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.