Jimmy Kimmel left out some important bits about Obamacare

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.

Brian C. Joondeph, M.D., MPS is a Denver based physician and writer.  Follow him on Facebook,  LinkedIn and Twitter.

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.

Brian C. Joondeph, M.D., MPS is a Denver based physician and writer.  Follow him on Facebook,  LinkedIn and Twitter.

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