Obamacare Took Months to Craft; Repeal May Be Much Swifter

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Proposed amendments to the Affordable Care Act during a markup by the House Energy and Commerce Committee in July 2009. CreditBrendan Smialowski for The New York Times

WASHINGTON — In June 2009, House Democratic leaders unveiled the first draft of legislation that would ultimately become the Affordable Care Act. A month later, three House committees began formally drafting the bill ahead of a House vote that came well into the fall, after the summer heat had dissipated and the leaves had begun to change.

On Wednesday, the House Ways and Means Committee and the Energy and Commerce Committee will formally mark up legislation to repeal and replace the act — less than 48 hours after Republicans unveiled the bill to the public. If all goes according to plan, the House will vote within a few weeks, and the Senate will take up the legislation before its spring recess begins on April 7.

Republicans excoriated Democrats for rushing passage of the Affordable Care Act — President Barack Obama’s landmark health law — blasting “back-room deals” and cheering on the nascent Tea Party movement, with its hostile chant “Read the bill, read the bill.” But Republicans have adopted a much more aggressive timetable for repealing the law and remaking Medicaid, the health program for more than 70 million low-income people.

“The difference between 2009 and 2017 is like black and white,” said former Senator Max Baucus of Montana, one of the chief architects of the Affordable Care Act, who spent countless hours in hearings and negotiations on the legislation as chairman of the Senate Finance Committee. “It’s a chasm. There’s no comparison.”

On Monday evening, House Republicans unveiled their proposals to undo the law, signed by Mr. Obama in March 2010. The two House committees plan to start debating, amending and voting on the legislation on Wednesday. By week’s end, they expect to finish this ritual, known as a markup.

Speaker Paul D. Ryan said the House would pass the repeal bill within a few weeks, and the Senate majority leader, Mitch McConnell, Republican of Kentucky, said that if the House kept to that timetable, the legislation “will be on the agenda here in the Senate” before the spring recess.

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Representatives Kevin Brady of Texas, left, and Greg Walden of Oregon, both Republicans, on Tuesday discussing the health care plan they helped put together. CreditStephen Crowley/The New York Times

In comparison with the pace of work on the Affordable Care Act, that is lightning fast.

“We don’t know how much it will cost, and we don’t know if this bill will make health care more affordable for Americans,” Senator Mike Lee, Republican of Utah, said on Tuesday. “This is exactly the type of back-room dealing and rushed process that we criticized Democrats for.”

Representative Jim Jordan, a conservative Republican from Ohio who objects to major provisions of the bill devised by House Republican leaders, said, “The American people don’t want us to rush this thing.”

In June and July 2009, with Democrats in charge, the Senate health committee spent nearly 60 hours over 13 days marking up the bill that became the Affordable Care Act. That September and October, the Senate Finance Committee worked on the legislation for eight days — its longest markup in two decades. It considered more than 130 amendments and held 79 roll-call votes.

The full Senate debated the health care bill for 25 straight days before passing it on Dec. 24, 2009.

“After years of howling at the moon about Democrats rushing through the Affordable Care Act,” said Senator Chuck Schumer of New York, the Democratic leader, Republicans are now racing to pass the repeal bill because “they don’t want anyone to know what’s in the bill.”

Democrats complained that the Republicans were rushing to approve a repeal bill without hearing from consumers, health care providers, insurance companies or state officials — and without having estimates of the cost or the impact on coverage from the Congressional Budget Office.

Representative Greg Walden, Republican of Oregon and chairman of the Energy and Commerce Committee, denied that Republicans were cutting corners to speed approval of their repeal bill.

“In fact,” he said on Tuesday, “the bill went online live for the entire American people, all of you, all of us to read, all of our colleagues to read, at 6 o’clock last night. It’s not that much to get through. It’s pretty well understood.”

The Republicans’ bill is indeed much shorter than the Affordable Care Act. With one paragraph of their bill, they can obliterate 10 or 20 pages of the law. One of their chief goals is to eliminate detailed federal standards, like those that define the permissible value of insurance plans — bronze, silver, gold and platinum.

Another previous complaint by Republicans seems to apply now. For years, Republicans have reminded voters that the Affordable Care Act passed without any Republican votes. If they now repeal it, they are unlikely to have a single Democrat with them.

In 2009, Democratic senators negotiated with Republicans for months in hopes of finding common ground, but Republicans now do not expect any help from Democrats.

“We’re not going to do this with Democrats,” said Senator John Cornyn of Texas, the No. 2 Senate Republican.

In remarks prepared for the Ways and Means Committee meeting on Wednesday, Representative Sander M. Levin, Democrat of Michigan, said: “Bad process makes for bad policy. And the process we are using today is not only bad; it’s reckless. Almost no time to review the bill, no hearings on the bill, no C.B.O. estimate of the cost or coverage impact — this is legislative malpractice.”

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