Republicans are under pressure to deliver an Obamacare repeal plan, and one of the crucial behind-the-scenes players is Congress’ longest-serving doctor, a low-key policy wonk with close ties to the health care industry.
Rep. Michael Burgess, of Lewisville, Texas, who previously worked as an OB-GYN in Denton County, Texas, is chairman of the House of Representatives health subcommittee tasked with determining what parts — if any — of Barack Obama’s signature health care law would remain in Trump’s America.
“I favor success over and above everything else,” Burgess, 66, said in an interview with McClatchy. “To me, success means we got rid of the individual mandate and then whatever other parts we can take care of.”
For Burgess, the path to changing Obamacare is clear — and it won’t need 60 votes in the Senate to pass.
Getting rid of the individual and employer coverage mandates is Burgess’ top priority. Penalties for declining to purchase health insurance and Medicaid expansion would also go away. But he thinks two popular provisions should stay: Parents would be able to keep their children on their health care plans until age 26 and coverage of pre-existing conditions would remain unchanged.
“I do realize some of the other voices that percolate around the halls have said we ought to do something simultaneously, but right now I can control what I can control,” Burgess said.
Burgess’ experience in Washington has made him a favorite of health care industry insiders. His top campaign contributors are doctors, drug companies and HMOs, and 12 bills he sponsored in the last Congress received lobbying from companies that donated at least $10,000 to his re-election effort.
“A lot of people can make broad comments about the health care bill and say things about the health care bill, but he always knew every book, chapter and verse,” said Kentucky Republican Rep. Brett Guthrie, who serves as Burgess’ deputy on the health care subcommittee. “I have joked with him and said, ‘Your copy of the Affordable Care Act reminds me of some of the Churches of Christ preachers’ Bibles I grew up with,’ that every thing is footnoted, tagged and that he really spent a lot of time trying to understand it.”
Legislating in Trump’s America
The House Subcommittee on Health is a body with 17 Republicans and 13 Democrats, and the minority party is determined to use committee hearings as a way to publicly voice displeasure at Republican efforts to repeal the Affordable Care Act.
Texas Rep. Gene Green is the ranking Democrat on the Health Subcommittee and serves alongside Burgess. He recalled a recent hearing on Medicaid where Democrats were particularly prickly toward Republican proposals to halt Medicaid expansion.
Green, who played a role in drafting the Affordable Care Act, vehemently disagrees with Burgess’ views on the matter but said he realized that Democrats in the subcommittee, which is within the Energy and Commerce Committee, had little opportunity to stall the bill.
The subcommittee is one of two in the House tasked with health care — the other is within the Ways and Means Committee — and the panels are where an Obamacare replacement bill would be debated and amended, if Republican leadership decides not to fast-track it.
But there’s pressure to get something done quickly, and Burgess, along with Republican leadership, has not offered a definitive time frame of when legislation would be formally introduced.
A leaked Obamacare replacement proposal out of Burgess’ committee, first obtained by Politico, would scrap Medicaid expansion and dole out money to states for high-risk pools for patients with pre-existing conditions. The plan, which Burgess helped craft, would pay for the proposal by limiting tax breaks on the health care plans people get through their employers.
Incumbent Republicans must deal with an already grumbling base of conservatives who want Obamacare immediately repealed on ideological grounds.
“I know the line has been repeal and replace. In Tarrant County, that’s not it,” said Arlington Republicans president William Busby, who worked on the campaigns of some of Burgess’ North Texas colleagues in the House. “They don’t want it replaced. It’s a free-market thing. They want competition on the market side; they don’t want government running it. They want it repealed, but I’m pretty sure the majority of Republicans, if you polled them in Tarrant County, wouldn’t want it replaced.”
Democrats aren’t happy either. Protesters railing against an Obamacare repeal packed town halls all week during the recent congressional recess, leaving Republicans like Burgess intent on finding a middle road in a potentially tough spot.
A recently released McClatchy-Marist poll found that 58 percent of Americans want to keep Obamacare while only 31 percent want a full repeal of the law.
Burgess faced criticism for choosing to hold a telephone call-in town hall during the recess but is scheduled to hold an in-person town hall Saturday in Flower Mound, Texas.
“You will see him walk out there and he sticks to his script,” said Denton County Democratic Party Chair Phyllis Wolper, who has known Burgess for decades. “He serves his masters.”
An ongoing relationship with health care
The “masters” Wolper is referring to is the health care industry.
Burgess received over $580,000 in campaign contributions from health professionals, pharmaceutical companies and health services providers during his 2016 campaign cycle, according to the Center for Responsive Politics.
“It’s kind of ridiculous. He really hasn’t had to spend any money,” Wolper said.
Burgess’ largest campaign contributor is the American College of Emergency Physicians, a lobbying and advocacy network for emergency physicians around the country. It donated $15,900 to his 2016 campaign and has given at least $10,000 to his campaign in every cycle since 2008.
“Mike’s very well informed and knows the current legislation very well,” said Dr. Rebecca Parker, the president of the American College of Emergency Physicians. “I definitely see Mike as sort of that thoughtful leader, a thoughtful expert, and I look forward to seeing what his ideas are.”
The emergency doctors network lobbied on six bills sponsored by Burgess during the last Congress, a common relationship in Washington, where big donors of campaign funds simultaneously lobby for bills they support.
“I think as a member of the House he is one of those people we can sit down and work with,” Parker said. “Do we agree with every single idea he has? We’ll see, but he understands emergency care is a core requirement for patients.”
Despite the campaign cash from parties with a vested interest in Obamacare, Burgess doesn’t need to worry about a serious re-election challenge for now. The Denton County-based seat is heavily Republican and he easily won re-election in November, with 66 percent of the vote. His Democratic challenger didn’t raise any money.
But Burgess’ district, which was once mostly rural and now is mostly filled with affluent bedroom communities of Dallas and Fort Worth, saw Trump lose nearly 7 percentage points compared with Mitt Romney in 2012.
“We are not a little rural county anymore,” Wolper said. Republicans “can see the same numbers I can.”
But Burgess isn’t afraid to take rhetorical shots when it comes to Obamacare.
“Oh, Jesus, yes,” Burgess said when he was asked whether the individual mandate was the most important aspect of Obamacare that must be repealed. “That is a freedom-killing, that was illegal, that was immoral, it was unconstitutional. There’s no way in the world that it should have been allowed.”
The future of Obamacare
Burgess got his start in a unique way. The OB-GYN had a natural constituency of Denton County mothers he had worked with in the delivery room.
“He started out as a doctor, and he was quite famous in these parts for all the babies he delivered,” Wolper said. “The ladies brought pictures of their babies to rallies.”
While faces like Kentucky Republican Sen. Rand Paul and House Speaker Paul Ryan, R-Wis., might be more recognizable in the national health care debate, Burgess relishes the role he will play, and he frequently meets with state-level politicians in Texas, health care lobbyists and Health and Human Services Secretary Tom Price to better understand how to implement a long-dreamed-of repeal plan.
“My job is to get something through the subcommittee that the full committee can vote on and send to the floor,” Burgess said. “If I can change America in the process, you bet, I want to do that. I signed up for it. But my right-now role is, yeah, I’ve got to keep the subcommittee working and functioning.”