At 4:30 am Thursday, after a 17-hour markup, the GOP’s health bill passed out of the Ways and Means Committee untouched.
The American Health Care Act passed out of committee exactly 58.5 hours after it was introduced on Monday evening. The committee voted in the bill’s favor without knowing how much it costs or whom it covers because they voted before the Congressional Budget Office — or any other credible authority — had time to assess the bill’s likely impacts. And Republicans preferred it that way. They didn’t want to know what their bill was likely to do, and they didn’t want anyone else to know, either.
I covered the first Obamacare debate back in 2009 and 2010. And this week, one thing has become quite clear: Republicans plan to move more quickly and less deliberatively than Democrats did in drafting the Affordable Care Act. They intend to do this despite repeatedly and angrily criticizing the Affordable Care Act for being moved too quickly and with too little deliberation.
The first draft of the law that became the Affordable Care Act — at least on the House side — was introduced on June 19, 2009. This was a discussion draft from the office of House Speaker Nancy Pelosi. This draft came after many white papers, debates, and hearings that stretched back to a few months before President Barack Obama’s election. John Canaan’s legislative history of the Affordable Care Act is an invaluable guide to that period, as well as what happened next in the House.
The point of Pelosi’s draft was to encourage discussion about the policies in the bill, and that’s exactly what Democrats spent a full month doing. The House Education and Labor Committee held a hearing on the discussion draft on June 23. The Ways and Means Committee held a three-day hearing from June 23 to 25.
The only draft available for discussion this time around was one leaked to Politico reporter Paul Demko.
These debates in late June and early July ultimately culminated in HR 3200, a bill introduced on July 14, 2009. That same day, the Congressional Budget Office released preliminary estimates of how much the bill would cost and whom it would cover. They estimated that the bill would reduce the number of uninsured by 37 million over 10 years and would cost about $1 trillion. (The Affordable Care Act they ultimately passed was less generous than this bill, and had lower coverage estimates.)
The markup process then moved quickly. Both Energy and Commerce and Ways and Means moved HR 3200 out of markup July 17, three days after the introduction of the bill, much like the current process. But what was so different in 2009 was all the work that came before the markup: a discussion draft, hearings, and preliminary figures from the Congressional Budget Office.
“We cannot afford to guess when it comes to health care”
Republicans, at the time, felt like the process was moving much too quickly. “Congress is moving fast to rush through a health care overhaul that lacks a key ingredient: the full participation of you, the American people,” said Rep. Paul Ryan.
Democrats moved with more information than Republicans have now, but also with less than you’d want for a legislature overhauling the American health care system. And much of the debate in 2009 — just as is true in 2017 — revolved around scores from the Congressional Budget Office.
At the June 23 Energy and Commerce health subcommittee hearing, Rep. Michael Burgess (R-TX) pressed on the issue. “Mr. Chairman, will you commit that we will at least have a CBO score on the bill that we will mark up?” he asked.
Burgess now chairs the Energy and Commerce health subcommittee, where he is currently marking up the American Health Care Act without a CBO score.
The CBO released preliminary estimates for the bill before markup but not a final score. “Those figures do not represent a formal or complete cost estimate for the coverage provisions of the draft legislation,” then-Congressional Budget Office Director Doug Elmendorf cautioned.
Rep. Dave Camp, who then served as the Republican ranking member on Ways and Means, was not pleased.
“We cannot afford to guess when it comes to health care,” he said at his opening statement for the Ways and Means markup in 2009. “This is not some think-tank experiment; these are people’s lives, people’s jobs we are talking about … his committee has no business marking up a bill of which CBO cannot tell us its cost or impacts.”
The CBO did ultimately release a more thorough score of the bill on July 17, the same day that two House committees voted it out of markup. It is very difficult to tell from the legislative record whether the vote occurred before or after the release of those figures.
But the difference is undeniable. When the major committees moved to mark up the Democrats’ health care bill, the proposals had been public for weeks, and Congress had basic estimates of its effects. None of that is present here.
Moreover, the bill would not pass the House until November Obamacare, from start to finish, took 15 months to pass. Republicans would like to pass their bill before the Easter recess in April, and Ryan plans to push his bill through the House in a matter of weeks.
The Democrats’ process wasn’t perfect. But it’s a lot better than what we’re seeing now.
Seven years later, the Republican critiques of Democratic process haven’t changed. On Tuesday, Ways and Means Chair Kevin Brady (R-TX) criticized the Affordable Care Act as “written in the dark of night and rushed through Congress.”
At 4:30 am Thursday — when it was still quite dark here in Washington — Brady’s committee passed the American Health Care Bill.
The Democrats did not run a perfect process around Obamacare. It was a bipartisan process for months that turned partisan in the summer of 2009, after brutal town hall meetings scared Republicans away from supporting the bill. Democrats ultimately passed Obamacare on a party-line vote.
But Republicans have taken the parts of this process that they profess to hate and supercharged them.
House Republicans passed a bill less than four days after its language was made public. They show no intention of engaging Democrats in any discussion of what might make this bill work better.
This strategy may yield political success. Moving quickly may indeed be the only way to get a bill passed.
“It seems to me that clearly the Republican leadership has made a decision that time is of the essence here,” Lanhee Chen, Mitt Romney’s former health care adviser, told my colleague Ezra Klein. “Now, would it be great to have all the information we need in place while or before we have these discussions? In an ideal world, yes. But I also think that runs up against the reality that the deeper we go into this process the harder it will be to achieve certain policy and political goals.”
This is a strategy for political wins, not good policy. The whole point of discussion drafts, hearings, and debate are to draw out the problems in a bill — to find the kinks that any first version of legislation inevitably have, and make those better.
If Republicans do succeed in passing a bill, they will have to do something much harder: implement that new law, and make it work well. This proved the most difficult part of Obamacare, even more so than the bruising legislative battle. And Republicans are setting themselves up for failure if the law they have to implement was rushed and poorly considered, and moved too quickly to find and fix its flaws.
Those flaws will come out in implementation — and Republicans will bear full blame for the resulting chaos.