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Amid criticism that Senate Republicans are working in secret to craft legislation that would repeal and replace the Affordable Care Act, Sen. Bernie Sanders tweeted a graphic that tried to make that argument in stark statistical terms.
The graphic, which Sanders tweeted on June 13, 2017, is titled, "Health Care Reform: Then and Now." It limits its comparison to the Senate, and it looks at two periods -- 2009 to 2010, when the Affordable Care Act was under consideration, and 2017, for the legislation the Senate is currently working on. (The House has already passed its version of a bill, the American Health Care Act.)
Sanders’ graphic said that when Democrats were crafting the Affordable Care Act, they allowed 160 hours of debate; 100 "committee hearings, roundtables, or walkthroughs"; and more than 171 amendments from the opposite party.
Currently, though, the graphic accuses Republicans now working on the repeal-and-replace bill of allowing none of those things -- hammered home with a string of red zeroes. How does the graphic add up?
Debating Obamacare in 2009 and 2010
The left column is the more accurate of the two.
When the Affordable Care Act was being put together, both the Senate and House passed distinct versions of the bill, but Democrats then lost a pivotal Senate seat in a special election, dropping their numbers below the crucial 60-seat threshold. Congressional leaders decided to have the House accede to the already-passed Senate version and then work out the differences in a subsequent round of legislation known as reconciliation.
When we contacted Sanders’ office, spokesman Josh Miller-Lewis provided us with extensive documentation for the numbers relating to the debate over the Affordable Care Act.
They sent us to a Senate Finance Committee fact sheet that includes six pages of detail on how the Senate version of the bill moved through the chamber. They also sent us several other documents about the legislative process in 2009 and 2010, as well as a February 2010 Obama administration letter that touted the "160 hours" the Senate had spent on the floor considering health insurance reform legislation
On the hours of debate, Steven S. Smith, a political scientist at Washington University in St. Louis, said the numbers seem broadly accurate. For the initial Senate version of what became the Affordable Care Act, the Senate started debating the bill in earnest on Nov. 21, 2009, and passed the bill on Dec. 24. Between those dates, "the Senate debated the bill nearly every day it was in session," Smith said.
Meanwhile, news reports generally support the idea that there were 100 hours of committee meetings and other types of official events. The New York Times reported that "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."
We previously fact-checked a claim related to Republican amendments. Combining the Republican amendments approved in markups at the Senate Health, Education, Labor and Pensions Committee and the Senate Finance Committee, the number of approved Republican amendments was close to the 171 cited in the infographic.
That said, it’s worth remembering, as we reported, that most of these amendments were technical in nature, and only two of them were passed via the more rigorous roll-call vote process used for more substantive matters.
The debate on repeal-and-replace in 2017
But if the left-hand column is pretty on target, the right-hand column -- covering the debate in 2017 -- cherry-picks a time frame that prevents an equitable comparison. That’s because the graphic compares a completed bill with one that hasn’t yet advanced very far in the process. It’s a case of comparing apples and oranges.
One of the three "zeros" in the chart may be justified -- the one that refers to time spent in committee hearings. Senate Republicans intend to bring the bill now being written directly to the floor once it’s analyzed for cost and impact by the Congressional Budget Office. That would mean bypassing the typical committee process.
However, the zeros for floor debate and amendments are more questionable.
Senate Republicans want to address the bill through a "reconciliation" process, which would enable passage with 51 votes rather than 60 votes to first cut off debate. If they take this course, there would be 20 hours of floor debate under rules for reconciliation bills.
Twenty hours is significantly less than the 160 hours spent on the Affordable Care Act, but it’s certainly not the zero suggested in the graphic. "There will be debate on the current proposal after it is introduced," said John Cannan, a law librarian at Drexel University who has written about the legislative history of the Affordable Care Act.
As for amendments, there will be an opportunity to consider some on the floor according to reconciliation rules, said Gregory Koger, a University of Miami political scientist. (Without committee consideration, amendments in committee will be impossible, however.)
Sanders’ office acknowledged that the graphic captures a moment in time. "Clearly, 2017 is ongoing, and the bill hasn’t passed the Senate yet, so the numbers in the right column might need to be updated at some point," Miller-Lewis said.
Still, this amounts to a flawed comparison and a statistically exaggerated picture, punctuated by a string of bold zeros.
Sanders’ graphic said that Senate deliberations on the Affordable Care Act in 2009 and 2010 included hundreds of hours of debate and more than 100 Republican amendments, compared with zero for the American Health Care Act this year.
Sanders has a point that the Democratic process in 2009 and 2010 included more active involvement by Republicans than Republicans are allowing in the current debate over the repeal-and-replace legislation.
However, it’s misleading for Sanders to make this point through an apples-to-oranges comparison that produces eye-catching zeros that will soon be rendered out of date. Under Senate rules, there will be debate and amendments.
We rate the statement in the image Half True.
Bernie Sanders, tweet, June 13, 2017
Senate HELP Committee, "The Cost of Prescription Drugs: How the Drug Delivery System Affects What Patients Pay" (hearing video), June 13, 2017
New York Times, "Obamacare Took Months to Craft; Repeal May Be Much Swifter," March 7, 2017
Washington Examiner, "McCaskill fired up over lack of hearings on healthcare bill," June 8, 2017
Washington Post, "Senate Committee's Bipartisan Health-Care Reform Talks Move Toward Center," Aug. 6, 2009
NPR, "What The 'Gang Of Six' Wants From Health Care Bill," Sept. 9, 2009
PolitiFact, "Gutierrez says 'hundreds of Republican amendments' were a part of Obamacare," March 16, 2017
PolitiFact, "Obama says health plan incorporates the ideas of Democrats and Republicans," Sept. 9, 2009
Email interview with John Cannan, law librarian at Drexel University who has written about the legislative history of the Affordable Care Act, June 13, 2017
Email interview with Gregory Koger, University of Miami political scientist, June 13, 2017
Email interview with John E McDonough, who teaches health policy and management at Harvard University’s T. H. Chan School of Public Health, June 13, 2017
Email interview with Steven S. Smith, political scientist at Washington University in St. Louis who studies the Senate, June 13, 2017
Email interview with Josh Miller-Lewis, spokesman for Bernie Sanders, June 13, 2017
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