The Passion of a Congressional Health Care Battle

In bird-dogging senators, I worked with one of our ace congressional correspondents, Thomas Kaplan, who honed his skills prying secrets out of the New York State Legislature. We deployed two interns, Emily Cochrane and Avantika Chilkoti, to help track the fast-moving events.

The Senate vote occurred at 1:30 a.m. on Friday and lasted about 15 minutes. It was strange to watch such riveting drama in the middle of the night. But it was speedy compared with the all-nighter in November 2003, when the House approved a bill adding prescription drug benefits to Medicare. That vote started at 3 a.m. and lasted nearly three hours as Republican leaders quashed an uprising by committed conservatives.

In 2009 and 2010, President Barack Obama and congressional Democrats basically knew what they wanted: a government guarantee of health insurance for all Americans. They disagreed on some important details. But Democrats had much more consensus than today’s Republicans.

The differences between President Trump and Mr. Obama are obvious. Mr. Trump floated above the gritty details of health policy and took occasional jabs at Republicans slaving over the issue. Mr. Obama immersed himself in the details, and his top aides occasionally reached out to journalists to provide tart-tongued tutorials on the politics of health care.

In some ways, the collapse of Republican efforts to uproot the Affordable Care Act recalled the last days of the “Clinton Care” effort to remake the American health care system. It appeared to be moribund, but its champions vowed to keep trying. It finally expired on the Senate floor in 1994. (That defeat inspired Democrats to try again 15 years later.)

The four rounds of health care legislating have one thing in common: the passion that surrounds the issue.

Cancer survivors, children with disabilities and young adults with diseases converged on Congress in a bid to save the Affordable Care Act. Lawmakers, listening to their stories, were clearly moved. I had never heard members of Congress speak with such empathy on behalf of Medicaid beneficiaries or drug addicts, whose treatment was financed by Medicaid.

But for every such testimonial, Republicans could cite reports from constituents aggrieved by the law: people who said they were spending more on health insurance premiums than on home mortgage payments, and “victims of Obamacare” who could not afford to use their insurance because the deductibles were so high.

The lawmakers were, in a sense, deciding who would live and who would die — but they had alternate versions of reality that could simply not be reconciled.

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