What Went Down On Health Care This Week

The single-payer amendment proposed by Republican Steve Daines failed, as expected. All the Republicans voted against it, along with independent Angus King and four Democrats: Joe Manchin (West Virginia), Heidi Heitkamp (North Dakota), Jon Tester (Montana), Joe Donnelly (Indiana). Those Democrats are all from states that voted for Trump by at least 19 points in November. The rest of the Democratic caucus voted “present.”

One of our editors, Micah Cohen, asked me how covering this health care policy process compares to covering other major votes on Capitol Hill. I was involved, when I worked at the Washington Post, in covering the passage of Obamacare in 2010. There was a big government funding battle between then-President Barack Obama and House Republicans in 2011 that I covered for the Post as well. And I was on Capitol Hill in a job at NBC News in 2013 when the government shut down. There are some similarities between this process and Obamacare’s. The ACA seemed dead a bunch of times — particularly once Scott Brown was elected to the Senate in Massachusetts and Democrats didn’t have 60 senators — but never died. President Trump is pushing his party’s members along, as Obama did; Obama, for example, implored then-House Democrat Dennis Kucinich of Ohio to back the Affordable Care Act on an Air Force One ride. Obama had promised during the campaign that all of the health care talks would happen on C-SPAN, but some of the details were actually written, behind closed doors, in the office of then-Senate Majority Leader Harry Reid. You’ve probably read that the 2010 process generally followed congressional norms of including committees and public hearings and that this 2017 process has not. That is true. Republicans have violated many congressional norms here. (Here’s an excellent look by Sarah Kliff at Vox at some of those differences.) But from my perspective, one of the biggest differences is the media environment. It was in 2009 and 2010 when Politico really started covering Capitol Hill — and boy, did they cover it. We had a team of five at the Post covering the Hill, and it felt like Politico had double that and some days triple that. They covered every detail of the Obamacare process very intensely. I remember Reid’s press secretary once complaining to me that he had messages from four Politico reporters all asking the same question. Twitter was around in 2009, but it wasn’t really the news hub it is today. So now, it’s not just journalists covering this process, but also experts and activists. I follow carefully the tweets of a former Obama administration official named Andy Slavitt, the Center for American Progress’ Topher Spiro and MoveOn.org’s Ben Wikler. Those three are all very pro-Obamacare, but they often have real information about the process (I assume from health care lobbyists they know) — at times before reporters do. And Politico has spawned a lot of other publications that are aimed in some ways at political junkies, so there’s more information sloshing around about every move McConnell makes than there was about Reid’s moves in 2009. That information flow and overflow has made this process seem very long and tortured, even though it’s really only been about six months. I also think, but can’t prove, that this complicates McConnell’s goal of passing a bill. I should emphasize that the biggest challenge Republicans have is the policy. The policies are unpopular. Additionally, Republicans bashed Obamacare, in part, for high deductibles and high premiums. Bashing Obamacare mostly for creating too big of a government role in health care would have lined up with existing conservative goals for health policy, like reducing Medicaid spending. Instead, Republicans set up a process with goals (low premiums and deductibles) that I’m not sure lined up with any plan that Republican senators would vote for. In contrast, Obama could be fairly direct about his goals in 2010: He wanted to expand health care to as many people as possible, and his bill was aiming to do that. In 2013, Ted Cruz, during the government shutdown, had a clear message as well: He wanted a shutdown to prevent the funding of Obamacare. But I think the frenzied media environment matters too. I suspect McConnell has operated so secretly — even keeping information from GOP senators — in part because word gets out about a “skinny repeal” and within minutes, people are tweeting about the idea, experts are analyzing it and reporters, reading those experts from their Twitter feeds, are asking senators about what the experts say. An idea can go from proposal to rejection by 10 senators at warp speed. So McConnell has sought minimum transparency in a media environment that is more transparent than ever.

The Senate is voting now on an amendment proposed by Sen. Steve Daines, Republican of Montana, to create a single-payer health care system. Daines, like the other Republicans, does not really support a single-payer system, and said he will not vote in favor of his amendment. (Daines said he copied the text of his amendment from this House bill.) His goal, rather, is to put Democrats’ votes on the record on an issue that’s divisive within the Democratic Party. But Sen. Bernie Sanders of Vermont, an independent who caucuses with the Democrats and has his own bill for implementing single-payer health care, has said he won’t participate in the Daines amendment and urged others in the Democratic caucus to vote “present.” Voting “present” relieves red-state Democrats from having to either go on the record supporting single payer or risk angering the more liberal wing of the party.