Why the Senate's Secrecy Over Obamacare Repeal Was Decades in the Making

Congress struggling to finish a huge budget reconciliation bill. A GOP president pushing a major overhaul of federal payments for health insurance that could transform the lives of sick patients.

Sound familiar? The year was actually 1986. I was a rookie health reporter on Capitol Hill and watched a Medicare bill move from introduction, to hearings, to votes in subcommittees, to full committees, and then to the entire House—an operation that took months and was replicated in the Senate, before the two chambers got together to iron out their differences for final passage. Everything was published in the official Congressional Record in almost excruciating detail for everyone to see—as long as they could read really tiny type.

Since then, in three decades of reporting, I’ve had a front-row seat to Congress’s slow, stuttering retreat from such step-by-step transparency, a process known as “regular order.”

It has now culminated in the Senate GOP leadership’s top-secret process to try to write a health bill that could change the formula for nearly one-fifth of the nation’s economy, with a vote they want to cast by July 4. In fact, a GOP Senate aide told Axios on Monday that no details would be forthcoming until the bill is finished, adding: “We aren’t stupid.” That means bypassing the debate that once traditionally went into lawmaking in order to achieve consensus.

The extreme secrecy is a situation without precedent, at least in creating health law. Still, it’s not hard to see how the country got here—and there is plenty of bipartisan blame to go around.

Since 1986, I have chronicled the passage, and repeal, of the Medicare Catastrophic Coverage Act; the fight over former President Bill Clinton’s health proposal; passage of the Medicare prescription-drug bill; and passage of the Affordable Care Act, in addition to a dozen budget reconciliation measures that altered health care, often in fundamental ways.

Despite promises from incoming Democratic and Republican leaders over the past decade to restore the time-honored process, regular order has not returned. In fact, not only has it become increasingly rare, but the legislative process itself has also become ever more truncated, with Congress skipping steps it deemed inconvenient to partisan ends, particularly as leaders have “end run” the committees that are supposed to do the lion’s share of legislative work.

So long as there is bipartisan agreement, regular order can still prevail. A major bill completed in 2015 to reconfigure how Medicare pays doctors was the product of 15 months of work by Democrats and Republicans in the House and Senate, and passed three committees in open session by unanimous roll-call votes.

But it has become progressively—and distressingly—more acceptable to set transparency aside in lawmaking over the years.

In the 1980s, Representative Bill Natcher, a Democrat from Kentucky, routinely closed the subcommittee markup of the spending bill to fund the Departments of Labor, Health and Human Services, and Education, even when there was no particular controversy to avoid. Reporters got to see the bill for the first time at the full Appropriations Committee markup.

Markups at the House Ways and Means Committee under Chairman Dan Rostenkowski, a Democrat from Illinois, were also frequently closed to the press and public, mostly for tax bills. I once personally held up a health subcommittee markup for nearly a half-hour because the vote to close the session—to make it members-only—required a majority to be present. I refused to leave until a couple of committee members could be located and brought to the room to vote in person and kick me out.

Even meetings open to the press were sometimes less than revealing. In House-Senate conference meetings, members would frequently refer to what they were talking about using numbers on notes that were not shared with the audience, including reporters. So they basically spoke in code, and if a person didn’t have the key they were just out of luck.

Of course, today there are fewer and fewer formal conference committees, where the two sides hammer out their differences in the public eye. Often the final versions of contentious bills are worked out behind closed doors, often without all of the members of the conference committee. In 2003, House Ways and Means Committee Chairman Bill Thomas, a Republican from California, retreated with all the Republican conferees and two of the seven Democrats into his Capitol hideaway office—a group he called “the coalition of the willing.” They wrote a final bill in secret while reporters and lobbyists stood outside in the hall for weeks on end. (Sitting in the Capitol is considered civil disobedience and is strictly forbidden.) We were there so long and got to know one another so well that on my birthday someone got all the conferees in the room to sign a birthday card for me.

The final version of that bill was the one that passed the House in the dead of night; Republicans purposely scheduled the vote to begin at 1 a.m. (on the theory it would be easier to get wavering members to vote yes if only to go home to bed). The vote didn’t end until nearly 6 a.m., after President George W. Bush reportedly got the last few members to switch, via phone calls.

In 2009, the creation process for the Affordable Care Act was both open and closed. There were hundreds of hearings and markups that lasted days or—in the case of the Senate Health, Education, Labor and Pensions Committee—months. But the unsuccessful effort by Senate Finance Committee Chairman Max Baucus, a Democrat representing Montana, to bring Republicans into the fold consisted of weeks of closed-door discussions. The Senate bill that would ultimately become the foundation of the ACA was written in Senate Majority Leader Harry Reid’s office before being debated on the Senate floor for almost a month.

Americans got a sneak preview of how the GOP might shepherd its health bill through in 2015, when Republicans—who by then controlled Congress—orchestrated a “dress rehearsal” ACA repeal bill that was vetoed, as they knew it would be, by former President Barack Obama. The bill was prewritten by leadership, approved by the relevant House committees, passed by the House, and sent to the Senate. The Senate passed it with small changes and without committee consideration. Rather than having a conference, the amended Senate bill was then simply approved by the House and sent to Obama for his veto.

That secretive process is being reiterated now. Only this time a Republican, Donald Trump, is president and the potential for change is real. Some Americans are outraged over the lack of transparency and the loss of regular order. But both Democrats and Republicans have laid the track on which this train is rolling.

This post appears courtesy of Kaiser Health News.

The show, this season, with exploitative plotlines that treat racism as entertainment, is becoming harder and harder to defend.

This post reveals minor plot points for The Bachelorette Season 13 Episode 6.

A few years ago, in response to a combination of scientific studies, legal cases, and human tragedies, commentators began to question the morality of watching American football. We’d always known the sport was an especially dangerous one to play—that, indeed, is part of its brute appeal—but now there was undeniable evidence of that brutality, rendered in statistic and awful anecdote. To watch the violence play out, it became increasingly clear, was to be in some way complicit in it—to cast a silent vote, not with one’s pocketbook but with one’s attention, in favor of all that violence continuing.

The Bachelorette, of course, depicts a sport only in the loosest sense; the show is very rarely violent in the literal sense of the term. And yet it has recently adopted the same rough outlines that football acquired a few years before: The show, always questionable, has become in its latest season more troubling than it has even been before. Recent episodes of the long-running ABC show have laid bare just how craven and exploitative its producers have become. Problems that have long been simmering in its world have come to a boil. Watching it has become harder and harder to enjoy—and, like that other blood sport, harder and harder to defend.