Since the election of Trump, Chris Smith has worked to burnish his “moderate” credentials in hope of avoiding the backlash that may come this November. Notably, he voted against his party’s signature legislative efforts in the tax overhaul and Affordable Care Act repeal. However, these attempts to temper his party fall short of what was required to make a difference. Rather, Smith bears a responsibility for the extreme and irresponsible behavior of the Republican party, and his record before the current Congress undercuts the moderate image he is trying to convey.
Smith’s votes surrounding health care are illustrative of his failure as a leader (or a supposed moderate). Prior to crossing party lines during the ACA repeal, Smith was a reliable anti-ACA vote. He voted for a full repeal numerous times, and several amendments attacking the ACA that would have significantly reduced access to care.
These votes matter. They cannot be written off as harmless, politically safe choices because the measures would not become law with a Democratic Senate and President. Every time Smith voted with Republicans to disable the ACA, he was endorsing the warped narrative and hysteria the GOP created around the bill. Republican lies about the ACA permeated every part of the conservative movement from politicians to pundits. Smith could not possibly claim to be unaware of them, and knew what he was participating in.
Of course, the biggest lie of all was that the ACA would create “death panels.” This falsehood was a joint effort in 2009 by Betsy McCaughey and recent GOP vice presidential candidate Sarah Palin. It pointed to funding for end of life decision counseling and the Independent Payment Advisory Board, (a cost control measure only triggered in extreme circumstances that was never used and has since been removed), as evidence. It was repeatedly debunked, even by some Republicans. But, that didn’t stop the GOP from embracing it.
Speaker Boehner said, “This provision may start us down a treacherous path toward government-encouraged euthanasia if enacted into law.” Senator Chuck Grassley claimed “You have every right to fear. You shouldn’t have counseling at the end of life, you should have done that 20 years before. You should not have a government run plan to decide when to pull the plug on grandma.” Representative Virginia Foxx (R, NC-5), said on the House floor that a Republican alternative for health reform was “pro-life because it will not put seniors in a position of being put to death by their government.”
Conservative media was apoplectic. Mainstream news outlets explained and debunked repeatedly. But according to Nexis data, in August and September of 2009, the phrase “death panels” was mentioned in news reports approximately 6,000 times. By October, it was still mentioned 150 - 300 times a week. The lie took hold. Polling indicated that 47 percent of Republicans believed it was true, with 23 percent unsure.
These lies, along with many others, became the animating force behind the Republican party for years. Republicans became so entwined with and indebted to this rhetoric that when they finally had control of Congress and the White House, they came within one vote of removing healthcare for 23 million people.
Every time Smith voted to repeal or damage the ACA, he was accessory to this madness. He could have abstained, he could have sponsored alternatives, he could have risen in opposition during debates, he could have used his seniority to publicly denounce the tenor of the debate and call for reason. Instead, he took the path of least political resistance and hopped on the bandwagon.
Besides complete repeal, the specific amendments attacking the ACA that Smith voted for paint a troubling picture. Smith voted in favor of the King amendment that would have prohibited funding to pay federal workers who implemented the law, leaving ordinary people just doing their jobs out of luck. He voted for the Price amendment that removed the Medical Loss Ratio provision, which requires health insurers spend 80 percent of premiums on medical claims and improving care instead of boosting profits.
Most appallingly, Smith voted for the Pitts amendment, removing funding for work “to specify or define, through regulations, guidelines, or otherwise, essential benefits as required” by the ACA. These essential benefits, which Smith sought to deny Americans coverage for, became:
- Ambulatory patient services (outpatient services)
- Emergency services
- Maternity and newborn care
- Mental health and substance use disorder services, including behavioral health treatment
- Prescription drugs
- Rehabilitative and habilitative services (those that help patients acquire, maintain, or improve skills necessary for daily functioning) and devices
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services, including oral and vision care
It’s difficult to reconcile Smith’s “pro-life” and “advocate for the disabled” image with this list.
Additionally, Smith made many false statements about the ACA that amount to petty fearmongering. He repeatedly insisted the ACA used taxpayer funds for abortions and went so far as to sponsor legislation to counter it, even though his claims were false. He railed against the requirements for birth control coverage as an assault on religious freedom.
Smith claimed earlier versions of the bill would allow illegal immigrants to get coverage. This was not true of a 2009 proposal, nor the final version of the law. He fed hysteria about government rationed care, walking right up to the death panel line when he said, “…government bureaucrats may construe a patient’s age, prognosis and medical outcome as factors precluding coverage of a vast array of services, from knee and hip replacements to expensive interventions to combat cancer.” He worked hard to frighten seniors about the law, stating, falsely, that “because Obamacare diverts $500 billion from Medicare, there is no doubt whatsoever that senior citizens and disabled persons will lose certain health benefits they now enjoy.” He claimed the ACA would kill jobs, which economic growth since its implementation clearly shows did not happen.
Interestingly, Smith objected to the ACA’s Medicaid expansion, but then cited his constituents who rely on Medicaid as a reason for voting against repeal in 2017.
Smith does sponsor worthy legislation on specific health topics, but every issue is affected by the broader national health care picture. The causes Smith champions are served well by the ACA’s expansion of Medicaid, caps on out of pocket costs, essential health benefits, greater availability of coverage, and outlawing of pre-existing condition denials nationwide. Smith has stated that he supports these initiatives, but from 2009 until today, he and his party are yet to devise another way to achieve them. Therefore, when Smith voted to undercut the ACA, he undercut his own efforts as well.
This is Smith’s record health care. This is who he is. He contributed to the lies and outright mania Republicans created around the ACA with his votes and false statements. He helped bring Republicans to the brink of removing health care for 23 million people, only turning away with the political winds when there were consequences. Smith had an opportunity nine years ago to be a moderating force, a responsible voice of reason, and a leader. To contribute meaningful ideas, be they conservative or liberal. Instead, Smith participated in the Republican lies about the ACA, preventing a useful debate on health care that could have helped the process and the American people.
Someone with Smith’s years of experience should know better. If he was truly a moderate who could stand up to his party, he would have done so when it wasn’t politically expedient and before the damage was done. That’s what leadership is. Smith declined, and his votes in 2017 do not absolve him of responsibility for the lie-fueled disaster the GOP sought to inflict on 23 million vulnerable Americans.