solve the problems of high premiums, market instability, and coverage access with legislation that is likely to make all of those issues much worse. And they want to pass an Obamacare repeal bill that nonetheless leaves its fundamental individual market structure in place, in a vastly degraded form.

It is no wonder, then, that they have chosen to fast track the bill through the legislative process in secret and, quite possibly, without any hearings.

It's a process that Republicans would surely be crying foul about were Democrats attempting anything like it to pass sweeping health care legislation. We can be sure of this because Republicans complained bitterly about the partisanship, speed, and secrecy they said Democrats relied on to pass Obamacare. That was never as true as Republicans made it out to be: As Dylan Scott notes, that law took a year to pass, and during that time Democrats released a discussion draft and went through a Senate markup that considered more than 500 amendments.

If Republicans thought the AHCA could withstand public scrutiny, they would be making it public and proudly defending it on the merits, taking time to explain their rationale for overhauling the nation's health care system and building public support for a plan they believed in. They are not doing so because they cannot.

In the long term, if the bill ends up becoming law, it is hard to see how this does not backfire as both policy and politics. Republicans are not stupid enough to try to defend the health care bill, but they may be stupid enough to try to pass it.