WASHINGTON — As they draft legislation to repeal the Affordable Care Act, Senate Republican leaders are aiming to transform large sections of the American health care system without a single hearing on their bill and without a formal, open drafting session.
That has created an air of distrust and concern — on and off Capitol Hill, with Democrats but also with Republicans.
“I’ve said from Day 1, and I’ll say it again,” said Senator Bob Corker, Republican of Tennessee. “The process is better if you do it in public, and that people get buy-in along the way and understand what’s going on. Obviously, that’s not the route that is being taken.”
The secrecy surrounding the Senate measure to repeal and replace the Affordable Care Act is remarkable — at least for a health care measure this consequential.
In 1993, President Bill Clinton empowered the first lady, Hillary Clinton, to assemble health care legislation in private, with input from a group of more than 500 experts. That approach won scathing reviews from Republican lawmakers and others shut out of the deliberations. But it took place at the White House, not in Congress. Once the Clintons’ health plan reached Capitol Hill, it died in the public spotlight.
Republican leaders this week defended their actions.
“Look, we’ve been dealing with this issue for seven years,” said the Senate majority leader, Mitch McConnell of Kentucky. “It’s not a new thing.”
Mr. McConnell said there had been “gazillions of hearings on this subject” over the years — a less-than-precise tabulation that offered little comfort to Democrats who want hearings held now, in this particular year, on the contents of this particular bill.
In the summer of 2009, when Democratic members of Congress were defending their effort to remake the nation’s health care system, they were taunted by crowds chanting, “Read the bill, read the bill.”
Now Democrats say they would love to read the Republicans’ repeal bill, but cannot do so because Republicans have not exposed their handiwork to public inspection.
“They’re ashamed of the bill,” the Senate minority leader, Chuck Schumer of New York, said. “If they liked the bill, they’d have brass bands marching down the middle of small-town America saying what a great bill it is. But they know it isn’t.”
The Senate’s decisions could have huge implications: Health care represents about one-sixth of the American economy, and about 20 million people have gained insurance under the 2010 health law, President Barack Obama’s signature legislative achievement.
In theory, the bill-writing process is open to any of the 52 Republican senators, but few seem to have a clear, coherent picture of what will be in the legislation.
Senator Ron Johnson, Republican of Wisconsin, offered a hint of the same frustration felt by Democrats seeking more information about the bill.
“I come from a manufacturing background,” Mr. Johnson said. “I’ve solved a lot of problems. It starts with information. Seems like around here, the last step is getting information, which doesn’t seem to be necessarily the most effective process.”
At a Senate hearing on Thursday, Tom Price, the secretary of health and human services, said that he also had not seen the Senate bill.
Senate Republican leaders say the bill is still a work in progress, and they have not said exactly how it will differ from the one approved last month in the House. President Trump raised the stakes when he told senators this week that the House version was “mean.”
The Senate bill is likely to phase out the Affordable Care Act’s Medicaidexpansion more slowly than the House version. It is also expected to include larger tax credits to help older Americans buy health insurance.
The legislation will be considered in the Senate under an expedited procedure that precludes a Democratic filibuster and allows passage by a simple majority. But, Republicans say, Democrats will still be able to offer numerous amendments once the bill is on the Senate floor.
It is not unusual for lawmakers to draft major legislation in private, but they usually refine, debate and amend it in open committee sessions. The House bill to repeal the Affordable Care Act did not receive a hearing, where outside experts could have testified. But lawmakers dissected its contents and were able to propose changes at three stages: in the Ways and Means, Energy and Commerce, and Budget Committees.
Senate Republican leaders evidently think their back-room approach gives them the best chance to devise a health care bill that can squeak through the Senate, given their narrow majority and the policy differences in their conference.
However Republicans feel about their coming bill — and they are far more comfortable criticizing the Affordable Care Act than talking up the virtues of their still-incomplete replacement — the process playing out in the Senate is quite different from the way Democrats went about passing the Affordable Care Act.
The Senate health committee approved its version in July 2009 after considering hundreds of amendments over 13 days. The Senate Finance Committee cleared its version in October 2009, after more than a year of hearings, round-table discussions and other spadework. A group of Democrats and Republicans from the Finance Committee had met for months behind closed doors, trying — but ultimately failing — to draft bipartisan legislation.
The full Senate passed the Affordable Care Act on Dec. 24, 2009, on the 25th consecutive day of floor debate.
While much of the Affordable Care Act was written in the open, some important provisions were hashed out in private, just before the Senate vote, by Senator Harry Reid, the Nevada Democrat who was then the majority leader.
Republicans complained bitterly at the time, and Democrats threw those complaints back at them this week.
“This massive piece of legislation that seeks to restructure one-sixth of our economy is being written behind closed doors, without input from anyone, in an effort to jam it past not only the Senate but the American people,” Mr. McConnell said in December 2009, using words that could be spoken by any Democrat today.
The repeal efforts this year have moved much faster, though not as quickly as Mr. Trump or Republican leaders might have hoped.
In March, days before House Republicans released their repeal bill, Democrats and an exasperated Senate Republican hunted around the Capitol for the elusive legislation. The senator, Rand Paul of Kentucky, brought with him a copy machine, just in case he found his prize.
Asked this week about the Senate bill, Mr. Paul replied, “Have you seen it?”
Mr. Paul said he had no plans to bring out the copy machine again, but he suggested that the Senate’s current course left something to be desired. “My preference would be a more open process in committees,” he said, “with hearings and people on both sides.”
In February, the Senate health committee held a hearing on stabilizing the individual insurance market. But since the House passed its repeal bill and the focus shifted to the other side of the Capitol, Senate Republicans have done their work out of public view.
Their efforts drew unwanted attention early last month because of the composition of the working group they assembled to chart a path on health care: It consisted entirely of men.
Since then, Republican senators have shared bits and pieces of the ideas being mulled in their private lunches and meetings.
Asked his level of comfort with the process, Senator John McCain, Republican of Arizona, cut off a reporter before he could finish his sentence. “None,” he said.
“We’ve got a divided caucus,” Mr. McCain said. “I listen avidly at lunch as we go over the same arguments over and over and over again.”