Andy Slavitt

Opinion columnist

Every so often, a “national moment” takes us out of our day-to-day and helps shape our national thinking. The Exxon Valdez oil spill helped forge our national opinion about environmental responsibility. Terri Schiavo’s life-support case made the public contemplate a dignified death. Someday, when we look back on the current health care debate, we may see how a national moment helped us articulate a new consensus when late night TV host Jimmy Kimmel told the poignant story of the birth of his son, Billy.

For those who missed it, Billy was born with a serious heart condition that required emergency surgery. There were many important parts to Kimmel's tale — from the nurse who first noticed a problem to the heroism of the doctors and clinicians who conducted open heart surgery that saved the infant's life.

But what made the Kimmel moment resonate was the juxtaposition of our hopes and needs as parents in the health care system with the stark reality of the Republicans’ American Health Care Act. On Wednesday, three weeks after the House passed it, the latest version of the AHCA finally had its impact evaluated by the non-partisan Congressional Budget Office, and the results were stunning: Similar to an earlier report, 23 million fewer people would be insured a decade from now. In addition, coverage would be unavailable or prohibitively expensive in large parts of the country for services such as mental health, substance abuse, maternity and pediatric dental care. Out of pocket costs would increase too as lifetime caps, outlawed under the Affordable Care Act, would return.

Kimmel’s experience forces the question that is boiling just below the surface — whether Americans have a basic right to health care, or whether that right is reserved for those who can afford it. Or as Kimmel simply put it, “No parent should ever have to decide if they can afford to save their child’s life.”

In 2010, the ACA took a big step toward guaranteeing that people wouldn’t need to choose between getting care and losing their home. Since it became law, it has helped reduce personal bankruptcy filings by half. At the core of the debate about the bill before the Senate is whether we want to build on that progress or surrender the health and financial security millions of Americans have gained.

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If the AHCA becomes law, people like Billy with pre-existing conditions would lose protection against being charged more for insurance. The prohibition against lifetime caps and the requirement that insurers cover a package of basic essential benefits would also disappear. Like many parents in his shoes, Kimmel shudders at the thought of his son growing up without access to care through no fault of his own.

To be sure, there are voices arguing against the right to health coverage. Rep. Raul Labrador, R-Idaho, recently said, “Nobody dies because they don’t have access to health care.” Newt Gingrich ridiculed Kimmel because, in his view, the emergency room is required to treat kids like Billy. Some politicians who have never been without access to care may like to believe that people without insurance will all be cared for, but they are grossly misinformed.

Emergency rooms are required to treat life-threatening cases, but unlike Medicaid, they don't have to provide the many other services and treatments people need. Without insurance, Billy would have had the experience described by John Phillips, a pediatric cardiologist in West Virginia. Beyond the immediate emergency, he writes, “care, procedures and surgeries ... are only possible if the child has health care coverage that allows the family to afford them.” With most kids in West Virginia living in or near poverty, he says, there's only one way to honor their “basic right” to care for everything from juvenile diabetes to congenital heart conditions to asthma: Medicaid.

In every community, Medicaid is the program that handles the needs of children, seniors in nursing homes, low-income people and people with disabilities. The bill in front of the Senate would cut Medicaid by more than $800 billion over 10 years, or 25%, to pay for large tax cuts for the wealthy.

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Kimmel’s experience crystallized the national debate for at least one Republican senator. Bill Cassidy of Louisiana, a doctor, told CNN he won’t support a bill that doesn’t pass “the Jimmy Kimmel test.” Appearing on Kimmel’s show, Cassidy and Kimmel agreed on that test: “No family should be denied medical care, emergency or otherwise, because they can’t afford it.”

Given our divisions, it’s often hard to imagine reaching a consensus in this country on anything. Yet polls show Americans are increasingly aligning behind the Kimmel test, in favor of universal and affordable coverage ensured by the government. In one sign of the times, after Miss USA — Kara McCullough — called health care a privilege, there was such backlash that she soon softened her words. “I said it, and I’m going to own it. It is a privilege to have health care,” she said, then added: “Do I believe it’s a human right? Of course I do.”

How quickly this consensus translates from ordinary Americans to the Senate is now the big question. Our deliberative body is under pressure to create a “win” for President Trump in another rushed process, but senators like Cassidy understand that they are all that stands in the way of millions losing their access to care. To change course, his colleagues must speak up now and say they will never vote to allow this to happen under any circumstances.

Andy Slavitt, a member of USA TODAY's Board of Contributors, is a former health care industry executive who was acting administrator for the Centers for Medicare and Medicaid Services from 2015 to 2017. Follow him on Twitter: @ASlavitt

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