. Kimmel has set himself up as the conscience of the current debate over the last effort at reforming health insurance, and Washington now talks of the “Jimmy Kimmel test,” which demands that insurance companies be obliged to cover preexisting conditions without exception or penalty.
We wish the very best to Jimmy Kimmel and his young son, Billy, but holding up cute babies is a dumb way to approach complex policy questions.
The basic architecture of the Affordable Care Act mandates that insurance companies essentially ignore preexisting conditions when writing new policies, obliging them to insure against events that already have happened — essentially requiring them to bet big on the Falcons in Super Bowl LI. It creates a perverse incentive: If there is no cost for the coverage of preexisting conditions, then people have no incentive to buy insurance at all until they are sick and need the benefits.
Experimenting with different approaches to preexisting conditions would in fact be desirable; there is no reason to suppose that the best solution for New Jersey is also the best solution for Oklahoma, and the only thing that is entirely clear about the preexisting-conditions approach put forward in the ACA is that it is not working.
Before the ACA, there were a great many Billy Kimmels whose parents had health insurance they could afford and that worked for them. And there is no health-care system — not the ACA regime, not the Graham-Cassidy reforms, not a British-style government-monopoly system — that would in fact ensure that every child in Billy Kimmel’s situation would receive everything he might need and his parents might desire at a price they can afford.
In the U.S. context, that means a number of parallel systems (individual insurance, employer-based plans, Medicare, Medicaid with many state-level variations, the VA system, etc.) That is not going to be sorted out by a late-night comedian or two and sympathetic appeals about sick children.