Chris Smith's COVID Response Can't Erase the Past

The COVID pandemic is exacerbating fundamental flaws and inequalities in our healthcare system, and the consequences will fall unevenly across racial lines on the most vulnerable in our society. The lessons we learn should extend beyond our response to the crisis.

While many politicians are setting aside partisan differences for the common good, evaluating politicians solely on their actions during the crisis glosses over their role in creating and perpetuating the inequalities that will now cause needless suffering. New Jersey’s Chris Smith is a prime example.

Smith is responding to the crisis responsibly, but we must remember how different the impact of COVID would be if Smith had gotten what he wished for prior to 2017: the Affordable Care Act would never have passed, and an additional 20 million Americans wouldn’t have health insurance.

Some states have reopened their ACA exchanges so previously uninsured individuals can buy insurance outside of the open enrollment period, but this is not possible in 38 states which rely on federally run exchanges because the Trump administration would not allow it. Coverage is also available through Medicaid if you qualify, more so if your state has implemented the ACA’s Medicaid expansion. These options are a crucial backstop to those experiencing a job loss or drop in income.

However, we are still failing the uninsured. Although COVID testing costs are covered, the Trump administration’s plan to compensate hospitals for uninsured patient’s COVID treatment may leave hospitals struggling to pay for personal protective equipment, ventilators, and beds.

Uninsured individuals are also less likely to seek medical treatment, which means even if the Trump plan is adequate there will have to be significant messaging to overcome the uninsured’s reluctance to seek care and risk expenses. If this messaging is not successful, someone experiencing COVID without insurance will suffer longer, have an increased risk of dying, and possibly expose others. The occupations of many uninsured are the very people we are relying on right now to hold our society together: grocery clerks, delivery drivers, custodial staff, etc.

If Smith and the GOP defeated the ACA and 20 million less Americans had health insurance, all of these challenges would be greater. How many more of these critical workers would delay care and suffer? How many more would die? How much further would the disease spread? How much more would hospitals struggle to provide care and protect their staff?

The ACA is also mitigating the effects of the COVID outbreak in other ways. CDC data shows that underlying conditions such as hypertension, obesity, diabetes, chronic lung disease, and cardiovascular disease increase the chances of a COVID hospitalization. Before the ACA, there were significantly more Americans with these conditions who lacked insurance due to higher premiums or outright denials. Without the ACA there would be more Americans whose chronic conditions were unmanaged, placing them at greater risk for hospitalization due to COVID.

While older Americans are in the highest risk category, data on hypertension, diabetes, COPD, asthma, and cardiovascular disease show that there are still a significant number of pre-Medicare age adults with conditions that increase COVID hospitalizations. (Of particular importance are those who fall in the 50-64 age range, elevating their risk of COVID hospitalization.) These are the very people the ACA is helping during the outbreak.

Nothing about chronic conditions and COVID should be viewed in a vacuum. Indeed, many of these medical issues overlap. But the ACA is saving lives during the COVID outbreak by reducing the cascading effect of unmanaged underlying risk factors. Every additional hospitalization places a strain on the healthcare system that reduces its ability to respond to COVID. By expanding insurance access and improving the management of underlying conditions that increase COVID hospitalizations, the ACA gave our healthcare system a head start in responding to the crisis.

Before voting to preserve the ACA in 2017, Smith was a reliable anti-ACA vote. He voted for a full repeal and several amendments to weaken the ACA.

Smith was determined to stop the law, and mislead the public with many false statements.

He insisted the ACA used taxpayer funds for abortions, but his claims were false. He called the requirements for birth control coverage an assault on religious freedom.

He participated in the “death panel” hysteria 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 stated 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 said “Obamacare is a crippling blow to both healthcare in America and our economy. Not only will Obamacare erode and undermine the quality of healthcare in America, it will...drag down the economy, hurt businesses, and destroy jobs.”

He also claimed that the ACA would lead to “...the end of employer-based healthcare.”

When Smith’s passionate objections vanished in 2017, he issued a press release and remained silent while his party came within one vote of repeal. The Trump administration is trying to dismantle the ACA in court. Smith hasn’t said a word.

Smith is trying to address the COVID outbreak. He’s made efforts to secure medical exam gloves, access to drugs without a positive test, worked to keep federal testing sites open, and communicated with the State Department about Americans stranded abroad. The point is not that Smith’s current efforts aren’t worthy, it’s that they aren’t everything. His irresponsible votes against the ACA would have amplified this crisis.

We should examine Smith and the GOP’s record on healthcare in total. Good deeds performed now should not obscure a yearslong effort to deny healthcare to millions. As we absorb the lessons from COVID and evaluate Smith’s response, let’s make sure we are not missing the forest for the trees.