Late-night host Jimmy Kimmel made an emotional plea to lawmakers to fund health-care spending for preexisting conditions on May 1. Kimmel teared up while discussing his newborn son Billy's heart condition on his show. (Amber Ferguson/The Washington Post)


Social media is burning up over the heartfelt plea for universal health care that Jimmy Kimmel made on Monday night. Kimmel repeatedly teared up as he recounted the jarring discovery that his newborn baby has heart disease that required immediate surgery, and then pointed out that before Obamacare became law, people with preexisting conditions — such as his new baby — could eventually be denied health insurance.

“We were brought up to believe that we live in the greatest country in the world, but until a few years ago, millions and millions of us had no access to health insurance at all,” Kimmel said. “If your baby is going to die, and it doesn’t have to, it shouldn’t matter how much money you make. I think that’s something now, whether you’re a Republican or Democrat, or something else, we all agree on that, right?”

Some are hoping this powerful moment will shift the argument decisively against the GOP health-care bill, if it garners enough attention. But in one important sense, it is unlikely to do that — and this, I think, sheds new light on a profound problem at the core of our current health-care debate. The problem is not that Kimmel and President Trump fundamentally disagree over what our health system should look like and that Kimmel’s case will simply fail on the merits to persuade Trump to see things his way.

No, the conundrum here is a good deal more confounding than that. It’s that Trump has persuaded himself that his plan would accomplish what Kimmel wants far more effectively than Obamacare would — in other words, that Trumpcare would be far better for people like Kimmel’s son than Obamacare has been, even by the lights of Kimmel himself. It’s hard to gauge whether this belief is rooted in even any effort at empirical analysis. He may have merely persuaded himself that whatever he signs simply must be better in all ways than Obamacare ever was, because otherwise he wouldn’t put the great Trump name on it. But the effect is that pleas such as that from Kimmel probably cannot penetrate his thinking at all.

This conclusion is very hard to avoid when you read the newly posted transcript of Bloomberg’s interview with Trump on Monday. In it, Trump suddenly said the GOP health bill is only a work in progress and that the final bill will be “every bit as good on preexisting conditions as Obamacare.” In reality, the current GOP bill guts protections for preexisting conditions. It allows states to waive the ban on jacked-up premiums on people who suffer from them — provided that states set up another mechanism such as “high-risk pools,” which historically have been plagued by under-funding, soaring costs and people going without coverage. Thus, the GOP bill could drive up sick people’s premiums astronomically and drive many out of the market.

But it is unclear whether Trump fully grasps that the GOP bill does these things, or the consequences they might have. In the Bloomberg interview, Trump was repeatedly pressed on whether the bill will protect people with preexisting conditions, and again and again, he fell back on the argument that it will be better on this front than Obamacare is, mainly because Obamacare is a disaster, and no more needs to be said. It’s as if this is all he really needs to know about the bill that will one day bear his mighty signature. In his Sunday interview on CBS, Trump showed a bit of awareness of the debate, referring to the “pools” in his plan, but he falsely equated this with a guarantee of protection for people with preexisting conditions.

After failing to repeal and replace the Affordable Care Act, Republican leaders said it will "implode." Health-care experts disagree, saying the ACA is stable under current law — but President Trump and congressional Republicans could change that. (Daron Taylor/The Washington Post)

Conservatives have long complained — understandably — that Trump secretly supports a far more robust government role in expanding coverage to the poor and sick than they do. And in the abstract, he may. In the Bloomberg interview, he says that he wants people to be taken care of and that his plan does this. If we take him at his word — if we assume he really wants this and believes his plan would do it — then this topic cannot be meaningfully debated at all. The dispute is not over whether people with preexisting conditions should be guaranteed access to coverage — which he says he believes — but rather over whether under his plan they actually will get this guarantee. But such a debate with Trump is beyond reach.

In fact, some Republicans know this is not the case. Some oppose the plan because it will not be nearly as good for people with preexisting conditions, as a candid statement from Rep. Billy Long (R-Mo.) explains well. Even Republicans who support Trumpcare understand this (though they are not always candid about it), but they genuinely believe the Affordable Care Act’s protections are not worth trade-offs they require. With those Republicans, we can at least debate this topic. We can argue that we think the trade-offs required for achieving those protections — and the ACA’s historic coverage expansion more generally — are worth it. But we can’t have this debate with Trump, because his plan, by definition, simply must be infinitely better than Obamacare and far more terrific for everyone, in every conceivable way. So there’s no obvious way Kimmel that could change Trump’s mind — no matter how powerful his plea.


* GOP STILL LACKS VOTES FOR HEALTH BILL: HuffPost’s Matt Fuller reports that House Republicans were still struggling to round up votes to pass repeal-and-replace, as of late last night:

Support among the rank-and-file is squishy and opposition among moderates doesn’t look any less fierce than days before … Even some GOP deputy whips … David Valadao (R-Calif.), Elise Stefanik (R-N.Y.), Kevin Yoder (R-Kan.), and Erik Paulsen (R-Minn.) … all reported Monday that they hadn’t made up their minds.

Fuller’s latest whip count: 19 Republicans look firmly against it; nine are leaning No; and more are undecided. The Hill’s count is at 21 committed No votes. Both are close to the 23 No votes needed to derail the bill.

* KEEP AN EYE ON VULNERABLE REPUBLICANS: The Washington Examiner reports that those House Republicans who are holding out against the GOP bill tend to be from districts that Hillary Clinton won or that Trump carried only narrowly:

House Foreign Affairs Committee Chairman Ed Royce is a new addition to the ranks of the official undecideds. [His] district voted for Clinton over Trump by a 51.5 percent to 43 percent margin … Rep. Mario Diaz-Balart, R-Fla., is another red flag … Diaz-Balart is unsure of his vote … Voting for the AHCA in its present form could be a problem for him in 2018 in a district that only voted narrowly for Trump over Clinton, 49.6 percent to 47.9 percent.

They know Democrats are eager to attack them for gutting protections for preexisting conditions — and that they’d be risking their careers to back something with little chance in the Senate.

* GOP SENATOR EXPRESSES SKEPTICISM OF HOUSE BILL: The bill would permit states to allow jacked-up premiums on preexisting conditions, if states set up high-risk pools for them. Sen. Bill Cassidy (R-La.) suggests that this breaks a Trump promise:

Cassidy was skeptical of the modified AHCA, which creates high-risk pools for people with preexisting conditions. “I suspect the advocates for the bill will say that’s their guarantee,” he said. “I will insist that the president’s pledges be met. And the president pledged that he would take care of people with preexisting conditions.”

Even if the House bill does pass the lower chamber, this is an early sign of what will happen to it in the Senate.

* DEMS TO UNLEASH MAJOR AD BLITZ IN GEORGIA: The Atlanta Journal-Constitution reports that Democrat Jon Ossoff is preparing to unleash a $5.2 million blitz of ads in the special election for a House seat in the Atlanta suburbs. The spending is meant to counter millions of dollars that conservative and Republican groups are pouring into the battle.

The massive amounts raised by Ossoff are a sign of the extraordinary energy that is animating Democrats right now, and a victory here could help sustain that heading into 2018. One recent internal Democratic poll has the race as a dead heat.

* TRUMP AFFECTION FOR STRONGMEN ALARMS RIGHTS ADVOCATES: The Post reports that human rights advocates are increasingly worried about Trump’s praise of totalitarian leaders and strongmen, because it is emerging as a meaningful pattern:

In an undeniable shift in American foreign policy, Trump is cultivating authoritarian leaders, one after another, in an effort to reset relations following an era of ostracism and public shaming by Obama and his predecessors … Trump has willingly turned a blind eye to dictators’ records of brutality and oppression in hopes that those leaders might become his partners in isolating North Korea or fighting terrorism.

As The Post’s story notes, Trump has yet to use the power of his office to “champion human rights and democratic values around the world.”

* HISTORIANS GRAPPLE WITH TRUMP’S LATEST: Trump continues to defend his suggestion that Andrew Jackson might have stopped the Civil War if he’d been president at the time, tweeting: “Would never let it happen.” Historian Jon Meacham has this rejoinder:

“The expansion of slavery caused the Civil War. And you can’t get around that. So what does Trump mean? Would he have let slavery exist but not expand? That’s the counterfactual question you have to ask.”

I think Trump really means that Trump would never have let it happen and that Trump would have averted the Civil War while ending slavery, through his combination of toughness and savvy dealmaking.

* AND THE TRUMPISM OF THE DAY, DEARTH OF A SALESMAN EDITION: Axios reports on a phone call that a House Republican claims he had with Trump:

During a recent phone conversation about the evolving health-reform bill, President Trump asked a simplistic but apparently sincere question: “Is what we are going to do going to take care of people? What I told people is: We’ll take care of people.”

No deep dive on the detail. But Trump, the salesman, wanted reassurance selling a big, complicated product he doesn’t fully understand.

It’s not clear whether Trump meant to ask whether the GOP bill actually takes care of people or whether it can be sold that way. It’s also not clear he appreciates the difference.