Rep. Mark Sanford (R-SC) is out with an op-ed in his hometown paper making the case for his vote in favor of the American Health Care Act, and reading it may give you the clearest sense of how much difficulty House Republicans are having defending the legislation on its merits.
Sanford represents a safe seat in a very conservative state, so he’s not exactly the kind of person who would tremble in terror at the thought of voting for an Obamacare repeal bill. But throughout his column, he keeps emphasizing that his vote in favor of the bill was not an endorsement of its contents per se.
“Despite all the hyperbole,” he writes, “ultimately the vote came down to one simple question: do we kill the bill and stop the debate from advancing to the Senate — or not?”
This is, in a literal sense, true. Congressional procedure junkies will note that there is no way the bill will pass the Senate exactly as written, so one might vote “yes” on it simply to move the process forward and see how things look in the future. In a practical sense, though, if you vote for a bill, you’re generally supposed to be able to defend the bill, and Sanford sort of can’t.
Sanford’s best case for the AHCA is it’s an “earnest ... attempt”
After a bunch of words trying — like the GOP caucus as a whole — to somehow straddle the tension between a Freedom Caucus that wants to eliminate all consumer protections in the bill and public opinion that wants the reverse, Sanford ends up damning the legislation with some very faint praise.
“The long and short of all of this,” he writes, “is that this bill represents an earnest, if rushed, attempt to protect people with pre-existing conditions while at the same time helping people who have seen dramatic increases in their insurance costs.”
Note that Sanford doesn’t say the bill actually will do those things (because it won’t); he just says that it’s an “earnest ... attempt” to do those things. If it doesn’t live up to those goals, well, that’s because it was rushed. And if it was so rushed and ineffective, why did he vote for it? Well, that’s another matter.
The Senate will fix it, maybe?
Sanford ultimately just comes down on the side of punting. He voted for the bill, he says, in the hopes that the Senate will write a better one:
Given the perfecting amendments added, I think that the issue is important enough to forward now to the Senate for their deliberation. I am quite certain the Senate will be even more conservative in their efforts to repeal portions of the Affordable Care Act, and if the bill actually moves through the Senate, it will come back to the House for yet another debate and vote before it could make its way to the president’s desk. In short, this week’s vote means simply that you and I will be talking about this issue for months to come, and I earnestly look forward to those conversations and the learning that will come with them.
Not only is this a little bit ridiculous on its own terms, but the expressed confidence that the Senate “will be even more conservative in their efforts” is a good signpost of how much Republicans can’t seem to express a clear message.
A more conservative approach to health care reform would mean adopting legislation that does less to help patients with preexisting conditions or difficulty paying for their health insurance. Sanford would have a hard time selling that, so his critique of the Affordable Care Act is that it doesn’t do enough to help people — even though the Republican proposal would do even less.
“In South Carolina,” he writes, “we are down to but one provider and premiums went up by 30 percent last year in the individual health care marketplace.”
The government could, of course, step in and do more to provide financial assistance to patients or introduce a public option to guarantee some consumer choice. Alternatively, it could embrace the Freedom Caucus approach, entirely deregulate the industry, and consequently let people buy cheaper but lower-quality products.
But Sanford — like the AHCA itself — doesn’t really want to admit to any trade-offs here. They are making an “earnest, if rushed, attempt” to be all things to all people on the individual market while simply sweeping more than $800 billion of Medicaid cuts under the rug.
When pressed for details, the best defense of the mess he has is that maybe the Senate will come up with something better. Maybe!