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2 Senate Republicans explain why they won’t stop the health care bill over secrecy

Dylan Scott covers health care for Vox. He has reported on health policy for more than 10 years, writing for Governing magazine, Talking Points Memo and STAT before joining Vox in 2017.

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As Senate Republicans have drafted their health care bill entirely in secret, several of their own have complained about the process. After years of slamming Democrats for writing Obamacare behind closed doors, Republicans have employed an even more opaque process to repeal the law.

Those senators' complaints raise the question, though: If they oppose the process, why don't they oppose the bill?

As it stands now, with leadership pressing for a vote before July 4, senators could have less than a week to review a bill overhauling one-sixth of the US economy. But as Sarah wrote last week, if just three of the 52 Senate Republicans withheld their support for the bill to protest the process, they could force Senate Majority Leader Mitch McConnell to change course.

So why aren't they? I asked Sens. Bill Cassidy (R-LA) and Ron Johnson (R-WI), who have criticized the process, this question.

Dylan Scott

Senator, if you’re not comfortable with the process, why not say that you’d vote against this bill unless leadership opened it up in a more public way?

Bill Cassidy

You know, in life, if you only wait for that which is exactly what you wish to have, you end up living on an island by yourself.

I always say the Democrats keep complaining about, "Oh, my gosh, it’s not an open process"; if two or three Democrats walked into Mitch McConnell’s room and said, "You have our vote for this," it would have an incredible impact. But if you just wait until, "Oh, we want an open process," then you never get that.

So at some point, you’ve got to play with the cards dealt to you, and that’s true of almost everything in life.

Dylan Scott

But the counterpoint to that would be that if three Republicans walked into Sen. McConnell’s office and said, "We won’t vote for this unless you have committee hearings..."

Bill Cassidy

I suppose. I suppose. But you probably have used your chit. Maybe you want three Republicans to say, "We won’t vote for it unless we have this in the bill." If that makes sense.

Later, I caught up with Johnson as he left the daily Senate GOP lunch meeting.

Dylan Scott

Senator, if you’re concerned about the timing and the process, why not say you’re going to vote against this unless they slow down?

Ron Johnson

Well, what I’ve said is I won’t vote yes until I’ve satisfied myself that it continues to improve over what we currently have. And I’ll need information to able to make that determination.

Dylan Scott

Senator, has your whole outlook on this process changed? I was listening to some old interviews with you back in mid-May where you seemed okay with you guys talking it out in private.

Ron Johnson

The decision was made. We’re doing this through reconciliation. I’m not sure how else you put together a bill with just one side other than in a room with a committee of the whole. That’s how we’re doing it. I don’t see how else you do it.

But we need to get the bill out there. It’s gotta be drafted. It’s gotta be presented to us. It’s gotta be presented to the American public. We need enough time to evaluate it, to get information on it.

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Kliff’s Notes

Your daily top health care reads, with research help from Caitlin Davis

Today's top news

  • "McConnell confirms: Healthcare bill released Thursday, vote 'likely' next week": “House Majority Leader Mitch McConnell said Tuesday the Senate plans to vote next week on a bill to repeal and replace Obamacare following the Thursday release of the legislative details, and a pricetag provided by the Congressional Budget Office. 'I expect to have a discussion draft on Thursday,' said McConnell, R-Ky. 'And we'll go to the bill obviously once we get a CBO score. Likely next week.'” —Susan Ferrechio, Washington Examiner
  • "Republicans are criticizing healthcare process in the Senate": “Several Senate Republicans are criticizing their own party for negotiating and writing an ObamaCare repeal-and-replace bill largely behind closed doors and without input from Democrats. 'Healthcare is such an important thing. I think we should have debated it in open, in committee hearings, have both sides bring in witnesses,' Sen. Rand Paul (R-Ky.) said Tuesday. 'I would like a more open process, that's for sure,' said Sen. Lisa Murkowski (R-Alaska), another key vote on the bill.” —Peter Sullivan, the Hill
  • "Senate Medicaid spending limits may lose moderate Republicans": “A key moderate Senate Republican says she's uncomfortable with the emerging Senate health care plan, which is likely to cap Medicaid spending and shift it to a lower growth rate in 2025. 'I think that's a problem. I think that sort of defeats the purpose of keeping people on, and at a level at which the program can be sustained,' Sen. Shelley Moore Capito told me this morning.” —Caitlin Owens, Axios
  • "White House: Trump wants GOP ObamaCare repeal to 'have heart'": “White House press secretary Sean Spicer on Tuesday doubled down on President Trump's reported remarks that the House GOP's healthcare bill lacks 'heart.' Asked during a press briefing to confirm the remarks and explain what Trump wants to see in the final bill to repeal and replace ObamaCare, Spicer said Trump 'clearly wants a bill that has heart in it.'” —John Bowden, the Hill

Analysis and longer reads

  • "If the Media Keep Ignoring Health Care, We’ll Lose It": "There is a giant scandal in Washington this week — and it’s not the one blaring from your television screen. Largely without media scrutiny, the United States Senate is quietly getting ready to pass its version of the House bill to repeal the Affordable Care Act.” —Jeremy Slevin, Talk Poverty
  • "Yes, Mitch McConnell’s secretive lawmaking is really unusual — in these 4 ways": “Dealmaking behind closed doors is common in the contemporary Congress. Still, the GOP’s extreme secrecy in hammering out a health-care deal strikes me as different in both degree and kind from past practice. Is this a legitimate approach, and can it succeed?” —Sarah Binder, Washington Post
  • "In just one year, nearly 1.3 million Americans needed hospital care for opioid-related issues": "The coast-to-coast opioid epidemic is swamping hospitals, with government data published Tuesday showing 1.27 million emergency room visits or inpatient stays for opioid-related issues in a single year. The 2014 numbers, the latest available for every state and the District of Columbia, reflect a 64 percent increase for inpatient care and a 99 percent jump for emergency room treatment compared to figures from 2005.” —Joel Achenbach and Dan Keating, Washington Post
  • "Medicaid expansion results in more emergency room trips; fewer patients uninsured": “Emergency room visits ticked up in states that expanded their Medicaid programs under the Affordable Care Act, and concurrently, payer mixes changed, with more of those patients having insurance, according to a new study from the Annals of Emergency Medicine.” —Jeff Lagasse, Healthcare Finance
  • "Despite A Growing Appetite, Buffet-Style Flat-Fee Clinics Shutter In Seattle": "In recent years, a small but growing number of practices embraced a buffet approach to primary care, offering patients unlimited services for a modest flat fee instead of billing them a la carte for every office visit and test. But after a pioneering practice shut its doors earlier this month, some question whether “direct primary care,” as it’s called, can succeed.” —Michelle Andrews, Kaiser Health News

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