On Monday in the U.S. Senate, there were not many people who knew what was happening with efforts to write health care legislation. But Sen. Orrin Hatch, R-Utah, was one. His senior legislative assistant Stuart Portman, a Jewish 26-year-old from Ballwin, was another.

The perceived secrecy around efforts to repeal and replace the Affordable Care Act — there have been no public hearings with stakeholders— has upset senators, both Democrats and some Republicans, outside the small group.

“Will we have a hearing on the health care proposal?” Sen. Claire McCaskill, D-Mo., asked Hatch, who chairs the committee writing the legislation, according to NBCNews.com. Hatch did not commit to one but invited McCaskill to share her ideas. “We have no idea what’s being proposed,” McCaskill responded.

So while McCaskill waits for answers, Portman, whose area of expertise is Medicaid policy, has been advising Hatch on how to write legislation that would protect children as well as disabled and elderly people, “while at the same trying to make a fiscally-responsible path for the Medicaid program,” Portman said.

How is it that a Jew who seems passionate about health care came to work for a Mormon senator who once described Democrats as “diabolical” in their push for health care reform?

The answer: Portman does not view being conservative and trying to help the most vulnerable people get necessary health care as a contradiction. Rather, he says “you can’t truly be conservative-minded in health care if you are not trying to help people improve their health and their general situation. The difference in the politics of it is whether the government is the one doing the action or is empowering the individual to take more action on their own.”

Portman grew up in a kosher home and spent summers working at Camp Ramot Amoona. The rest of the time, he would often shadow pediatricians and anesthesiologists. 

“I always wanted to work in health care,” said Portman, 26, who attended Parkway West High School. 

He had been set on being a pediatrician but after studying biology and political science at the University of Denver, he applied to medical schools and master’s in public health programs. When he didn’t get into any medical schools, the decision was made for him.

He realized that by working on the policy side, he could still “do something that I loved.” 

In 2014, he started to work for Hatch, the most senior Republican senator, who has taken a variety of stances in terms of health care reform. In 1993, as President Bill Clinton was pushing for health reform, Hatch sponsored legislation that featured an individual mandate to purchase health insurance. That bill ultimately did not pass. Then when Democrats were considering legislation at the start of President Barack Obama’s presidency, Hatch responded to a proposed requirement for individuals to have insurance by saying, “Congress has never crossed the line between regulating what people choose to do and ordering them to do it. The difference between regulating and requiring is liberty,” according to National Public Radio.

Despite his strong criticism of Democrats’ health reform proposals in 2009, Hatch said in February — before the failed Republican legislative efforts — that he “could stand either” repealing or repairing the law, according to the Washington Post. 

Portman said that if left alone, health insurance companies will continue to withdraw from the public marketplaces created as part of the Affordable Care Act, and that the markets will not stabilize. 

In May, the House passed a health care bill that included deep cuts to the Medicaid program. Doctors, health insurers, hospitals and some consumer groups expressed opposition to the bill.

Portman said he could not share specifics about the Senate legislation but that “it will look different from the House bill.”

“Some of the concerns that people with disabilities and children’s advocacy groups have raised were taken to heart,” said Portman. 

As to the concern about the lack of input from Democrats and other stakeholders, Portman said, “that has generally been confusing to me because everyone who has asked for a meeting has received a meeting in our office.”

If the Senate Republicans are able to pass legislation, Portman said, “then there will be a lot of pressure to have that become law. It’s definitely close over here.”

When Portman and Hatch aren’t talking health policy, they often talk religion — as in Judaism, the staffer said.

“We have had conversations about kashrut when driving around Utah, about what I can eat and can’t eat,” said Portman. Hatch has mezuzahs on all the doors in his office, Portman said, and last year met with Prime Minister Benjamin Netanyahu in Israel, after which Hatch issued a statement saying, “Bibi and I are longtime friends, just as our nations are steadfast allies.” And after the death of Elie Wiesel, the Holocaust survivor who became a prominent author and political activist, Portman helped Hatch write a tribute that he delivered in the Senate.

“Being Jewish and working for the senator, I get to engage with him on more than just policy,” Portman said. The St. Louis native said he would like to return to Missouri at some point and work on Medicaid and health policy at the state level.

For now though, Hatch is happy to have his advisor.

“Stuart is a stellar staffer whom I have long looked to as an expert on all things health care,” Hatch said in a statement. “His Judaism only reinforces his desire to do the right thing and help as many people as possible. I deeply admire the strength of his religious convictions and the way they have influenced his policy recommendations.”