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Honorable Mark Sanford

Representing the 1st District of South Carolina

Vote Notes: H.R. 1628, The American Health Care Act

May 5, 2017
Blog Post

I voted yesterday for the American Health Care Act, and given the intensity of feelings and thoughts surrounding this bill, I wanted to write to explain my reasoning.

Despite all the hyperbole, ultimately the vote this week came down to one simple question: do we kill the bill and not let the debate advance to the Senate - or not?

In its original form back in March, my vote was that we do just that and not allow the Senate to debate the bill. The bill was rushed and not ready. With the three amendments that came in the wake of my and others’ efforts to shut down the bill in March, it’s my belief that it was at least worth letting the Senate debate the bill.

Let me explain.

I held eight town hall meetings over the last few months and have directly heard from so many at home who registered a whole host of grave concerns about what might come next in healthcare. I tried to take those concerns into consideration not only in March but with this vote.

It is for those warranted reasons that I was but one of three Republicans who voted no when the bill came through the Budget Committee in March and was subsequently one of the holdouts that caused the bill to not make it to the House floor.

But that is not where the bill ended.

Many Republicans will claim this bill eliminates the Affordable Care Act. These may be good talking points, but it’s not so accurate. It eliminates some portions of the Affordable Care Act and leaves other portions standing.

Specifically, the bill is predominantly about eliminating most taxes and penalties, and this narrow construct was driven by the procedure called reconciliation that required the bill to be budget neutral and primarily deal with budgetary issues. In its original form, the Congressional Budget Office scored the bill as saving a little over $350 billion over the ten year budget window. Since then, there were three amendments, but if they were to drive the bill from being a budgetary savings to a cost, the whole bill would be discarded based on budget rules.

The three amendments that came after the bill’s collapse in March were sponsored by Rep. Mark Meadows and Congressman Tom MacArthur, and these had further perfecting amendments that were offered by Congressman Gary Palmer and Rep. Fred Upton.

The first amendment by Meadows and MacArthur was designed to find some middle ground between conservatives and moderates on how we might allow different states to try different approaches in regard to healthcare. In short, it allowed Vermont to go to a single-payer system, if they so choose, and South Carolina to go to a market-based system. Protection for pre-existing conditions and allowing one to stay on their parents’ plan until the age of 26 were both attributes of the Affordable Care Act and built into the base bill. What was at question as a result of this amendment, though, was if a state opted out of part of some of the regulations in what’s called Title I, an insurance company could charge someone with a serious health condition more.

This is where the Palmer Amendment came in. If a state was to opt out, then they would be required to set up a high-risk pool in the fashion that Maine successfully did some years ago. The Upton Amendment added another $8 billion for high-risk pools on top of the $15 billion that came with the Palmer Amendment in addition to the $115 billion that came in the bill for states to use with Medicaid or indeed things like high-risk pools. .

In short, what the bill was trying to get at was striking some sort of balance between protecting people with pre-existing conditions and profound health needs while at the same time lowering the cost of insurance for the majority of people in the individual marketplace who do not have these same needs. These people have increasingly found themselves facing ever escalating premiums and dwindling choices, and this group has received surprisingly little attention in the debate of the last month - but they are important stakeholders in what occurs. In South Carolina, we are down to but one provider and premiums went up by 30% last year in the individual healthcare marketplace. In Maryland this year, premiums will go up by 60%. In Iowa, 94 of 99 counties now have but one insurance provider. Just this week, Aetna announced that they were withdrawing from Virginia, leaving 24 counties out of 95 counties with but one insurance carrier.

The long and short of all of this 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 the cost of their insurance. It will certainly be my aim to look for ways to both protect people with pre-existing conditions or significant medical hardships while at the same time working to lower insurance premiums.

Given the perfecting amendments that have been inserted, 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 bill’s passage 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.