In recent weeks, the Senate has launched a process for revising the House-passed bill to repeal the Affordable Care Act (ACA) that, due to its extreme secrecy, independent observers have described as “a situation without precedent” for major health legislation. As Majority Leader Mitch McConnell prepares for a potential vote next week — just days after releasing a “discussion draft” of the bill’s text, and very shortly after Congressional Budget Office (CBO) will release its analysis that may not even reflect the bill in its final form — he appears likely to do even more to obscure the nature of the legislation he seeks to ram through.
Most crucially, while the Senate released the bill text on Thursday, substantial changes will likely occur before next week’s vote — as the term “discussion draft” implies. Yet there’s no guarantee that the public or other senators will see these changes until shortly before the vote or that CBO will have a chance to evaluate their impact on health coverage and consumers’ costs before a Senate or even a subsequent House vote if it passes the Senate. In all likelihood, both Senate leaders and on-the-fence senators will claim major improvements in the bill without facing real scrutiny as to whether the final product achieves what they promise.
That means senators and the public might have virtually no time to see the actual text that the Senate will vote on — and that could become law if the House then passes it without further amendment. Moreover, McConnell could force a vote on this new substitute proposal without a CBO analysis of its impact on health coverage and cost of health insurance. That would enable senators who vote for the final bill to claim that it covers more people or increases costs less than CBO’s earlier analysis indicated, with no evidence to back up that point.
Unsurprisingly, CBO later confirmed that the funding “would not be sufficient to substantially reduce the large increases in premiums for high-cost enrollees.” But CBO didn’t release that analysis until weeks after the House passed the bill, with members justifying their “yes” votes on the basis of the exact claims that CBO later refuted.
And, unlike the House-passed bill — which was destined to undergo further changes in the Senate and return to the House — the Senate likely would never have to vote on the bill after CBO completes its analysis. Indeed, House leaders reportedly may rush a vote immediately after Senate passage. This means that the bill could pass the House as well — sending it to the White House for the President’s signature — before policymakers and the public understand the health care implications of any last-minute changes.
At every turn, the Senate’s process has served to change the deeply damaging and unpopular House bill as little as possible while obscuring that fact. Since it’s impossible to improve the bill substantially while maintaining its basic structure — deep cuts to health coverage to pay for large tax breaks for the wealthy — the only way to achieve the Senate’s political imperative is to maintain as much confusion as possible as to what’s really in the bill. As the Senate races towards a vote, we have every reason to believe that the Senate will continue to try to obscure the impact of its bill.