Late-night comedian Jimmy Kimmel, in a recent opening monologue, spoke tearfully of his newborn son Billy, born with a serious congenital heart defect. Heart defects in newborns, while uncommon, occur in 1 in 100 births. The more serious ones, meaning those needing surgery in the first year, represent about a quarter of all congenital heart defects.
Jimmy’s son fell into the latter category, with Tetralogy of Fallot, bad plumbing in the heart, causing oxygen-poor blood to circulate out into the body without picking up a fresh supply of oxygen from the lungs. Hence the newborn baby turning blue.
I have firsthand experience with this, as my youngest son was born with the same heart defect. He needed surgery as an infant and then two additional open heart procedures before reaching adulthood. I have walked in Jimmy Kimmel’s shoes and understand exactly what he is feeling – terror, anguish, guilt, helplessness, and hopelessness.
We all empathize with the Kimmel family and wish them well. But there is room for hope and optimism. Shaun White, snowboarding champ, had the same heart defect. My son easily ran a Tough Mudder race, while I was huffing and puffing, trying to keep up with him. The wonders of modern surgery. The first steps in fixing these troubled hearts occurred in the 1940s at Johns Hopkins University and was chronicled in the film Something the Lord Made.
History aside, and politics aside, one can’t help but feel empathy for Kimmel and his family. But unfortunately, politics wasn’t aside in his monologue. As Rahm Emanuel once said, “you never let a serious crisis go to waste.” And Kimmel did not.
In the second part of his monologue, Kimmel pivoted from family health crisis to typical late-night comedy show shtick, bashing Donald Trump, Republicans, conservatives, and all things not liberal. Kimmel made a pitch for pre-existing condition coverage under Obamacare and for National Institutes of Health funding, which Trump threatened to cut in his proposed budget.
The House, in their recently passed Obamacare replacement bill, created a convoluted process where, “under certain conditions,” insurers could charge premiums based on an individual’s health as well as providing federal funding for high risk pools. NIH funding was increased by $2 billion in the recent House budget continuing resolution bill. Not the gloom and doom Jimmy Kimmel was predicting.
What I would like to address is his premise, delivered on his show, that “those born with congenital heart issues like his son could be turned down for health insurance because they were deemed as having a pre-existing condition.”
First, a baby born to parents with health insurance will be covered under the parents’ plan. Pre-existing conditions in this case are moot. The child can remain on his parents’ plan until age 26, something not likely to change in any replacement bill. After age 26, the situation changes, but who knows what the insurance landscape will look like in a quarter of a century?
Second, a newborn baby with a health emergency would not and legally could not be turned away from the hospital, regardless of insurance status or ability to pay. Billy Kimmel would have had his surgery even if his father were poor and uninsured.
Jimmy Kimmel praised Obamacare but left out a few important bits, quite relevant in his circumstance. How might little Billy have fared if his parents had a standard Obamacare insurance plan?
First scenario. Suppose that the Kimmels had a bronze plan with a $12,000 deductible – pocket change for Jimmy Kimmel, but one quarter of the average family income, currently $52,000. To be paid up front. And that’s each year, for a child likely to need regular cardiology appointments, ultrasound and stress tests, catheterization, and possibly medication. Unaffordable to the average family.
Second scenario. Regardless of which type of Obamacare plan the Kimmels had, suppose their particular plan had a narrow network of providers – physicians and hospitals. Not an issue for Billy Kimmel as he was turning blue and needed urgent surgery. What if, instead, he had a heart murmur but was otherwise stable, not turning blue, oxygenating well? He would have been discharged a few days after birth with instructions to see a pediatric cardiologist.
Suppose Cedars-Sinai, UCLA, and Children’s Hospital of Los Angeles were all out of network for his insurance, with the only in-network hospital being one with a mortality rate for pediatric open-heart surgery three to five times the national average.
This is not fear-mongering, but reality, as mortality rates indeed vary widely between hospitals. Now what? Accept lower-quality care by necessity because the top-tier hospitals won’t take his insurance? How different is that from the issue of pre-existing conditions?
Obamacare may provide insurance, but what good is it if it is still unaffordable in terms of premiums, co-payments, and deductibles? Or if the doctor or hospital you want to use won’t accept your insurance? And the one that does may be of below average quality?
What happened to “If you like your doctor you can keep your doctor”? That part is conveniently overlooked by Jimmy Kimmel, who, based on his economic status, won’t ever have to contend with such issues.
I’m happy that Billy Kimmel received the same level of care my son did for his heart defect. And that he will have the potential to be the next Shaun White. But please don’t tell us about the virtues of Obamacare, which you don’t need or use, and which doesn’t serve desperate children and their families as well as you think it does.
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Most important question is, what if you are not Jimmy Kimmel? Most people arguing with that he can get an outstanding service because he is Jimmy Kimmel. What if Mr. John Doe find himself in the very same situation?
While I agree that the ACA is not the most affordable plan, the proposal changing in the ACHA would not have placed Kimmel and his family in a better position. One question I do have is, if the child has a pre-existing does that parents have to pay for their insurance under the ACHA? In addition, yes, the hospital cannot turn any children away from emergency care, however they can send a huge medical bill to the family who will be responsible for the cost of the procedures. Going to the ER does not mean they don’t have to pay, it mean they will have to pay later, which can be up to tens of thousand A DAY! In the end, I wish the best for his family, and anyone else who has to deal with this.
How do you conclude that the new legislation will provide less expensive coverage? Of course bronze and even silver Obamacare plans are not ideal at low income levels…but the replacement plans do not improve on that, and in addition are predicted to cover many millions fewer people…both Medicaid and exchange. Going to an emergency room does not constitute “access” to quality health care in this country.
“How do you conclude that the new legislation will provide less expensive coverage?”
Trump said it would be cheaper and better didn’t he? The only way to get to cheaper coverage is to reduce benefits – it’s the math.
“Going to an emergency room does not constitute “access” to quality health care in this country.”
Only to Republicans.
While I agree with the premise that ACA deductibles and choice are far from ideal, I don’t agree with your statement “but who knows what the insurance landscape will look like in a quarter of a century”. Tell that to today’s 23-year olds with CHDs or to the 21-year old with CHD with a freelance profession. Before the ACA they all were having heck of a time getting insured. And most likely because of the lack of good insurance, their transition from pediatric to adult care is universally poor. Only in the last 10+ years it has improved thanks largely to advocacy work but it’s very far from ideal too.
This is not a “sob story” as someone below callously suggested. It’s the life of many people, 1 in 120 to be precise. CHDs are actually a perfect example where it’s imperative to have government involvement because it’s the government that gets involved with public health, not the private sector, and right now the CHD care continuum is driven by the private sector. They are not preventable and require highly-specialized in-hospital and ambulatory care for a LIFETIME. We need the government to agree on some standard quality measures risk-adjusted for age and complexity, so if centers are not meeting them, no payer, private or public, should cover care there. So, no, it’s not simple and yes, it’s important to talk about.
I sobbed right there with J. Kimmel.
My point is not to argue ACA versus AHCA. Especially since the latter is only an opening gambit, a House bill, not a law that if it ever makes it through the full legislative process, will look far different from the House bill. Kimmel’s implication is that under ACA, children like his will get care similar to his kid. My point is that these kids do get cared for, as they did pre Obamacare. And in some situations Obamacare can make it more difficult for them. He is using his family health crisis for political gain.
Maybe the kid needed a shunt as a temporizing measure. Total repair when he is older. That was the process for my son, though the shunt was a few months after birth.
“My point is that these kids do get cared for, as they did pre Obamacare.”
Pre-Obamacare they would get treated, at least on emergency basis, but who pays for the care if the patient is uninsured? At least ACA provided care givers payment.
” And in some situations Obamacare can make it more difficult for them.”
Obamacare “more difficult” than being uninsured? Please tell us how?
I am less certain about that than you. There is actually a body of literature on outcomes for people w/o health insurance. Outcomes are worse. There is actually a paper specifically addressing pediatric patients and post-op outcomes of those who do not have insurance, and outcomes are worse. If my archives were in better shape would link for you, however we also have that documented for ICU care.
As to Kimmel’s motives, I think you can get in trouble assigning motives to others when you don’t really know for sure. I have cried more than once over our special needs kid and have seen lots of parents cry when handing their kids over to me. It really does look like the AHCA will leave a lot of people w/o insurance so I don’t think it so far fetched to worry that other people will have worse care as a result.
Outcomes for people without insurance might be more reflective of socio economic status. Conflating socio economic status with other healthcare variables often leads to the wrong impression. This is frequently done for ideological reasons.
Brian- Most Tet babies don’t have surgery right away. Yes, if it is an emergency they get surgery. If the parents don’t have insurance, more likely to be the case under the AHCA, the kid gets (could) poor care up until the surgery takes place. (In reality they will mostly be followed in academic institutions and insurance won’t be so much of an issue.)
Next, narrow networks aren’t really going to matter that much. Not that many parents can afford to take their kid far away for surgery. The reality is that most are going to take their kid to the nearest pediatric cardiac program. If you live in a big city you have some choices, but otherwise you really don’t. (I spend some time working at a critical access hospital in a very poor area. We have a decent peds facility an hour away. We have a world class place another 40 minutes away (CHOP). Almost impossible to persuade parents to go that extra 40 minutes.)
Last of all (almost), deductibles? Really? You do know that higher deductibles is part of the AHCA plan?
Last, really, that staying on insurance until the age of 26 thing? Came from the ACA.
…”but what good is it if it is still unaffordable in terms of premiums, co-payments, and deductibles?”
So the ACA is the only insurance with unaffordable premiums, co-pays and deductibles?
This needs to be fixed for ALL insurance. At least under the ACA his son won’t have a lifetime cap.
“Billy Kimmel would have had his surgery even if his father were poor and uninsured.”
But certainly with bigger bills unless he could be accepted to and get to St. Jude or similar.
“Regardless of which type of Obamacare plan the Kimmels had, suppose their particular plan had a narrow network of providers – physicians and hospitals.”
So non-ACA don’t have narrow networks? This also needs to be fixed for all insurance.
The ACA is insurance, that works if you get a subsidy and have a pre-exist, or so it seems for all the town hall folks outraged at their Repug reps.
These are the same arguments put forth by the repeal folks who want to go back to no alternative for the uninsured. As to the the replace part, will it be affordable with lower co-pays and deductibles – only yes if coverage is cut.
It’s the math of actuarial tables, not magic.
1. I didn’t reveal it. He did. I’m not the child’s physician.
2. Who knows? AHCA is only a passed House bill at this point, not statute.
3. Good question, hopefully better than now (see below)
4. Multiple times. My family and I have employer based commercial insurance. Many Denver physicians are out of network for us. So we either stay in network or pay cash.
Fortunately I don’t have an Obamacare policy. If I did, and had cancer and lived in NYC, I couldn’t go to the mecca for cancer care…
Of course it’s not the hospitals’ fault for leveraging their brand to charge exorbitant prices. Not to mention the fact that those brand name hospitals you cited don’t even always have better outcomes than less glamorous less expensive hospitals.
Last, pretty disingenuous to pretend that Obamacare is the root of all evils when the pre-Obamacare situation was 100 times worse and the AHCA situation will merely be 50 times worse. Seriously, what’s the point of this post?
1. Is revealing the diagnosis of Mr.Kimmel’s son a HIPAA violation?
2. What would be the equivalent annual premium under the AHCA plan?
3. What will be the accessibility to “top-tier hospitals” under the AHCA plan?
4. Based on your economic status, did you ever really have to contend with such issues?
Thanks Bryan! Probably the best article I’ve read on this site and I’ve written one!
It’s great because it’s factual and brave to stand up to the propaganda. For some reason his diatribe really bothered me. Pre-ex would not apply, he’s on his parents plan ,so few understand how things work and every sob story is exploited by these Hollywood types who are so out of touch. I’m sick of these late night hosts and their bias. Would Johnny Carson ever pull stuff like that? Even libs like Leno and Letterman didn’t pull stuff like these guys, they are clueless and have no idea how great this country and the reasons it’s great. And it’s not great because of crap legislation like the ACA.
“so few understand how things work and every sob story is exploited by these Hollywood types who are so out of touch.”
Kimmel can answer that.