Why Jimmy Kimmel is Right!
And Newt Gingrich is Wrong
Jimmy Kimmel has lived through every parent’s nightmare, which was to hear from doctors that his newborn son, Billy, was facing a life-threatening health condition. In Billy’s case, the condition was a congenital heart defect known as tetralogy of Fallot with pulmonary atresia, a condition that occurs in about one out of every 2,000 babies. Kimmel spoke about this in his late night show, Jimmy Kimmel Live, a few weeks ago.
As Kimmel explained in an emotional monologue, his son will have to have at least three heart surgeries over the course of his childhood — two of which will take place in the first year of life — to correct the condition.
After Billy’s birth at Cedars-Sinai Hospital and diagnosis of the condition, he was transferred to Children’s Hospital Los Angeles (CHLA) to have successful cardiothoracic surgery. Kimmel said, “It was the longest three hours of my life.”
Kimmel went on to say:
We were brought up to believe we live in the greatest country in world. But until a few years ago, millions and millions of us had no access to health insurance at all. You know, before 2014, if you were born with congenital heart disease, like my son was, there was a good chance you’d never be able to get health insurance because you had a pre-existing condition … and if your parents didn’t have medical insurance, you night not live long enough to even get denied because of a pre-existing condition.
If your baby is going to die and it doesn’t have to, it shouldn’t matter how much money you make. I think that’s something that whether you’re a Republican or a Democrat or something else, we all agree on that, right? . . . Whatever your party. . ., we need to make sure people who are supposed to represent us, people who are meeting about this right now in Washington, understand that very clearly. . . Don’t let partisan squabbles divide us on something every decent person wants. We need to take care of each other.
I saw a lot of families there. And no parent should ever have to decide if they can afford to save their child’s life. It just shouldn’t happen. Not here.
Parents all across the country felt for Kimmel, sent him prayers and supportive notes, and made donations to CHLA. Every parent knows that feeling or has had that fear. Kimmel’s expression of gratitude for the health of his child, his understanding that others may not be as fortunate, and expression of support that all parents are able to “afford to save their child’s life” is something to be commended.
And yet, there are those that somehow found fault and outrage in that.
The Kimmel Naysayers are Out-of-Line and Wrong
In fact, after thanking all the people across the country that expressed their support to him, Kimmel noted, “There were also — and I know this will shock people — some not-so-nice things that people said on-line about me, including members of the media.”
For example, Newt Gingrich criticized Kimmel on Fox News for implying that the House bill to “repeal and replace” the Affordable Care Act (ACA) could leave children unprotected or worse off.
Despite the fact that the Congressional Budget Office (CBO) has analyzed the House’s American Health Care Act (AHCA) and found that it would increase the number of uninsured in the country by 23 million, cuts Medicaid by $834 billion, and threatens to undermine a number of consumer protections in current law, Gingrich disputes Kimmel’s concern that the coverage of newborns with life-threatening health conditions might be threatened by the House package. Gingrich attacked Kimmel by arguing:
If you show up at a hospital with a brand new baby and the brand new baby has a heart problem, the doctors of that hospital will do everything they can to save the baby. They don’t say, ‘We’ll take care of the baby right after you write a check.’ They try to save the baby’s life and that’s true across the board in this country.
A week later, Gingrich took it a step further and claimed that CBO should be abolished for pointing out that hundreds of billions of dollars in health care cuts might actually harm people. In another interview with Fox News, Gingrich said, “Abolish CBO. It is totally destructive. It is totally dishonest.”
A few others piled on. Washington Times columnist Charles Hurt wrote a diatribe entitled “Shut up, Jimmy Kimmel, you elitist creep” and Cheryl Chumley wrote another attack piece in the same paper entitled “Jimmy Kimmel’s crying pro-Obamacare jag” that argued:
Where in America did newborn children not receive the health care they needed?
What hospitals cruelly tossed a child into the street — a newborn child with a health defect — and called out, as the door slammed shut, ‘No health care for you!’”
Before spouting off again, Gingrich, Hurt, and Chumley should consider picking up numerous studies that have found the lack of insurance coverage is detrimental to the health of children. For example, in a study by Frank H. Morriss, Jr. of over 4 million hospital discharges, he found, “. . .uninsured neonates were 2.6 times as likely to die as were those with private insurance, Medicaid, Medicare or other expected primary or secondary payer.”
Finally, in a column in the New York Post, Michelle Malkin asserted that, prior to the enactment of the ACA, “[i]f parents had health insurance, the child would have been covered under the parents’ policy whether or not the child had a health problem.”
She added that pre-existing conditions or being uninsured are irrelevant because “virtually all hospitals are legally obligated to provide emergency treatment to every patient who urgently requires emergency medical care regardless of the patient’s insurance status. . . It does not matter if you are rich, are poor or you are uninsured.”
Do these pundits really believe health coverage and wealth “does not matter” in this country? Are they so unaware that our nation has one of the highest infant mortality rates in the developed world? Do they not understand that there are numerous studies that clearly show insurance coverage increases access to care, improves health outcomes, and saves lives?
The criticisms from Gingrich, Hurt, Chumley, and Malkin not only lack compassion but they are clueless. They either do not know how the health care system actually works or didn’t even bother to listen to what Kimmel actually said before deciding to attack him for proposing that our nation adopt a national health policy that ensures “no parent should ever have to decide if they can afford to save their child’s life.”
Jimmy Kimmel’s comments were not only morally right, but they were also factually correct.
Children with Pre-Existing Conditions Need Protections
First, Kimmel was not speaking about protecting just the children who have medical conditions that are identical to those of his son. Kimmel was also speaking about the need for health coverage, the perils of medical underwriting and pre-existing condition exclusions that were imposed upon children, including newborns, prior to the enactment of the ACA (“Obamacare”), and the problems the AHCA (“Trumpcare”) would cause if it were to be signed into law because it rolls back many of those protections.
According to the Kaiser Family Foundation (KFF), “Prior to the ACA’s coverage expansions, we estimated that 18% of individual market applications were denied.”
KFF identified the following medical conditions as examples of those “declinable conditions” in the individual market prior to the enactment of the ACA. Depending on how the states respond, these conditions could be, once again, subjected to medical underwriting under Trumpcare.
Prior to the passage of the ACA, parents with employer-sponsored coverage that covered dependents (and not all employers did or do cover the children of their employees or subsidize that coverage, so it was often unaffordable) were protected in they enrolled during the first 30 days of life. Kimmel naysayers seem to love to point this out, but it is important to highlight that just over half of all children are in employer plans.
Moreover, even in these plans, children could be subjected to pre-existing condition exclusions, waiting periods, or higher costs if their families experienced a lapse in coverage for their children at any point of their childhood.
In the non-group market, prior to the ACA, the guarantee of coverage was dependent upon a wide array of state insurance laws and policies. In many states, children could be subjected to coverage denials for pre-existing conditions, even at birth if the parents were uninsured prior to the child’s birth. In fact, this happened to Houston Tracy just months before the ACA took effect. Although Houston’s parents had coverage for his two siblings, he was subjected to a pre-existing condition exclusion by his insurance carrier for a congenital heart defect at birth and denied coverage for his life-saving surgery at Cook Children’s Medical Center in Fort Worth, Texas.
In Oklahoma, before the ACA was fully implemented, Governor Mary Fallin signed a rule that eliminated “‘birth’ as a qualifying experience for insurance” so that babies could be denied child-only individual coverage by insurance carriers through the first year of life.
Lifetime and annual caps were also an enormous threat, as children with special health care needs could reach lifetime limits within the first year or few years of life in both employer and individual market plans.
In short, Kimmel’s naysayers are wrong, as they ignore the reality of insurance coverage barriers and limitations prior to the enactment of the ACA.
Jimmy Kimmel is right. Children with life-threatening conditions in this country should be protected, and the AHCA threatens those protections in a number of ways.
Emergency Care is Not the Solution
And yet, Kimmel naysayers wrongly argue that health coverage for children, in Markin’s words, “does not matter” because children can always get care in hospital emergency rooms.
First, while the Emergency Medical Treatment and Labor Act (EMTALA) requires hospitals to stabilize and treat anyone coming to an emergency department, regardless of their insurance status or ability to pay, hospitals will bill uninsured and underinsured families for the uncompensated costs of their child’s costly medical care.
Consequently, according to a study by Dr. David Himmelstein, Senator Elizabeth Warren, and others, “62.1 percent of all bankruptcies in 2007 were medical; 92 percent of these medical debtors had medical debts over $5000, or 10 percent of pretax family income.” A prior study by the same authors found that 7.7 percent (see Exhibit 2) of debtors cited the birth or addition of a family member as the specific reason for their filing for bankruptcy.
Fortunately, since passage of the ACA and a corresponding significant drop in the number of uninsured Americans, Consumer Reports has found that personal bankruptcy filings have “dropped about 50 percent from 1,536,799 in 2010 to 770,846 in 2016.”
Health coverage matters to both children and their families.
Second, the Kimmel naysayers are wrong to suggest that less insurance coverage and more emergency room care is an optimal solution to treating our nation’s children with life-threatening conditions. In fact, that is a strange argument coming from so-called “conservatives.” Treatment delivered in the emergency room is often more costly and does not necessarily provide the best quality of care necessary to treat a number of medical conditions.
Third, health insurance is important to children in a number of different ways. According to KFF:
Children with health coverage fare better on measures of access to care compared to uninsured children, and access for children with Medicaid and CHIP is comparable to access for children with private coverage along these measures. Studies also show that Medicaid and CHIP coverage contribute to long-term positive outcomes in health, school performance and educational attainment, and economic success. Moreover, parents say they are thankful for Medicaid and CHIP and have peace of mind knowing their children are covered.
Fourth, the naysayers failed to understand that Jimmy Kimmel’s son’s care would not be addressed by a single hospital emergency room visit. The fact is that children with special needs typically require years of on-going care and treatment to treat their health conditions, which is care and treatment that emergency rooms do not provide.
As Kimmel explained, his child was delivered at Cedars-Sinai, where he was diagnosed but then transferred to the Heart Institute at CHLA for his surgery. This was not a situation that was best addressed in an emergency room at Cedars-Sinai. The best treatment for Billy’s condition was at Children’s Hospital Los Angeles and so will be his on-going care. As Paul S. Viviano, president and CEO of CHLA, explains:
Mr. Kimmel said his son will need at least two more surgeries in his lifetime. It is not uncommon for pediatric patients with serious conditions to require multiple procedures and a long-term plan of care. In fact, many of the more than 1,000 open heart surgeries CHLA surgeons perform each year are on children who have been in the operating room before.
Pre-existing heart conditions such as Tetralogy of Fallot require lifelong medical attention that can amount to hundreds of thousands of dollars in expenses.
So no, simply having access to an emergency room isn’t the solution. The loss of access of health coverage to children, particularly those with special health care needs, could have life-threatening consequences.
Again, Jimmy Kimmel is right, and Newt Gingrich and friends are wrong.
$834 Billion in Medicaid Cuts Will Absolutely Harm Children, Particularly Those with Special Health Care Needs
Finally, Medicaid provides 37 million low-income and disabled children with health insurance coverage across the country. Studies of the arbitrary Medicaid per capita caps or block grant option that the AHCA would impose on the Medicaid program by Avalere Health and the American Action Forum show that children would be disproportionately harmed by those cuts if the bill were enacted.
Avalere estimates that the AHCA would slash $43–78 billion out of Medicaid due to the per capita cap or block grant option between FY 2020–2026 for non-disabled children. The cut likely would be tens of billions more if they could have estimated the impact on children with disabilities as well.
The impact on our nation’s most vulnerable children would be extensive. As CBO explains:
. . .enrollees could face more significant effects if a state reduced providers’ payment rates or payments to managed care plans, cut covered services, or curtailed eligibility — either in keeping with current law or to a greater extent, if given the flexibility. If states reduced payment rates, fewer providers might be willing to accept Medicaid patients, especially given that, in many cases, Medicaid’s rates are already significantly below those of Medicare or private insurance for some of the same services. If states reduced payments to Medicaid managed care plans, some plans might shrink their provider networks, curtail quality assurance, or drop out of the program altogether. If states reduced covered services, some enrollees might decide either to pay out of pocket or to forgo those services entirely. And if states narrowed their categories of eligibility (including the optional expansion under the ACA), some of those enrollees would lose access to Medicaid coverage. . . .
Despite the claims of Gingrich and others that attacked Kimmel, billions of dollars in cuts to Medicaid would endanger the health coverage for millions of children across the country. The health of children, such as Natalie Weaver’s daughter (Sophia), Bill and Elaine Nell’s daughter (Lydia), Kim and Rich Rankin’s son (Nathaniel), Kristy Steele Chervy’s son (Matty), and Brian Farrington and Keli Barish’s daughter (Emma), would all be threatened.
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In Emma’s case, Philadelphia Inquirer columnist Ronnie Polaneczky writes:
Emma is only one of the countless thousands of Americans who rely on Medicaid when their luck runs out. Sick kids, disabled adults, the impoverished elderly — there is a real person, a real family, behind every dollar. Trump’s butchering of Medicaid would trade the well-being of these Americans for tax breaks for those who are already rich enough to buy and staff their own hospitals.
That possibility is not just immoral.
The current Medicaid program ensures that millions of young patients with complex needs across the country have access to age-specific health benefits through the Early and Periodic Screening, Diagnosis, and Treatment Program. Important safeguards like these are being threatened and, in sharing his own hospital experience, Mr. Kimmel gave those patients a voice. . .
Now that the House of Representatives has passed AHCA, the Senate will begin debating these changes to healthcare legislation that will jeopardize children who are reliant on federal and state funding to cover their care. Traditionally, the Senate has shown bipartisan support for protecting children, and we hope our lawmakers rally around Jimmy’s heartfelt words so that children are not left out of the conversations on Capitol Hill.
Fortunately, Senator Bill Cassidy (R-LA) is one who may get it. He has called for any Obamacare replacement bill passed by the Senate to meet the “Jimmy Kimmel test.” Cassidy asks and answers, “Would a child born with congenital heart disease be able to get everything she or he need in that first year of life? I want it to pass the Jimmy Kimmel test.”
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Such a test should ensure that coverage, affordability, benefits, access to care, and quality are, at a minimum, protected. We must not head backwards — not now, not ever.
Consequently, the United States Senate should firmly and resoundingly reject the AHCA. Instead, the Senate should strive to reach the goal of health reform, which would include achieving Kimmel’s critically important test that:
. . .no parent should ever have to decide if they can afford to save their child’s life. It just shouldn’t happen. Not here.
But if they can’t even do that, at the very least, they should listen to former ER doc and Rep. Raul Ruiz (D-CA) and commit to “do no harm.”