The vote was looming, and his party was going to lose, but the senator stood up to condemn what the health-care debate had become.
“Even many of the people who support this bill with their votes don’t like it,” he said. “We’re left with party-line votes in the middle of the night, a couple of sweetheart deals to get it over the finish line, and a public that’s outraged.”
The accusations could have come from any Democrat, condemning the battering-ram progress of House Republicans’ American Health Care Act. But they came from Sen. Mitch McConnell (R-Ky.), then the leader of a 40-seat Senate Republican minority, attacking the Affordable Care Act on Christmas Eve of 2009.
Four elections and more than seven years later, the GOP’s push to repeal the ACA has repeated many of the sticky process battles that the party campaigned against. Plans to pass the AHCA in the House on March 23, the anniversary of the ACA’s final passage, emphasize that the GOP is trying to undo in a matter of weeks what Democrats did over a grueling and politically damaging year.
“The ACA took months of deliberations and debate before passage,” said Jim Messina, who was deputy White House chief of staff during the ACA debate. “So the speed and secrecy around the Republican health-care process is pretty shocking, even by Washington standards.”
It’s an especially sore point for Democrats, who spent years defending the ACA from accusations that it had been rammed through. They aimed, early in 2009, to pass a reform bill with bipartisan support. The process dragged through most of the year as Senate Democrats worked to win over Sen. Charles E. Grassley (R-Iowa) and Sen. Olympia J. Snowe (R-Maine), both of whom would vote against final passage.
“What we did, in spite of what they said to the contrary, was hold 26 hearings,” said Rep. James E. Clyburn (S.C.), the House Democratic whip during the 2009-2010 process. “We did that for a year. We accepted over 100 Republican amendments. Now here they are, and they won’t accept a single Democratic amendment.”
For years, Republicans not only campaigned against the implementation of the ACA, but explained that Democrats weakened themselves politically by pushing it through. In 2010 and every subsequent election, they decried how Democrats reformed health care with no support from the minority, an original sin that voters could understand.
“We thought — correctly, I think — that the only way the American people would know that a great debate was going on was if the measures were not bipartisan,” McConnell told the Atlantic in 2009. “When you hang the ‘bipartisan’ tag on something, the perception is that differences have been worked out, and there’s a broad agreement that that’s the way forward.”
But the push to pass the AHCA in the budget reconciliation process has left Republicans arguing among themselves, explaining why conservatives should back the bill — not why it would be more broadly popular. Most of House Speaker Paul D. Ryan’s interviews about the bill have been conducted by conservative media outlets, where he’s emphasized its tax cuts and Medicaid caps.
“We’ve been dreaming of this since I’ve been around — since you and I were drinking at a keg,” Ryan told National Review editor in chief Rich Lowry at a forum Friday.
When pressed about the speed of the repeal push, Republicans often insist that Democrats cut more corners.
“None of us are saying what Nancy Pelosi said, her comments about how you had to pass it first,” Sen. John Barrasso (R-Wyo.), one of the Senate’s few doctors, said about the Democrat, then the House speaker.
“Folks watching on television now can go online and read what the bill is,” said Office of Management and Budget Director Mick Mulvaney last week. “They can watch the committee hearings. Those are things that were dramatically missing in Obamacare.”
“We’ve allowed the committees to work their will,” White House press secretary Sean Spicer said Tuesday. “The House has taken up the amendment. It’s been online. I mean, there’s always a balance between jamming it down and getting it done and over it, which is how the Democrats operated at one point when they finally moved on their bill, versus how this is done.”
In fact, there were more public debates and committee meetings about the ACA than about the AHCA. In 2009, the House Energy and Commerce Committee held three days of hearings; this year, the committee held one marathon “markup” that went overnight. The text of the earlier bill’s various versions was online for days before each vote. As the Senate closed in on a vote, then-Sen. Tom Coburn of Oklahoma moved, successfully, for the bill to be read in its entirety on the floor. And Pelosi’s accidentally immortal pledge that voters would “find out what’s in” the ACA only after it passed was actually made in March 2010, weeks after the final version of the bill was made public.
Republicans “accuse Dems of ramming through Obamacare,” wrote Philip Klein, a Washington Examiner editor who covered the ACA fight and wrote a book about the law, in a Tuesday tweet. “But Obamacare was passed at the pace of Zootopia DMV sloths compared to this AHCA attempt.”
Additionally, some of the ACA features that the party once railed against also survived in the AHCA. While Republicans have proposed eliminating subsidies, they replaced them with tax credits that some hard-line conservatives view as the same sin. They have adopted a proposal by mainstream New York Republicans to change how the state pays out Medicaid, evoking memories of similar carve-outs that won moderate Democratic support for the ACA.
And the bill keeps cuts to Medicare spending — featured in countless campaign ads — while delaying the “Cadillac tax” on some employer plans until 2025, echoing the “gimmicks” that Ryan once railed against.
“There aren’t that many options,” said Andy Slavitt, acting director of the Centers for Medicare and Medicaid Services under President Barack Obama. “A lot of these are in fact cheap imitations of the ACA that don’t do the job as well.”
This year’s speed also risks unintended consequences, similar to the ones that spawned lawsuits and legislative fixes after the passage of the ACA. Using the budget reconciliation process for what Republicans call the first of three phases to repeal and replace Obamacare allows them to pass their first bill with just 51 votes, but it leaves it open to challenges that it does not meet the “Byrd rule,” which requires such bills to pertain only to budget matters. An amendment, expected to be added on the House floor Thursday to mollify conservatives, changed the language about group plans in a narrow way that might make many veterans ineligible for a tax credit.
“The risk for Republicans in running a much more fast-paced and secretive process is that Republican members will be held accountable for every provision in this legislation — including those added at the last minute that will not fare well with sunlight,” said Messina. “For those voting yes this week, they will face the impossible task of either defending the details that come out or admitting they didn’t take the time to scrutinize such important legislation before it passed. That type of impossible question is one Republican members will face in town halls, editorial boards and interviews for the next 19 months.”
In the meantime, they have gotten stuck in a familiar series of process fights. In January, when Republicans developed the repeal strategy, the message guru Frank Luntz suggested that they frame it as a “rescue” mission for a health-care system that was breaking. Democrats used similar messaging to defend the ACA when it was leaking support. Now, said Luntz, Republicans are experiencing their own drift away from a strategy that worked.
“Obamacare promised to lower health-care costs. It didn’t,” said Luntz. “It promised to make health care easier and simpler to access. It didn’t. They promised you could keep your doctor, your hospital, and your health-care plan. It didn’t. This is a simple case to make, yet they aren’t making it. From a communication standpoint, they should be focused on the problem instead of fighting over the solution.”
Democrats, feeling no pressure to bail out the majority party, argue that the backlash is clarifying what they always wanted voters to see in the ACA.
“They’re finding out what’s in it,” said Clyburn. “They love it. Now these guys are trying to take it away from them before they figure out why they love it. Sounds like a couple marriages I know.”
Karen Tumulty contributed to this report.