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WASHINGTON — As they draft legislation to repeal the Affordable Care Act, Senate Republican leaders are aiming to transform large sections of the U.S. health care system without a single hearing on their bill and without a formal, open drafting session.

That has created an air of distrust and concern — on and off Capitol Hill, with Democrats but also with Republicans.

“I’ve said from Day 1, and I’ll say it again,” said Sen. Bob Corker, R-Tenn. “The process is better if you do it in public, and that people get buy-in along the way and understand what’s going on. Obviously, that’s not the route that is being taken.”

The secrecy surrounding the Senate measure to repeal and replace the Affordable Care Act appears to be remarkable — at least for a health care measure this consequential. In 1993, President Bill Clinton empowered the first lady, Hillary Clinton, to assemble health care legislation in private, with input from a group of more than 500 experts.

That approach won scathing reviews from Republican lawmakers and others shut out of the deliberations. But it took place at the White House, not in Congress. Once the Clintons’ health plan reached Capitol Hill, it died in the public spotlight.

Republican leaders this week defended their actions.

“Look, we’ve been dealing with this issue for seven years,” the Senate majority leader, Sen. Mitch McConnell of Kentucky, said. “It’s not a new thing.”

McConnell said there had been “gazillions of hearings on this subject” over the years — a less-than-precise tabulation that offered little comfort to Democrats who want hearings held now, in this particular year, on the contents of this particular bill.

In the summer of 2009, when Democratic members of Congress were defending their effort to remake the nation’s health care system, they were taunted by crowds chanting, “Read the bill, read the bill.”

Now Democrats say they would love to read the Republicans’ repeal bill, but cannot do so because Republicans have not exposed their handiwork to public inspection.

“They’re ashamed of the bill,” the Senate minority leader, Chuck Schumer of New York, said. “If they liked the bill, they’d have brass bands marching down the middle of small-town America saying what a great bill it is. But they know it isn’t.”

The Senate’s decisions could have huge implications: Health care represents about one-sixth of the U.S. economy, and about 20 million people have gained insurance under the 2010 health law, President Barack Obama’s signature legislative achievement.

In theory, the bill-writing process is open to any of the 52 Republican senators.

Sen. Ron Johnson, R-Wisconsin, offered a hint of the same frustration felt by Democrats seeking more information about the bill.

“I come from a manufacturing background,” Johnson said. “I’ve solved a lot of problems. It starts with information. Seems like around here, the last step is getting information, which doesn’t seem to be necessarily the most effective process.”

At a Senate hearing Thursday, Tom Price, the secretary of health and human services, said that he, too, had not seen the Senate bill.

Senate Republican leaders say the bill is still a work in progress, and they have not said exactly how their bill will differ from the one approved last month in the House.

The Senate bill is likely to phase out the Affordable Care Act’s Medicaid expansion more slowly than the House version. It is also expected to have larger tax credits to help older Americans buy health insurance.

The legislation will be considered in the Senate under an expedited procedure that precludes a Democratic filibuster and allows passage by a simple majority. But, Republicans say, Democrats will still be able to offer numerous amendments once the bill is on the Senate floor.

It is not unusual for lawmakers to draft major legislation in private, but they usually refine, debate and amend it in open committee sessions.

The House bill to repeal the Affordable Care Act did not receive a hearing, where outside experts could testify. But lawmakers dissected its contents and were able to propose changes at three stages — in the Ways and Means, Energy and Commerce and Budget committees.

Senate Republican leaders evidently think their backroom approach gives them the best chance to devise a health care bill that can squeak through the Senate, given their narrow majority and the policy differences in their conference.

However Republicans feel about their forthcoming bill — and they are far more comfortable criticizing the Affordable Care Act than talking up the virtues of their still-incomplete replacement — the process playing out in the Senate is quite different from the way Democrats went about passing the Affordable Care Act.

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