The fate of America’s latest attempt at comprehensive health care reform may hinge on the opinions of a late night talk show host. I’ve nothing against Jimmy Kimmel; topical political jokes are the meat and potatoes of late-night comedy. And in fact, Kimmel has a reputation for joking about the problems of Obamacare when liberal comedians such as Stephen Colbert were afraid to say what was obvious.
But Kimmel recently had a son born with a heart defect. It was an understandably traumatic and transformative event, and Kimmel got to thinking about the kids born with a heart defect whose parents were not as rich as he was. So he started using his show to lecture his audience on certain aspects of health reform. One Republican senator, Louisiana’s Bill Cassidy, responded by saying Kimmel raised some valid points. “I ask, does it pass the Jimmy Kimmel test?” Cassidy said in May on CNN. “Would the child born with a congenital heart disease be able to get everything she or he would need in that first year of life … even if they go over a certain amount?”
So the new GOP health care bill, known as Graham-Cassidy, was written with this in mind. The bill grants a lot of flexibility and authority for health care spending to the states, provided that the states demonstrate that they are keeping insurance coverage affordable for those with pre-existing conditions, e.g. babies born with heart defects. However, Obamacare required a large number of health benefits be required by insurance companies, and Graham-Cassidy significantly reduces the number of essential health benefits that are required to be covered. Another waiver in Graham-Cassidy allows insurance plans more flexibility in introducing premium pricing.
The bottom line? The GOP bill makes a good-faith effort at requiring pre-existing conditions be covered, but it’s hard to say in practice whether or not doing away with essential health benefits and premium price controls will allow to insurers a backdoor to deny coverage to people with pre-existing conditions in certain circumstances. The problem is that it’s really hard to provide an ironclad guarantee on “the Kimmel Test.” That’s because providing affordable health care for the greatest number of people inevitably involves trade-offs.
The bill does away with those requirements and price controls because they are major drivers in raising the cost of insurance writ large, and it also allows for much more affordable “catastrophic” health insurance plans to be offered. Obama promised that Obamacare would lower family insurance premiums by $2,500 a year, but by 2015 insurance premiums had gone up nearly $5,000 on Obama’s watch in spite of the law. Kimmel himself would do an extended bit last year, shortly before Election Day no less, mocking Obamacare’s massive premium increases.
Now it may seem in the short-term that offering total assurance on pre-existing conditions is the humane thing to do. But the current rate that insurance premiums are rising is unsustainable and it’s going to affect millions of people. On the other hand people with pre-existing conditions who haven’t maintained health coverage consistently—and only those who don’t maintain coverage are at risk of being denied—are a small group of people.
Graham-Cassidy is trying to strike a balance in dealing with the huge problem of premium cost increases while minimizing any additional problems giving insurers more pricing flexibility might create for those with pre-existing conditions. Obviously, how well Graham-Cassidy passes the Kimmel test in practice remains to be seen.
But unpacking all of this requires a fairly nuanced understanding of the issues and it would help if we had a rational debate. We have no such luck, however. While there’s a kernel of valid criticism in what Kimmel is saying, he’s overstating the problems, and in some of his criticisms, he’s flatly wrong—he says Graham-Cassidy is a “gift” to insurance companies, for example. Insurers have come out against the bill. He’s also claiming the senator lied to him, and leading scorched earth political campaign to get viewers to oppose the bill.
I think Cassidy, a medical doctor with an extensive health care resume, has tried to be more nuanced in his remarks on the Kimmel Test than he’s given credit for. On the other hand, trying to have a very sober debate through the medium of a late night comedian who is understandably emotional about his infant son’s health was a mistake, and Cassidy invited Kimmel to be a part of the debate by publicly embracing “the Kimmel test.”
The awful thing is that, unlike some late night political hosts (looking at you Colbert), Kimmel hasn’t been a big liberal activist publicly – I think his motivations come from a real place of concern, given his son’s struggles. At the same time, I think that Cassidy is sincere in trying to do what he can to protect those that are especially vulnerable, given the necessary trade-offs. But the complexity of health care policy combined with the human drama of lives hanging in the balance make it hard to be dispassionate and scrupulously analytical about what the best policy for most people is going to be.
The bottom line is that I don’t think any good is coming of this debate, and the media has predictably, framed much of the debate and commentary around the Kimmel Test. Both in terms of substance and venue, the Kimmel test is a counterproductive way of understanding our health care challenges.
