The Transom, Ben Domenech, May 4, 2017

Yesterday the New York Times published a piece titled: Pre-Existing Conditions: Evaluating Competing Claims.   Written by a former Politifact fact-checker, it mentions and links to Jimmy Kimmel’s recent viral plea regarding his son, which you’ve doubtless seen by now and has been responded to by former President Obama and Hillary Clinton. But the NYT doesn’t check Kimmel’s comments for accuracy in the text, except to say: “It was less common for insurers to deny coverage to children with pre-existing conditions, such as Mr. Kimmel’s son, than to their adult peers, Larry Levitt of the Kaiser Family Foundation said. “But it certainly did happen,” he said.”

But how often did it happen? Kimmel claimed it happened quite a lot. “Before 2014, if you were born with congenital heart disease like my son was, there was a good chance you’d never be able to get health insurance because you had a pre-existing condition. You were born with a pre-existing condition. And if your parents didn’t have medical insurance, you might not live long enough to even get denied because of a pre-existing condition.” That’s a significant claim, and certainly many people find it moving. Is it so wrong to ask that it be backed up with facts?

I’ve since asked the writer, whose Twitter bio invites suggestions for fact-checks, that she do so.  This is important, after all. Kimmel’s appeal is understandably emotional. But his claim – that before 2014, there was a good chance infants born with congenital heart defects would never be insured, is an audacious one considering the facts. As Hadley Heath Manning notes:   “Anyone who has welcomed a new baby knows that you have 30 days to add a new son or daughter to your health insurance plan. This was the case before Obamacare, and it’s the case now. What many people may not know is that, even before Obamacare, insurance companies added newborn infants at standard rates, regardless of their health condition, because of guaranteed renewability laws.”

So to be clear we’re talking only about the children of the uninsured, and we are supposed to take it on Kimmel’s word that a significant number of those born with congenital heart defects never received insurance of any kind – governmental or private – through the massive number of Medicaid, CHIP, and high risk pool programs already in existence prior to Obamacare?

This point is lost in the shuffle, of course. People like CNN’s Matt Lewis have gotten huge blowback from saying Kimmel’s emotional monologue wasn’t the ‘right move.’  And MSNBC’s Elise Jordan has not been the only one to use it as an attack on the GOP, saying that ‘dead babies’ not ‘good messaging.’  Well, tell that to Planned Parenthood. But all this suggests a binary situation: that before Obamacare, children born with congenital heart defects were facing a death sentence and their parents facing bankruptcy because of our existing system.

According to research cited by the CDC, from 1999–2006, there were 41,494 deaths related to congenital heart defects in U.S. That number includes much older individuals – a bit less than half of those deaths were among infants aged one or younger.  20,000 deaths of the youngest and most vulnerable among us is of course a sad result, and our hearts should go out to anyone facing such calamity. But our survival rate in America for children born with non-critical defects has risen to 97 percent, and for critical defects has risen to 75 percent – and 69 percent of whom will make it to 18. That’s an incredible medical feat considering how low rates of survival were in the past.

Today, there are over 2 million children, adolescents, and adults living with congenital heart defects. They will face increased costs over their lifetime, yes, and we should do what we can from a policy perspective to mitigate that. But the point is this: there is nothing about this situation that requires a massive overhaul of the entire American health care system in order to better aid those born with congenital heart defects. And it ignores what’s actually going on right now all across America with the existing insurance market.

Sarah Kliff – no Obamacare critic she – yesterday cited examples of insurers pulling out of entire areas as the reality of how Obamacare explodes.  Aetna is now pulling out of Virginia’s individual market, citing big Obamacare losses.  And Medica, the last insurer selling individual health policies in most of Iowa, is likely to exit the state.

Let’s accept for the sake of argument that what Kimmel says is true, that all 20,000 of those poor infants born with congenital heart defects in the space of seven years before Obamacare’s protections died uninsured and without quality care. My question for anyone citing that story would be: What does it matter if the government requires insurers to do something if the insurer isn’t even selling insurance in the marketplace? You can force insurers to change a product. You can’t force them to stay in business to sell it.

Today the House is likely to pass the AHCA in amended form, with an additional eight billion dollars in funding through 2023 to lower premiums and support high risk individuals via state programs.  It’s not an ideal legislative solution at all, in my book, and the Senate is certain to make significant changes to it. But to act as if the AHCA represents the end of coverage for infants with congenital heart defects is just not true. It represents supporters of Obamacare making the same mistake so many critics of Obamacare did – ascribing to it too much importance, as if before Obamacare American health insurance was the Wild West, and after Obamacare all was government-run. The truth, as always, is a lot more complicated than that – and it’s important, particularly in this policy arena, to know the truth.