Trumpcare

Trump Defends Bill That Failed the “Jimmy Kimmel Test”

The president either doesn’t understand the bill he is promising to sign, or he is lying about its effects.
President Donald Trump
By The Washington Post/Getty Images.

Few Republicans, let alone most Americans, seem to know what’s in Graham-Cassidy, the fifth incarnation of the effort to repeal and replace Obamacare, though the bill may be on the verge of passing the Senate. There have been no public hearings, and no official score from the Congressional Budget Office.“If there was an oral exam on the contents of the proposal, graded on a generous curve, only two Republicans could pass it. And one of them isn’t Lindsey Graham,” one senior G.O.P. aide told Axios earlier this week. “You could do a post office renaming and call it ‘repeal-replace’ and 48 Republican senators would vote for it sight unseen.”

One of the few people grappling publicly with the bill’s effects was late-night talk-show host Jimmy Kimmel, who found himself at the center of the Obamacare-repeal debate in May when he announced that his infant son had been diagnosed with a heart disorder that would mean he would have a pre-existing condition for life. Before Obamacare, he said, his son might not have been able to get coverage. “If your baby is going to die and it doesn’t have to, it shouldn’t matter how much money you make,” Kimmel said. Senator Bill Cassidy, who would later appear on Kimmel’s show, termed it the “Jimmy Kimmel test”—and said that any piece of Republican legislation would have to pass it.

Four months later, Cassidy is one of the two primary co-sponsors of a bill that could strip those same protections away. And Kimmel is furious. “This guy, Bill Cassidy, just lied right to my face,” he said on his show Tuesday night. “He said he wants coverage for all; no discrimination based on pre-existing conditions; lower premiums for middle-class families; and no lifetime caps. And guess what? The new bill does none of those things.”

Cassidy isn’t the only one misrepresenting, or perhaps misunderstanding, what the latest Republican effort to repeal Obamacare would mean for people with pre-existing conditions. “I would not sign Graham-Cassidy if it did not include coverage of pre-existing conditions,” President Donald Trump wrote on Twitter Wednesday night, as Kimmel’s monologue went viral. “It does! A great Bill. Repeal & Replace.”

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This, as Kimmel correctly noted, is not true. Graham-Cassidy doesn’t strip away the Affordable Care Act provision that requires insurers to cover sick Americans. But it does allow states to apply for waivers that would allow them to opt out of a number of regulations that currently prevents insurance companies from charging exorbitant rates for people with pre-existing conditions. Under Graham-Cassidy, states could lift that ban; remove the requirement for insurers to cover “essential health benefits,” such as emergency services and prescription costs; and impose higher premiums based on an individual’s age. The bill also rolls federal spending for Obamacare and Medicaid into block grants for states, which would result in a dramatic decrease in subsidies over time. The result would be rising premiums, which would almost certainly incentivize states to apply for waivers to shunt the sickest and most vulnerable populations into their own high-risk pool.

“Kimmel did not overstate the impact,” Georgetown University’s Center for Children and Families director Joan Alker told Politico. “If Graham-Cassidy becomes law, there is no guarantee a child born with a congenital heart defect will get the coverage they need. It would depend on where they live, but even states with good intentions would struggle to protect children with the massive cuts to Medicaid included in this bill.”

Proponents of the legislation counter that states must include an explanation of how they will provide “adequate” and “affordable” health-care options for individuals if they apply for waivers. “Knowing that states may want to experiment, we specify that in the waiver request they must have adequate and affordable coverage for those with pre-existing conditions,” Cassidy said. But that is a far cry from a guarantee. The terms “adequate” and “affordable” are not defined in the text of the bill. As Chris Sloan, a senior manager at the health-research firm Avalere, explained, “You could stretch the definition pretty broadly of what counts.”