The GOP health effort takes secrecy to new levels

In 2009 and 2010, as Democrats prepared to overhaul the American health care system, they held 44 congressional hearings and public meetings over the course of 15 months of drafting and discussing their legislation.

They held hearings on topics including “strengthening employer-provided health care” and “examining the single-payer option” and “What is quality health care, and who decides?” There were, according to a tally made by Vox’s Garet Williams and Carly Sitrin, 22 hearings in the Senate and 22 in the House.

Republicans are on track to hold exactly two congressional hearings — both in the House of Representatives — on their six-month sprint to repeal and replace the Affordable Care Act. The Senate plans no hearings at all on their legislation, which they are expected to take a vote to open debate on today. You can see how the timeline stacks up in the graphic below.

Our analysis is a bit different from one published earlier this week by the New York Times, which looks at all public activity (including floor debate) around drafting a health bill. We focus specifically on public hearings.

The point of these hearings, of course, is to actually discuss and figure out what a health care bill ought to do. The Senate held an entire hearing in April 2009 to hear from states which health reform efforts had worked locally, and another to examine how to address underinsurance in the United States.

But the Senate bill will receive no expert input from public testimony and little, if any, public debate before a vote. The bill was introduced on Thursday without any committee process. Some Republican senators didn’t see the document until it was posted online. New provisions have since been added with little debate and fanfare.

Make no mistake: This is a very different process from what we saw in 2009 and 2010 during the 110th Congress, when the Affordable Care Act was drafted. To show this, we used a tool from the research website ProQuest to search for all hearings marked as part of the bill’s legislative history. We found 38 events. We also added six additional hearings not in the ProQuest history but that we deemed clearly related to the law’s drafting.

This means we can compare the public discussion between the current and last health reform efforts. And the difference, as you can see below, is quite stark. Compared with their Democratic colleagues eight years earlier, Republican legislators are crafting their bill with little input from the public — and little time to debate and discuss its merits.

Hearings in the 115th Congress on a bill to repeal and replace the Affordable Care Act

1. Markup of Committee Print, Budget Reconciliation Legislative Recommendations and H. Res. 154 (March 8, 2017)
2. Markup: Budget Reconciliation Recommendations to Repeal and Replace Obamacare (March 8, 2017)

Hearings in the 110th Congress to draft the Affordable Care Act

House hearings

1. Making Health Care Work for American Families: Designing a High Performance Health System (March 10, 2009)
2. Strengthening Employer-Provided Health Care (March 10, 2009)
3. Health Reform in the 21st Century: Expanding Coverage, Improving Quality and Controlling Costs (March 11, 2009)
4. MedPAC's Annual March Report to the Congress on Medicare Payment Policy (March 17, 2009)
5. Making Health Care Work for American Families: Ensuring Affordable Coverage (March 17, 2009)
6. Full Committee Hearing on the President's FY2010 Budget and Medicare: How Will Small Providers Be Impacted? (March 18, 2009)
7. Making Health Care Work for American Families: Improving Access to Care (March 24, 2009)
8. Making Health Care Work for American Families: The Role of Public Health (March 31, 2009)
9. Health Reform in the 21st Century: Reforming the Health Care Delivery System (April 1, 2009)
10. Making Health Care Work for American Families: Saving Money, Saving Lives (April 2, 2009)
11. Health Reform in the 21st Century: Insurance Market Reforms (April 22, 2009)
12. Ways To Reduce the Cost of Health Insurance for Employers, Employees and Their Families (April 23, 2009)
13. Health Reform in the 21st Century: Employer-Sponsored Insurance (April 29, 2009)
14. Health Care Reform in the 21st Century: A Conversation with Health and Human Services Secretary Kathleen Sebelius (May 6, 2009)
15. Examining the Single-Payer Health Care Option (June 10, 2009)
16. Termination of Individual Health Policies by Insurance Companies (June 16, 2009)
17. Economic Case for Health Reform (June 19, 2009)
18. The Tri-Committee Draft Proposal for Health Care Reform (June 23, 2009)
19. Comprehensive Health Care Reform Discussion Draft (June 23-25, 2009)
20. Health Reform in the 21st Century: Proposals To Reform the Health System (June 24, 2009)
21. Full Committee Hearing on the Projected Physician Shortage and How Health Care Reforms Can Address the Problem (July 8, 2009)
22. H.R. 1740, the Breast Cancer Education and Awareness Requires Learning Young Act of 2009; H.R. 1691, the Breast Cancer Patient Protection Act of 2009; H.R. 2279, the Eliminating Disparities in Breast Cancer Treatment Act of 2009; and H.R. 995, the Mammogram and MRI Availability Act of 2009 (October 7, 2009)

Senate hearings

1. Full Committee Hearing: Investing in Health IT: A Stimulus for a Healthier America (January 15, 2009)
2. Full Committee Hearing: What States Are Doing to Keep us Healthy (January 22, 2009)
3. Full Committee Hearing: Access to Prevention and Public Health for High Risk Populations (January 27, 2009)
4. Crossing the Quality Chasm in Health Reform (January 29, 2009)
5. Full Committee Hearing: Implementing Best Patient Care Practices (February 5, 2009)
6. Principles of Integrative Health: A Path to Healthcare Reform (February 23, 2009)
7. Addressing Underinsurance in National Health Reform (February 24, 2009)
8. Scoring Health Care Reform: CBO's Budget Options (February 25, 2009)
9. President's Fiscal Year 2010 Health Care Proposals (March 10, 2009)
10. Workforce Issues in Health Care Reform: Assessing the Present and Preparing for the Future (March 12, 2009)
11. What Is Health Care Quality and Who Decides? (March 18, 2009)
12. The Role of Long-Term Care in Health Reform (March 25, 2009)
13. Roundtable Discussions on Comprehensive Health Care Reform (April 21, 2009)
14. Learning from the States: Individual State Experiences with the Healthcare Reform Coverage Initiatives in the Context of National Reform (Roundtable Discussion) (April 28, 2009)
15. Primary Health Care Access Reform: Community Health Centers and the National Health Service Corps (April 30, 2009_=)
16. Roundtable Discussions on Comprehensive Health Care Reform (May 5, 2009)
17. Roundtable Discussions on Comprehensive Health Care Reform (May 12, 2009)
18. Reforming the Indian Health Care System (June 11, 2009)
19. Healthcare Reform Roundtable (Part 2) (June 12, 2009)
20. Expanding Dental Health Care in Indian Country; Promises Made, Promises Broken: The Impact of Chronic Underfunding of Contract Health Services (December 3, 2009)
21. President's Fiscal Year 2011 Health Care Proposals (February 3, 2010)

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