Jimmy Kimmel, the talk show host who has become the unlikely face of opposition to Senate Republicans’ latest health care push, insisted he had done his homework.
Kimmel spent a second straight night arguing against the proposal on Wednesday. Sen. Bill Cassidy of Louisiana, a co-sponsor of the bill, responded by telling news outlets that “Jimmy doesn’t understand.”
Earlier this year, the men seemed to be on the same page. Cassidy had appeared amicably on the program in May after Kimmel told an emotional story about his infant son’s heart condition. In an appearance a week earlier on CNN, Cassidy had coined the “Jimmy Kimmel test” when he was asked about insurance companies capping their payouts to customers.
“As you present that, I ask: Does it pass the Jimmy Kimmel test?” he said. “Would a child born with a congenital heart disease be able to get everything she or he would need in that first year of life? I want it to pass the Jimmy Kimmel test.”
But in recent days, Kimmel argued that the bill Cassidy had co-sponsored fell short. A review of the factual statements in Kimmel’s Wednesday night monologue suggests he has a strong grasp on the proposal, though there are nits to pick.
Kimmel said the bill would cut $243 billion in funding, but Cassidy claimed some states would see “billions more.”
The Congressional Budget Office has not provided a score of the bill yet, but three groups have recently released estimates. Kimmel cited the highest of the three, which comes from the left-leaning Center on Budget and Policy Priorities. Avalere Health, a Washington-based consulting firm, estimated the states would lose $215 billion federal funding through 2026. The Kaiser Family Foundation released a lower figure Thursday morning: $160 billion.
Cassidy claimed his bill provides more funding to “states passed by Obamacare,” like Maine, Virginia, Florida, and Missouri. But according to all three groups, Florida would lose billions by 2026. Avalere and CBPP estimate that Maine would also see less money, while funding to Virginia and Missouri would decrease beginning in 2027.
It’s also misleading to characterize these states as “passed by Obamacare.” All four “deliberately” chose not to expand their Medicaid programs, said Sara Rosenbaum, a professor of health law and policy at George Washington University.
The groups found that funding would decrease in 30-some states but increase in more than dozen — largely states that did not expand Medicaid. In 2027, when the bill’s funding expires, funding would shrivel across the board.
Kimmel said people with pre-existing conditions may not be able to afford coverage, but Cassidy said the protections are “absolutely the same.”
“There is just no question that protections for people with pre-existing conditions are at risk under this bill,” said Larry Levitt, a senior vice president at the Kaiser Family Foundation.
While Cassidy’s bill forbids insurers to deny coverage to people with pre-existing conditions, it does permit states to obtain waivers that allow insurers to charge more based on health status.
Cassidy’s argument hinges on a provision in the bill that requires states to describe how they intend to provide “adequate and affordable health insurance coverage for individuals with pre-existing conditions” if they approve a waiver. Experts are skeptical that the requirement will amount to the same level of protection as the Affordable Care Act.
The current law “has layer on layer of requirements and prohibitions, all of which are aimed toward ensuring that people with health issues have the same access as people who are healthy,” said Timothy Jost, an expert on health care at Washington and Lee University. Cassidy’s bill, he said, contains a “simple promise” without a guarantee.
The bill does not define “affordable and adequate,” leaving states to interpret the requirement as they see fit. Jost speculated that high-risk pools, which tended be very expensive to insure before the current health care law took effect, may be acceptable to some states.
The measure also does not stipulate any way to make sure that states and insurers follow through with their declared intentions.
Kimmel said federal funding “disappears completely after 2026,” but Cassidy disputed that.
Kimmel is correct that the bill authorizes block grants through Dec. 31, 2026, with no mention of funding after that year. Independent policy groups estimate that all states will begin to see a reduction in funding beginning in 2027.
Cassidy expressed confidence that block grants would be reauthorized because they are created as an amendment to the Children’s Health Insurance Program, a federally financed program for low-income children that he said was “just reauthorized” and for which “there’s always bipartisan support.”
“That doesn’t, however, mean that its continued funding is tied to CHIP,” Levitt said.
Rosenbaum also pointed to the current dilemma facing the program. Two senators introduced a bipartisan bill to extend funding for five years on Sept. 18, but funding for CHIP expires Sept. 30 and Congress has yet to reauthorize the program. In a Kaiser Family Foundation survey of 42 states, 32 said they “will exhaust federal funds as of the end of March 2018.”
Kimmel said insurers can opt out of providing essential benefits.
The bill allows states to waive the Affordable Care Act’s requirements that insurers provide “essential health benefits.” These are 10 categories of benefits that include maternity care and pediatric services, as well as hospitalization and mental health care.
Kimmel inaccurately described what Cassidy had promised “to my face.”
When the senator appeared on Kimmel’s show in May, they found considerable common ground, but Cassidy did not make the specific promises Kimmel said he did — at least, not on the show.
The two did not discuss pre-existing conditions during the five-minute interview, except for a passing mention in reference to President Donald Trump’s stance. When Kimmel asked about annual or lifetime payout caps, Cassidy suggested they were unnecessary but stopped short of a promise.
“Yeah, as it turns out, the caps don’t contribute — having a cap does not contribute that much to the expense,” Cassidy said in May. “You can eliminate that cap and it does not really impact the cost of the policy. It does to an extent, but not to such an extent that you have to have them.”