Stakeholders Get Limited Say In Obamacare-Repeal Process

Outside groups say they are not actively negotiating with Republican lawmakers on their health care overhaul, a stark contrast with the deals struck to pass the Affordable Care Act

AP Photo/Charles Dharapak
Erin Durkin
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Erin Durkin
June 19, 2017, 8 p.m.

Hill Demo­crats aren’t the only key play­ers who feel shut out of the Obama­care-re­peal pro­cess.

Out­side groups with much to gain or lose from the health-care over­haul ef­fort ap­pear to have had lim­ited in­put on what Sen­ate Re­pub­lic­ans are draft­ing—a re­peat of the pro­cess that un­fol­ded in the House—with some lob­by­ists not­ing that act­ive ne­go­ti­ation is ab­sent from their meet­ings with law­makers and staffers.

“This has been the most closed le­gis­lat­ive pro­cess I have ever seen in my ca­reer in Wash­ing­ton, and that ap­plies to the House ac­tion as well,” said Dick Wood­ruff, seni­or vice pres­id­ent of fed­er­al ad­vocacy at the Amer­ic­an Can­cer So­ci­ety Can­cer Ac­tion Net­work.

Sen­ate Re­pub­lic­ans have been meet­ing for weeks on the le­gis­la­tion and have said that pieces of their bill are be­ing run by the Con­gres­sion­al Budget Of­fice. Dur­ing this pro­cess, stake­hold­ers say of­fices have been will­ing to listen, but haven’t ac­tu­ally al­lowed them in­to the rooms where key de­cisions are be­ing made.

“There is an open­ness to listen­ing to your con­cerns,” said one health care lob­by­ist who wanted to re­main an­onym­ous giv­en the sens­it­iv­ity of the health care dis­cus­sions. “There is not a give-and-take ne­go­ti­ation like there is in a lot of in­stances. … There’s not a ne­go­ti­ation go­ing on of any kind.”

Wood­ruff said he was very con­cerned that this was all be­ing done be­hind closed doors without the be­ne­fit of any hear­ings or pub­lic testi­mony. “It seems to be a bit of a black box,” he said.

The Re­pub­lic­an pro­cess for their health care over­haul is a stark con­trast with the one that pro­duced the Af­ford­able Care Act. The Obama ad­min­is­tra­tion ne­go­ti­ated with dif­fer­ent in­terest groups and even­tu­ally cut a deal with the phar­ma­ceut­ic­al in­dustry to help the law get passed.

“The Obama ad­min­is­tra­tion entered in­to ex­tens­ive dis­cus­sions with stake­hold­ers as it was design­ing le­gis­la­tion,” said former Demo­crat­ic Rep. Henry Wax­man. He ad­ded that the ad­min­is­tra­tion kept con­gres­sion­al staff in­formed, some­times after deals were cut.

But Wax­man said the Re­pub­lic­ans are now ig­nor­ing every in­terest group. “Re­pub­lic­ans have learned if people don’t know what’s in it … it makes their job easi­er to le­gis­late in secrecy,” he said.

Of course, the Obama ad­min­is­tra­tion’s ap­proach had its own pros and cons. The White House at the time was cri­ti­cized for cut­ting deals, ac­cused by some of dol­ing out giveaways to power­ful lob­by­ists and spe­cial in­terests. But get­ting key in­dustry groups on board early also meant that the pres­id­ent had im­port­ant al­lies when it came time to lobby for votes on Cap­it­ol Hill and sell the fi­nal pack­age to the pub­lic.

In the cur­rent de­bate, the Sen­ate GOP’s de­cision to re­duce stake­hold­er in­volve­ment could be a re­ac­tion to neg­at­ive at­ten­tion groups gave the House bill, the Amer­ic­an Health Care Act.

“If you re­call, a num­ber of prom­in­ent health groups came out against the AHCA in the House, and giv­en re­ports that the Sen­ate’s ef­forts may be largely sim­il­ar to the House bill on some key pro­vi­sions, Sen­ate Re­pub­lic­ans may be try­ing to pre­vent that same kind of pub­lic op­pos­i­tion to their ef­forts,” said Molly Reyn­olds, a fel­low in gov­ernance stud­ies at the Brook­ings In­sti­tu­tion.

Some GOP law­makers ex­pressed sym­pathy for the groups’ con­cerns.

“We speak to stake­hold­ers every day, a lot them. But I would like to see hear­ings on this, as you know,” said Sen. Rob Port­man.

Sen. Mike Rounds said mul­tiple parties would like to have more im­pact on the le­gis­la­tion. “I think every­body would like to have more, in­clud­ing mem­bers of Con­gress,” said Rounds. “We’re do­ing our best to try to get dif­fer­ent or­gan­iz­a­tions to come in and speak to us. Sen. [Lamar] Al­ex­an­der had a great series of meet­ings early on with stake­hold­ers com­ing in, but there’s al­ways room for more in­put.”

Oth­er Re­pub­lic­an law­makers have voiced com­plaints about secrecy. Sen. Susan Collins re­cently slammed the pro­cess in an in­ter­view with the Port­land Press Her­ald and said she has largely been kept in the dark. Sen. Dean Heller earli­er this month pressed Health and Hu­man Ser­vices Sec­ret­ary Tom Price for an­swers on what lead­er­ship may be look­ing at when it comes to chan­ging Medi­caid.

“I’m try­ing to find an an­swer to this ques­tion, and I can’t get it out of our meet­ings,” said Heller. As it turns out, as of last week, Price had also not seen le­gis­lat­ive text.

But a former sen­ate staffer said what Sen­ate Re­pub­lic­ans are do­ing isn’t so out of the norm, not­ing that the Re­pub­lic­ans are try­ing to un­wind cur­rent law rather than cre­ate a whole new health care sys­tem. “I think there is a little dif­fer­ence in nu­ance in cre­at­ing something and un­wind­ing a lot of something,” he said.

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