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Mental health experts have praised celebrities like Sinead O’Connor, Justin Bieber and Jay-Z

More and more celebrities are opening up about their struggles with mental illness.

On August 4, Sinead O’Connor made headlines after sharing a hysterical video on Facebook of an emotional breakdown during which she contemplated suicide and opened up about her mental illness.

And she wasn’t the first to do so. 

Just last week Justin Bieber cancelled the rest of his world tour so he can heal his ‘mind, heart and soul.’

In June, Jay-Z surprised fans by mentioning his therapist in one of the 10 tracks featured on his most recent album 4:44. 

Smile, the third song on the album, breaches pressing issues including sexual identity and the difficulty of being a black man in America. And among those statements, he raps: ‘My therapist said I relapsed.’

And earlier this year Selena Gomez cancelled her world tour to take care of her mental health. She told In Style in an interview that cancelling it to check into a Tennessee-based treatment center was the best decision she’s ever made.

Though some people have criticized these celebrities for being over the top or exaggerating their conditions, mental health experts have praised their honesty. 

By expressing their personal troubles, celebrities are impacting and inspiring more honest discussion about mental health and removing the stigma from these issues.  

Earlier this year Selena Gomez cancelled her world tour to take care of her mental health. She told In Style in an interview that cancelling it to check into a Tennessee-based treatment center was the best decision she's ever made

Earlier this year Selena Gomez cancelled her world tour to take care of her mental health. She told In Style in an interview that cancelling it to check into a Tennessee-based treatment center was the best decision she’s ever made

Jay Z, Justin Bieber and Sinead O'Connor have been praised by mental health experts for recently opening up about their struggles with mental health. In June, Jay-Z mentioned his therapist in one of the 10 tracks featured on his most recent album 4:44

Just last week Justin Bieber made news for cancelling the rest of his world tour so he can heal his 'mind, heart and soul'

Jay-Z, Justin Bieber and Sinead O’Connor have been praised by mental health experts for recently opening up about their struggles with mental health 

Dr Parul Jain, from the Scripps College of Communication at Ohio University, told Daily Mail Online that when these celebrities speak about their battle with mental illness it destigmatizes the subject. 

‘Mental health is stigmatized and people feel discouraged to talk about it and about the difficulties they are facing,’ Dr Jain said. 

That impact seems to be particularly true in teenagers, who are already more influenced by these media figures. 

Data from the National Institute of Mental Health indicate 12.5 percent of teenagers between the ages of 12 and 17 had at least one depressive episode in 2015. 


Suicide rates among teenage girls reached a 40-year high in 2015, new data reveal.

The research from the National Center for Health Statistics showed 524 girls aged between 15 and 19 years old took their own life two years ago. 

That is the highest figure ever since records began in 1975, when 305 girls committed suicide. 

But it has not been a steady increase; the report reveals a recent spike, with rates doubling between 2007 and 2015. 

The figures, released on Thursday, come amid controversy over the Netflix show 13 Reasons Why, which some experts believe could be driving interest in suicide among girls and young women. 

The report showed suicide rates among boys the same age have dropped far below the peak between the 80s and 90s. 

However, suicide remains four times more common among teenage boys than teenage girls, with 1,537 suicides among males aged between 15 and 19 in 2015.

Meanwhile, suicidal thoughts and attempted suicides are more common among teenage girls, who tend to use pills, while boys tend to use guns.  

It is not clear what is driving the current increase in rates among girls – perhaps the current drug abuse and overdose epidemic, or internet bullying. 

The report did not specify the clinical background of those who committed suicide – whether they were in therapy, on medication, or went to hospital. 

Experts warn the figures, though lacking in detail, highlight the need to take delicate measures to treat mental illness in teenage girls.   

The institute also found 25 percent of teens between 13 and 18 had a lifetime prevalence of anxiety or an anxiety-related disorder. Suicide is the second leading cause of death among teens aged 15 to 19. 

Dr Jain said when celebrities open up about their experience with things like depression and anxiety, people are more likely to seek help. 

She said she came to this conclusion in 2015 after Bollywood Star Deepika Pukadone spoke openly about her battle with depression in an interview on a popular television channel. 

During the interview she spoke candidly about her symptoms, her coping mechanisms and her medical treatment.  

Dr Jain and her colleagues found in their research that this open communication influenced fans to see mental illness as something that was more common and to seek help if they are experiencing anything similar.  

‘I found that there was a strong correlation between people who knew and were fans of this actress and their desire to seek help for things like depression,’ she said. 

‘Even though people don’t actually know these celebrities, they feel like a friend or like a friendly face, and help people feel empowered to get help.’ 

Dr Jain also praised these celebrities coming forward because it serves similarly to a campaign for mental health. 

‘You don’t see as many campaigns for mental health as you do for things like smoking or binge drinking,’ she explained. 

‘But celebrities sharing their struggles tells people they aren’t alone and though they may be functioning it’s still good to speak out and to seek help.’  

She said this same effects have been seen when other celebrities come forward about other illnesses like cancer or HIV.

‘When Magic Johnson came forward as HIV-positive, and Angelina Jolie gave the interview where she talked about genetic testing, there was a visible movement of people who then sought treatment or testing,’ Dr Jain explained.

Speaking about Sinead O’Connor, Dr Jain said she isn’t sure if the video went too far or not.

In the video, which was posted to Facebook August 4, O’Connor sobbed through the words: ‘I’m fighting, fighting, fighting, like all the millions and millions that I know I’m one of – to stay alive every day.’

Dr Parul Jain said this same effects have been seen when other celebrities come forward about other illnesses like cancer or HIV. She gave the example of Magic Johnson, who said in a news conference in 1991 that he was HIV-positive

Dr Jain also brought up Angelina Jolie who got genetic testing to look for the BRCA gene

Celebrities fighting for personal causes: Dr Parul Jain said celebrities speaking out about  their diseases or treatment other than mental health have had a similar effect. She specifically mentioned Magic Johnson (left), who revealed in a news conference that he was HIV-positive, and Angelina Jolie who spoke about genetic testing for the BRCA gene

Speaking about Sinead O'Connor, Dr Jain said she isn't sure if the video went too far or not. In the video, which was posted to Facebook August 4, O'Connor sobbed through the words: 'I'm fighting, fighting, fighting, like all the millions and millions that I know I'm one of - to stay alive every day'

Speaking about Sinead O’Connor, Dr Jain said she isn’t sure if the video went too far or not. In the video, which was posted to Facebook August 4, O’Connor sobbed through the words: ‘I’m fighting, fighting, fighting, like all the millions and millions that I know I’m one of – to stay alive every day’

Barely able to speak at times, she left countless fans who viewed the 12-minute clip in no doubt about the reasons behind her public outpouring. 

She spoke about her suicidal thoughts and belief that she had been forsaken by those who should love her, saying she felt she was reduced to being ‘invisible.’ 

Dr Jain said the video could have served in two different ways: to trigger people with a similar mental illness, or as a wake-up call to people who are avoiding treatment.  

‘Seeing something so extreme and emotional could cause people to go back into their shell,’ she said. 

But, she said it could also serve as a ‘teachable moment’ for society, pushing people who might think they can function without seeking help to realize that there is a breaking point.

‘It could show people that this is something real and can happen to people who seem to be otherwise functioning,’ she explained. 

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‘Health Attacks’ on US Diplomats in Cuba Baffle Both Countries

“This is likely another installment in the long saga of spy-vs-spy in U.S.-Cuba relations,” said Peter Kornbluh, a co-author of “Back Channel to Cuba: The Hidden History of Negotiations Between Washington and Havana.”

The Cuban government has long harassed American government employees in Havana. Stories of feces left in diplomats’ residences became part of Cold War lore. The power would go out, and agents would tailgate diplomats’ vehicles and make it impossible to change lanes. But the recent sicknesses were worse than the standard harassment, even in the worst times, officials said.

“They would come into your house and erase the pictures of your kids off your computer, or turn all the books around on your bookshelf, just to show you that you had no privacy,” said James Cason, who ran the United States Interests Section in Havana a decade ago said. “They never did anything physical to anybody.”

This, he said, “sounds like a science experiment.”

The mystery deepened this week, when Canada said that its employees had also gotten sick.

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“Cuba has very good relations with them, so it doesn’t make sense for them to have been a target of something intentionally designed to injure, even if it was a rogue operation,” said William M. LeoGrande, a professor at American University who is the other author of “Back Channel To Cuba.” “None of the existing speculations make any sense to me.”

John Caulfield, chief of mission at the United States Interests Section in Havana from 2011 to 2014, said it was “inconceivable” that a third government would have been able to act without the knowledge if not the cooperation of the Cubans. The Cuban government, he said, kept “such close tabs on us they would’ve immediately detected someone else.”

He added, “My speculation is that it was a surveillance effort that went bad.”

In a statement Thursday, the Cuban Foreign Ministry said that “Cuba has never allowed or will it allow the Cuban territory to be used for any action against accredited diplomatic officials or their families, without exception.”

Several Americans cut their tours in Cuba short after falling ill last year, the State Department said, adding that the government expelled two Cuban diplomats from Washington, because Cuba had failed in its obligation to keep American diplomats safe.


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The State Department said the employees got sick in late 2016. The Cuban government learned of it in February and two of its diplomats were expelled in May.

Mark Feierstein, a former senior adviser at the National Security Council, said the fact that President Trump did not tear up the Obama administration’s Cuba policy demonstrated that even the Trump administration did not believe that Cuban senior officials were responsible. In June, Mr. Trump curtailed a few minor Cuba policy rules, but left the majority of Mr. Obama’s measures intact.

Benjamin J. Rhodes, a deputy national security in the Obama administration who helped negotiate the normalization of relations with Cuba, said he also found it inconceivable that Cuba would intentionally physically harm American diplomats.

“It just doesn’t strike me as something the Cuban government would do,” Mr. Rhodes said. “They’ve been pragmatic about Trump.”

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In our opinion: Quality of Utah hospitals is high, but the state may need more health care services

With health care funding a primary topic of recent political debates, Utah can take some satisfaction in the quality of its hospitals, but policymakers must be clearheaded in deciding the quantity of health care services needed going forward.

The recent U.S. News and World Report ranking of hospitals across the country looked at “nearly 5,000 hospitals in 16 adult specialties, 9 adult procedures and conditions and 10 pediatric specialties.” It represents one of the more comprehensive comparative measures of quality among medical institutions nationally. To be ranked nationally, an institution must rank in the top 50 institutions in a particular specialty.

Utahns should be pleased to find that three institutions in the state were nationally ranked: University of Utah Health Care-Hospital and Clinics in Salt Lake City (two adult specialties), Intermountain Medical Center in Murray (one adult specialty) and Primary Children’s Hospital in Salt Lake City (10 pediatric specialties). In addition, a number of hospitals were rated as “high-performing” in a variety of procedures and conditions.

With three nationally ranked institutions, Utah compares well against other similarly sized states such as Iowa and Arkansas (the two states closest to Utah in total population), which each have a single institution ranked nationally.

While Utah compares well with other states on quality of its flagship hospitals, the quantity of health care is another matter. Utah employs about 20 percent fewer health care workers than the national average when comparing the number of health care workers as a percent of the total workforce. In fact, among the major industry categories measured by the Bureau of Labor Statistics, Utah’s health care employment is farther below the national average than any other major industry sector in the state.

This no doubt reflects an efficient health care system and a relatively healthy population — which is to be applauded. However, it also suggests there may be some in the state who are not receiving the services they require, especially with regard to citizens in rural counties with few doctors. The current debate on expanding Medicaid coverage in the state is also an example of this deficiency.

Additionally, there’s a growing recognition that many of the homeless in Utah require more medical services to become stable members of the community. These factors, combined with a growing population and the inevitable increase in medical services that will be required for the retiring baby boomers, suggest demand for health care workers and services in Utah will increase in the coming years, and the state must be able to supply it while still maintaining quality.

How the state meets this growing need will be one of several key factors in the state’s future economic and social success. Additional funding will be required as well as additional skilled workers. Balancing the future supply against the rising demand for these medical services — while maintaining the high quality of services Utahns expect — will be essential to the state’s healthy and prosperous future.

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Your Instagram Posts May Hold Clues to Your Mental Health

Depressed participants were more likely to post photos containing a face. But when healthier participants did post photos with faces, theirs tended to feature more of them, on average.


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As revealing as the findings are about Instagram posts specifically, both Mr. Reece and Mr. Danforth said the results speak more to the promise of their techniques.

“This is only a few hundred people, and they’re pretty special,” Mr. Danforth said of the study participants. “There’s a sieve we sent them through.”

To be included in the study, participants had to meet several criteria. They had to be active and highly rated on Amazon’s Mechanical Turk platform, a paid crowdsourcing platform that researchers often use to find participants. They also had to be active on Instagram and willing to share their entire posting history with the researchers. Finally, they had to share whether or not they had received a clinical diagnosis of depression.

Out of the hundreds of responses they received, Mr. Reece and Mr. Danforth recruited a total of 166 people, 71 of whom had a history of depression. They collected nearly 44,000 photos in all.

The researchers then used software to analyze each photo’s hue, color saturation and brightness, as well as the number of faces it contained. They also collected information about the number of posts per user and the number of comments and likes on each post.

Using machine-learning tools, Mr. Reece and Mr. Danforth found that the more comments a post received, the more likely it was to have been posted by a depressed participant. The opposite was true for likes. And depressed users tended to post more frequently, they found.

Though they warned that their findings may not apply to all Instagram users, Mr. Reece and Mr. Danforth argued that the results suggest that a similar machine-learning model could someday prove useful in conducting or augmenting mental health screenings.

“We reveal a great deal about our behavior with our activities,” Mr. Danforth said, “and we’re a lot more predictable than we’d like to think.”

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‘Hindrance Became The Power’: Passion Pit’s Angelakos On Music And Mental Health

Michael Angelakos of Passion Pit initially exchanged his new album Tremendous Sea of Love for tweets supporting the #weneedscience Twitter campaign. It became available to stream July 28.

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Michael Angelakos of Passion Pit initially exchanged his new album Tremendous Sea of Love for tweets supporting the #weneedscience Twitter campaign. It became available to stream July 28.

Courtesy of the artist

Michael Angelakos founded the musical project Passion Pit as a college student in his dorm room at Emerson College. A decade and four albums later, Angelakos is more than just a musician: He has become an advocate for mental health, too.

In February, Angelakos founded the Wishart Group, which aims to provide support services for musicians. One of its priorities is improving mental health services — something Angelakos, who has bipolar disorder, has found particularly lacking in the music business over the course of his career.

“If you read any book on the music industry, if you talk to anyone in the music industry, it’s like, ‘Well, this is just the way it is,’” he tells NPR’s Scott Simon. “There’s no healthcare. There are no benefits. There’s no one taking care [of you].”

In March, Angelakos offered free downloads of a new Passion Pit album, Tremendous Sea of Love, in exchange for tweets in support of the #weneedscience Twitter campaign. Four months later, the album was released to streaming services. Angelakos is also donating royalties from the sales of Tremendous Sea of Love to the Stanley Center for Psychiatric Research at Broad Institute of Harvard University and the Massachusetts Institute of Technology.

Angelakos joined Scott Simon on Weekend Edition to talk about how his childhood and his mental illness inform his music. Hear the conversation at the audio link, and read an edited transcript below.

Passion Pit: Tiny Desk Concert

Scott Simon: How did you find music?

Michael Angelakos: My dad recalls me singing in perfect pitch when he was changing my diapers. My father was a musician [and] a music teacher for 15 years at public schools — when his son suddenly becomes a professional musician, and you were always trying to be a musician — he’s not the one who’s going to give me that for free. I love my father, I love him to death, but it naturally came to me. [My father] tried to pay for lessons, and I would go to lessons and get my hands slapped because I didn’t understand why I needed to learn other people’s music when I could just write my own. And I also thought that, with my obsession with The Beach Boys around four or five — I thought they had annual tryouts!

To be in The Beach Boys?

Yeah, I just wanted to be a Beach Boy, really. I thought I would impress them if I wrote songs. So I was a little bit of a brat, but it was encouraged. My family was very kind about allowing me to sit in my room — I recorded over all my dad’s tapes. I wreaked havoc, but at the end of the day they nurtured a songwriter, and that was really all I ever wanted to be.

Passion Pit's Michael Angelakos: 'I Was Really Pretty Lost'

On Tremendous Sea of Love, there’s a song called “For Sondra (It Means The World To Me).” May I ask — who’s Sondra?

Sondra Radvanovsky, the opera singer. I’ve met a lot of famous people in my life, but one of the only people who made me cry upon meeting them — like just freaking out — was Sondra. Opera was something that I shared with people I’m very close with, that I had to go through a lot with. And something about that night, meeting Sondra and everything, brought the women in my life to a place where — I’m just very grateful to my mother and my wife, my grandmother, all of these people that I just didn’t know how to talk about, really.

Did this song help you do that talk to them?

Yeah. You connect it to something, a memory like that — it allows you to access a certain place. I don’t know. It’s something that I remember thinking, at that time — I was like, I missed everybody. When I met Sondra, I missed everyone. Because at that time, I was blaming lots of people for problems that are just impossible to explain, that are in my head.

What does that mean?

Well, I have bipolar I disorder, rapid cycling, with anxiety and PTSD. And what I’ve always been doing with my music, even though at certain points I just denied it flat-out, was just a way of explaining it sonically. I just wanted to hear what it sounded like, what my bipolar disorder sounded like. And it would sound like, to me, I was the underdog winning, or something like that. And that’s been my life. It’s really just trying to explain and apologize and work through this illogical world in my head that has been like running with weights, but no one can see the weights. And suddenly at a certain point when you’ve lived through it, that’s one thing that I started realizing: the hindrance became the power.

The hindrance became the power.

I started realizing, as a mental health advocate, that everyone’s going to deal with melancholia. Everyone’s going to deal with anxiety, grief, so-and-so. But how you walk through them is important, because you could develop something very serious. And I cared deeply. Because when I was sexually molested, what happened [was] I did not go to counselling — and I was 12, 13, 14 years old. What happens when you’re in your twenties — these things develop bad behaviors that look like choices, but they become treatments, self-medicating — things that are really, really dangerous.

I don’t want to lose sight of your album, because it’s good music. Point us to a song you’d like us to hear.

A song that I love is “Hey K.” A lot of my music has been about my wife, and my life with my disorder and how much we went through. You know, you’re a hormonal nightmare as a male in your twenties. [Laughs.] You’re going through a lot, on top of having a disorder and having to be the center of attention the whole time, and like — it’s a giant miscommunication. At a time when I just couldn’t connect, when I was manic — and a lot of people, when you’re manic, you really have to quarantine yourself. And so we weren’t talking, but just through this music I was able to kind of speak to her and say something along the lines of, “Don’t forget that my entire life and everything that I’m doing — all the work I’m doing now — is because I’m also trying to protect you. I’m going to actually try and do something, instead of just talk.”

Listen to Tremendous Sea of Love at Spotify and Apple Music.

Web intern Karen Gwee contributed to this story.

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Oklahoma health providers fear they’ll bear costs after cigarette tax falls

A cigarette fee that would have balanced Oklahoma’s budget has gone down in flames, and some health care providers worry cuts could devastate rural services if lawmakers don’t come up with more revenue.

The Oklahoma Supreme Court ruled Thursday that a $1.50-per-pack “fee” on cigarettes was actually a tax. The state has strict laws on passing taxes, including requiring a three-quarters majority to pass one, and the cigarette measure fell short.

The court’s decision raised fears of cuts to Medicaid and other social services programs. The tax would have raised $215 million, including:

•Department of Mental Health and Substance Abuse Services: $75 million

•Oklahoma Health Care Authority: $70 million

•Oklahoma Department of Human Services: $69 million

Charles Danley, CEO of Grand Lake Mental Health Center in Nowata, said centers that provide mental health care under a state contract can’t absorb large budget reductions. In many parts of the state, there aren’t enough providers in private practice to step in if the centers had to cut back, he said.

“It would be devastating for rural Oklahoma, because services in rural areas are hard to come by anyway,” he said.

If their funding falls, the centers might only be able to serve people who are in mental health crisis, rather than helping them avoid a crisis by treating them early, Danley said.

“Everybody will be affected. The police will be affected. The emergency rooms will be affected,” he said. “It’s like a tsunami.”

Other providers worried about cuts to Medicaid payments. Nico Gomez, president and CEO of the Oklahoma Association of Health Care Providers, said cuts could force nursing homes out of business. Long-term care facilities are particularly vulnerable because an average of 70 percent of their patients have coverage through Medicaid, he said.

“We cannot sustain any rate cut,” he said. “These are businesses that are trying to stay solvent.”

In March, the Oklahoma Health Care Authority reported it would need $69 million in new funding to avoid Medicaid rate cuts to providers, and could cut rates by as much as 8 percent if the state held its budget flat.

Becky Pasternik-Ikard, OHCA’s CEO, told lawmakers that providers would stop treating patients covered by Medicaid at some point if reimbursements fell too low, but she wasn’t sure if an 8 percent reduction would hit that tipping point. The agency cut rates by 3.25 percent in 2010, 7.75 percent in 2015 and 3 percent in 2016.

Rural nursing homes would be hit particularly hard if Oklahoma cut its state contribution to Medicaid, Gomez said, and patients might have to move away from their home towns to find an open bed.

The state would also lose matching federal funds, bringing the state’s total losses to $519 million if legislators can’t replace the $215 million from the cigarette fee, said Craig Jones, president of the Oklahoma Hospital Association. Even if they do pass a plan, state agencies may have to make some cuts because the revenue won’t be available on the day the governor signs it, he said.

“The hole just keeps getting deeper and deeper,” he said.

Jo Stainsby, spokeswoman for the Oklahoma Health Care Authority, which oversees the state Medicaid program, said it’s too early to speculate on whether rate cuts will be necessary. Officials don’t know if lawmakers will return for a special session or if they will vote to raise more revenue, she said.

The state will continue to reimburse medical providers at the current level and on the usual schedule, Stainsby said.

“Once we know how big a hole we’re working with, then we can move forward,” she said. “Everything will proceed ‘business as usual’ until we know what we’re doing.”

Ed Lake, director of the Oklahoma Department of Human Services, also wasn’t ready to specify what cuts his agency might have to make if lawmakers don’t make up the lost funding.

“Obviously, our agency could not absorb a $69 million cut to our budget, but we are not ready to declare the sky is falling just yet,” he said in a written statement. “We will be working closely with the governor’s office and members of the House and Senate on solutions to this loss of revenue.”

The Oklahoma Department of Human Services already cut more than $29 million from its budget in the current fiscal year. The cuts included reducing payments to foster families, cutting the number of senior meal sites, freezing the number of low-income families receiving child care assistance for six months and dropping the number of hours that people with disabilities can receive at-home services each week.

The legislature didn’t pass a line-item budget, so agencies would have some discretion about which programs to cut, said Joe Dorman, CEO of the Oklahoma Institute for Child Advocacy. Still, it’s likely some children’s programs, like payments to foster families, would have to sustain more reductions, he said.

“The agencies have made some pretty tough cuts,” he said. “You can only make so many cuts before reducing down these critical services.”

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Suggestions For A Bipartisan Approach On Health Care

In the wake of Senate Republicans’ failure to roll back key features of the Affordable Care Act (ACA), there is renewed interest in exploring a bipartisan approach. Following their votes that halted action on the Senate repeal legislation, Senators John McCain, Susan Collins, and Lisa Murkowski called for a bipartisan fix for health insurance markets. A coalition of nearly 40 House Republicans and Democrats, dubbed the Problem Solvers Caucus, has advanced a proposal to stabilize individual insurance markets and encourage state experimentation.

Although it is unclear whether such efforts will bring opposing sides together, these are important developments. Major social legislation is more stable when there is support from members of both parties. A major flaw of the ACA is that it was passed with only Democratic votes, which reduced acceptance of the law among a large segment of the electorate. Political instability can lead to programmatic instability, as is now clear with a Republican administration in charge of implementing key features of a law it is trying to repeal.

The willingness of a growing number of lawmakers to consider a bipartisan approach provides an opportunity to build a more stable foundation for health policy in coming years, but only if the effort is aimed at the right goal. For months, many House and Senate Democrats have said that they were open to sitting down with Republicans to discuss how to improve the ACA. That is the wrong goal, and Republicans should not agree to it.

Such talks would end in small adjustments to current law and grudging Republican acquiescence to some aspects of the ACA. Instead of rehashing each side’s opposing views of the ACA, true bipartisanship calls for a broader vision of what constitutes health reform. If policy makers hope to gain the support of the public, they will have to look for solutions that make health care more affordable for everyone without sacrificing quality and without confining current and future taxpayers to fiscally unsustainable spending commitments.

Political Constraints Limit Options

Many Republican repeal and replace bills have been criticized by conservatives as “Obamacare lite.” That may be true, but Republicans do not have many other options. Both the ACA and Republican proposals are constrained by major aspects of the current system for financing health care that have long been accepted by policy makers and the public. Most people have employment-based insurance, which covers nearly 178 million workers and their dependents. While not everyone enrolled in such coverage is perfectly satisfied with what they have, most workers are reluctant to give it up for an untested alternative.

Medicare serves the elderly and disabled, and Medicaid provides coverage for lower-income people. These public programs are deeply embedded in the existing system and are very difficult to reform. Policy makers regardless of political party are unlikely to advance reform plans that could significantly disrupt private or public insurance systems on which millions of people rely.

Consequently, both the ACA and the GOP-drafted replacement plans are focused on improving options for the relatively small number of people who are ineligible for employer coverage, Medicaid, or Medicare. Both sides of the political aisle are reaching for the same limited number of policy levers that can make the system work better for this population.

For instance, GOP proposals include refundable tax credits for individuals who do not have access to employer coverage. Those tax credits are similar to the premium credits provided under the ACA. Republican replacement bills repeal the ACA’s individual mandate penalties but impose a premium surcharge or a waiting period to encourage healthy individuals to remain insured. There is general agreement that some such measure—whether mandate, surcharge, or waiting period—is needed to retain regulatory protections allowing people with preexisting conditions to purchase insurance in the individual market.

There are many differences between the ACA and GOP replacement proposals, and details matter. Nonetheless, the similarities between the GOP replacement plans and the ACA provide a starting point for discussion that could bring about compromise on health reform.

The Starting Point For A Productive Conversation

For a bipartisan process to be successful, both parties must agree on the core principles of health reform.

Republicans need to accept that everyone should be enrolled in health insurance and that the federal government has an important role alongside the private sector in striving for this goal. The GOP should move from being the opposition party to one that works to build a system that brings health insurance within the grasp of everyone.

For their part, Democrats must fully accede to a vision for health care that provides ample room for consumer choice, market competition, private initiative, and state experimentation. President Barack Obama and many supporters of the ACA have often said that they borrowed conservative ideas for a market-driven system when developing the law, inspired in part by the framework put in place by GOP Governor Mitt Romney in Massachusetts. But the health system today is far from a well-functioning Marketplace. If Democrats want Republican support for broadly expanding enrollment in private insurance, the party must also agree to actions necessary to bring market discipline to the system.

Components Of A Bipartisan Compromise

If a bipartisan compromise is to be reached on health reform, it must go beyond the immediate crisis and (relatively) simple fixes that get the most attention in Washington. The following is our suggestion for where bipartisan discussion should focus.

Stabilize the Market In The Short Run

Continuing uncertainty about the direction of federal policy has contributed to concerns that insurers may drop out of many exchange markets and that premiums could increase by 20 percent or more next year. Republican proposals included policies intended to stabilize the insurance market, but we have reached a point when immediate action should be taken to ensure that consumers will have affordable coverage options next year. It is particularly important for Congress to provide funding to insurers for cost-sharing reduction subsidies that help low-income enrollees pay for their health care. Additional steps to ensure market stability, including funding for reinsurance or high-risk pools, should be part of a more comprehensive reform plan that could gain bipartisan support.

Improve Support For The Middle Class

Proponents of the ACA argue that low-income enrollees purchasing insurance through the exchanges are largely insulated from rising premiums and deductibles in the individual market. The ACA’s premium subsidies, which are available to those with incomes between 100 percent and 400 percent of the federal poverty level (FPL), increase dollar for dollar with premium increases. In contrast, middle-class families buying their own coverage on or off the exchanges often are not eligible for ACA premium subsidies, or they only receive small subsidies when buying through the exchanges. These families are largely unprotected in the face of rapidly rising premiums and deductibles. Moreover, they are not eligible for the large tax break that families who get insurance through employers enjoy.

To address this inequity, the American Health Care Act (AHCA) provided a flat tax credit for households higher up the income scale than the ACA. Republicans and Democrats should explore ways to combine that concept with income-tested tax credits for low-income families.

Strike A Compromise On Medicaid Expansion And Reform

Republican Medicaid reforms would provide more budgetary control and give states more authority over the program. Democrats want to maintain the ACA’s expansion of the program and continue federal funding at existing levels. To reach a compromise, Republicans must accept that Medicaid is the nation’s safety-net program that should provide insurance to individuals below some specified threshold. However, the threshold could be set lower than the ACA’s expansion to138 percent of FPL.

To encourage all states to conform to a compromise approach, the federal government should offer significant bonuses to states that expand their Medicaid programs. States not providing coverage would lose the bonus payment, which would be distributed among those that meet the new standard. This approach is more likely than current law to get all states to a uniform standard of eligibility, and thus to provide insurance to many millions who are poor and remain uninsured under the ACA.

In return for this concession, Democrats must agree to move toward GOP proposals to reform Medicaid. The specific approach to reform will require negotiation, but it will need to include greater budgetary control at the federal level combined with additional flexibility for the states to manage the program without federal interference. State flexibility should be focused on green-lighting reforms that might improve the efficiency of the program and less on allowing states to unilaterally change benefits or restrict eligibility.

Explore Alternatives To The Individual Mandate

The ACA’s individual mandate is among the law’s least popular provisions, but it is viewed as crucial by the Congressional Budget Office (CBO). The CBO’s estimates of the GOP’s replacement plans showed large increases in the number of people going without insurance, in large part because those proposals would eliminate the tax penalty tied to the mandate.

Republicans are opposed to the government imposing on consumers the requirement to buy the product on those terms, but their replacement plans also include penalties on individuals who are uninsured without good reason. Republican alternatives to the mandate impose either a premium surcharge for one year or a waiting period before coverage begins. The penalties do not increase with the length of time a person chooses to remain uninsured. Adverse selection would be exacerbated as these approaches provide an even stronger incentive than the ACA does for healthy people to delay insurance enrollment as long as possible.

A compromise is needed to respond to the genuine resentment the mandate generates without creating excessive market turbulence. One option could be to construct insurance rules so that people who have had a break in coverage must make up for the premiums they saved when they return to the market. The penalty for going without insurance would therefore be reflected in the pricing of products instead of a payment to the federal government.

Make Consumer-Directed Health Plans Available To All Individual Insurance Market Enrollees

The ACA prescribes the types of insurance products that may be sold on the exchanges and does not allow consumers to buy high-deductible health plans combined with health savings accounts (HSAs). Such consumer-directed health plans help reduce the cost of insurance and are growing in popularity for employer-sponsored health benefits. Consumer-directed options are less commonly offered in the individual insurance market.

Insurance regulations could be written to encourage or require insurers to make this option available alongside more traditional offerings in the exchanges. Individuals selecting such plans could purchase insurance with a higher deductible and deposit any remaining funds from the premium and cost-sharing reduction subsidies into the HSA. The rules for HSAs also need to be amended to allow account holders to use their resources to get access to care through well-run integrated care plans. Today, the rules push enrollees to use fee-for-service care, which is less efficient.

Establish Automatic Enrollment

Many uninsured Americans do not use the assistance available to them under the ACA to get coverage. More than 19 million Americans who did not enroll in 2015 either paid the individual mandate tax or received an exemption from the tax. It is likely that many of these households would have qualified for some assistance to cover the cost of insurance, and those subsidies were not used.

Automatic enrollment could improve take-up of insurance and provide a measure of financial protection against high health costs for many more people. Individuals eligible for tax credits who fail to purchase coverage could be placed into an insurance plan that provides catastrophic protection. Premiums for the “default” plan could be set equal to the amount of the subsidy available to the individual, who would not be required to pay an additional premium. This would be accomplished by adjusting the plan’s deductible. Individuals who are automatically enrolled would have the option of selecting another plan or dropping coverage altogether.

Replace The Cadillac Tax With A ‘Tax Cap’

There is little appetite in either party for imposing a limit on the tax break for employer-sponsored insurance, although doing so is crucial to bringing more market discipline to health care. The ACA’s “Cadillac tax” is a clumsy mechanism for doing this. It imposes a 40 percent excise tax on all premiums in employer plans exceeding $10,200 for individual coverage and $27,500 for families. The tax was supposed to go into effect in 2018, but it was delayed until 2020 during the Obama administration. GOP replacement plans would have delayed it further, to perhaps 2026.

Not implementing the Cadillac tax leaves in place the incentives of current tax rules that have helped fuel the continuing rapid growth of health spending. If we expect to rely on market mechanisms for cost control, we should change the financial incentives that drive spending. An upper limit should be placed on the amount of employer-paid premiums that can be excluded from the taxable compensation of workers. That would encourage workers to select plans with higher cost-sharing requirements, which would help slow the growth of health spending.

A tax cap is also a more progressive approach than the Cadillac tax, which causes premiums for high-benefit plans to increase for everyone regardless of their income. With a tax cap, higher-wage workers in higher tax brackets who purchase expensive health plans would pay more than lower-wage workers buying the same plans. The policy could be designed to exempt most lower-cost insurance plans as well as households with incomes below a certain threshold. The effect of the policy would be to give well-paid people with expensive insurance strong incentives to seek out lower-cost options.

Improve The ACA’s Delivery System Reform Agenda

The most difficult and important problem facing the US health system is waste and inefficiency in delivering care to patients. The ACA launched a delivery system reform agenda that has used Medicare’s financial and regulatory leverage to change the way hospitals, physicians, and other providers organize themselves and care for patients. This agenda—highlighted by accountable care organizations (ACOs) and bundled payment initiatives—is too narrowly focused and fails to promote active patient involvement to seek efficient care.

New approaches to delivery system reform should be developed that allow beneficiaries to share in the savings from efficiency measures and that give them better information about their options. Policies should be developed to improve competition among Medicare Advantage plans, a revamped ACO option, and the traditional fee-for-service program. Medicare regulations could be amended to give beneficiaries strong incentives to use high-quality, low-cost providers of services for certain high-volume procedures.

Repeal The IPAB

Another point of bipartisan agreement is opposition to the Independent Payment Advisory Board (IPAB), which was created by the ACA to enforce limits on Medicare cost growth. If Medicare spending is expected to exceed a targeted growth rate, then the IPAB must make recommendations to eliminate the excessive spending. Congress could substitute other cost-saving policies for IPAB’s recommendations but would be required to meet IPAB’s savings amount. If Congress fails to act, the IPAB’s recommendations automatically go into effect. If no one is appointed to the IPAB, the Department of Health and Human Services (HHS) secretary is required to make recommendations to control spending that would also be automatically implemented.

The delegation of so much power to an unelected board (or the HHS secretary) concerns lawmakers of both parties. In a bipartisan reform plan, there may be sufficient support for repealing the IPAB before it becomes operational.

Short-Term Stabilization Is Not Enough

There is a pressing need for Congress to take steps necessary to stabilize the individual insurance market, ensuring that individuals will have a range of affordable plan options for 2018. Passing a proper appropriation for cost-sharing reduction payments would resolve a major uncertainty for the market, but that would take bipartisan cooperation.

Although it is important, resolving this funding problem is only a patch on the ACA that does not address more fundamental problems. It would be a mistake to assume that this fix is all that is needed to move health policy onto a more stable bipartisan foundation. The ACA was passed in 2010 without any Republican votes. The parties need to engage in a negotiation over more important aspects of the health system. Only then will the parties, and especially the Republicans, believe they have been given a fair opportunity to participate in the policymaking process.

The good news is that agreement might be easier to achieve than some imagine. When the Democratic Party embraced the ACA, it endorsed a system of private insurance competition and consumer choice. The Republican Party should acknowledge this embrace and use it as an opportunity to build a bipartisan consensus around strengthening market discipline to lower costs and improve the options available to consumers. That perspective might be enough to allow both parties to get past the stalemate that has made bipartisan cooperation impossible in recent years.

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Health Insurers Struggle to Win Reprieve of Obamacare Tax

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Health insurers won a victory in 2015 when a tax that was part of the Affordable Care Act was suspended. Now as they fight to repeal or delay the tax again before it comes back into effect, the odds don’t seem to be in their favor.

Insurers, businesses and conservative groups are scrambling for ways to at least delay the health-insurance tax, or HIT, following the collapse of health-care legislation in July. They seemed poised for victory just a few months ago, when the health-insurance fee, and most of the other levies enacted to help fund Obamacare, were targeted in repeal bills passed by House Republicans and considered by Senate Republicans.

The health-insurance tax, which is scheduled to go back into effect in December, is an annual fee owed by insurers such as Anthem Inc., UnitedHealth Group Inc. and Aetna Inc. that varies based on their share of net premiums written nationally — the aggregate amount owed would total $14.3 billion in 2018. Those opposed to the tax are trying to pitch the message that repealing it could prevent higher premium costs for consumers. 

The HIT took effect in 2014, but an omnibus bill passed at the end of 2015 temporarily suspended it starting last year.

Health-Care Premiums

With a full Obamacare repeal stalled, one option for HIT opponents is to push for including its repeal or delay in broader legislation to overhaul the U.S. tax code, according to three people familiar with the effort. An alternative would be to add the provision to a continuing resolution to fund the government, said the people, who asked not to be named because they weren’t authorized to speak publicly. Both options face considerable opposition.

“There’s broad agreement in Washington that we need urgent, bipartisan solutions to improve health-care affordability,” said Elena Tompkins, executive director of Stop the HIT, a coalition of industry groups and small business associations that wants to repeal the tax. “It’s why we need Congress to act now and provide immediate relief from the health-insurance tax.”

Tompkins said Congress needs to take action as soon as possible since insurance companies lock in premiums for the individual insurance exchanges in September. She said the group is considering all legislative options.

Three dozen conservative groups and activists including Americans for Tax Reform urged House Speaker Paul Ryan and Senate Majority Leader Mitch McConnell to repeal or delay the HIT and Obamacare’s medical-device tax, to avoid “higher premiums and higher costs for middle class families, seniors, and small businesses,” the groups said in a letter dated Aug. 10. The health-insurance tax will increase premiums by $5,000 per family over the next decade, the letter said, citing research from the American Action Forum.

Revenue Loss

Ryan has signaled openness to eliminating another Obamacare levy — a 3.8 percent net investment income tax on top earners — as part of a tax overhaul but he’s been firm so far on the health-insurance tax. The difference is that the investment tax affects “capital income” and might slow the economic growth that he and other Republicans have pledged to deliver, Ryan said. “Other taxes that affect health care, like the HIT tax and those taxes, those we see as part of Obamacare,” he said.

Ryan’s reluctance may be related to making Congress’s tax-math work. The health-insurance tax is estimated to raise $145 billion over a decade, according to the Congressional Budget Office. That revenue loss would further complicate efforts to keep any tax changes from adding to the long-term federal deficit. Republican leaders need to achieve that goal in order to use a budget procedure that allows them to bypass Democratic opposition in the Senate.

“If you’re going to cut the corporate tax rate, somebody’s got to pay for it,” said Don Williamson, the executive director of the Kogod Tax Policy Center at American University.

A spokeswoman for Ryan didn’t respond to requests for comment. Lauren Aronson, a spokeswoman for the tax-writing House Ways and Means Committee said in an email that Chairman Kevin Brady still “believes the best way to get the Obamacare taxes out of the economy is through health-care reform legislation.”

‘Fiscal Mania’

The industry may also lobby for adding a repeal or delay of the HIT into a continuing resolution, which would fund the government after September if a formal budget hasn’t been approved, as appears likely. A continuing resolution would need Democratic support, since it requires 60 votes to pass in the Senate.

Since the tax provision is estimated to lose revenue, it would have to be offset with cuts to mandatory programs like Social Security or Medicaid under budget rules, according to Bill Hoagland, senior vice president at the Bipartisan Policy Center. That’s unlikely to get any endorsement from Democrats, Hoagland said.

Lawmakers could also look to the reauthorization of the Children’s Health Insurance Program funding bill as a possible vehicle for repealing parts of Obamacare, Senator John Cornyn, the No. 2 Republican, told Bloomberg BNA.

Congress needs to resolve other pressing issues before year’s end, including raising the debt-limit. “It is going to be just fiscal mania all fall,” said Maya MacGuineas, president of the Committee for a Responsible Federal Budget, which advocates for decreasing the deficit.

As for repealing or delaying the HIT, she said: “I can certainly see this not happening.”

Even a standalone HIT repeal bill that has 155 cosponsors in the House could run into problems with timing given the packed legislative calendar, she said.

‘Top Issue’

The industry trade group America’s Health Insurance Plans estimates that reinstating the tax would increase premiums by as much as 3 percent. It also said that the HIT costs employees of small business $210 annually and $530 for families.

Insurance companies including Anthem, UnitedHealth and Aetna lobbied on the tax in the second quarter, according to disclosures. Aetna spent almost $1.4 million on lobbying on all issues during the quarter, filings show.

The Chamber of Commerce, which is often the highest-spending lobbying group in Washington, also urged Congress on Aug. 3 to delay the tax again as part of an effort to stabilize insurance markets.

Though the effort faces difficulties, if the industry were able to get the HIT moratorium reinstated, companies including Anthem, UnitedHealth and Cigna Corp. could see analysts’ estimates of their income growth jump, said Ana Gupte, a senior analyst at Leerink Partners, who covers health-insurance companies. Additional percentage growth in the “mid-single to as much as teens” range might be plausible, she said.

Gupte said insurers are assuming the tax will return, but they’ll still try to do everything they can to fight it.

“It is their top issue, and regardless of their mix of business they have something at stake here,” she said.

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How Alexa’s best skill could be as a home health-care assistant

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Tech's healthcare ambition

Yvonne Meyer is no Luddite. The 81-year-old not only uses a computer; she gave up her landline for a cellphone long ago. Still, she was skeptical when her home health aides gave her an Amazon Echo Dot to try.

“I didn’t understand why I needed this” but soon became a fan, said the former teacher, who lives at a senior living facility in Los Angeles. She said the voice assistant has made getting in touch with her home health aides much easier.

“If I’ve fallen, I have this button I can push,” she said, pointing to the Life Alert pendant she wears around her neck. “But it often times takes a while for them to answer and find out what my problem is, but with Alexa it takes no time at all and they come right away.”

Yvonne Meyer

Nurses and home care aides at Libertana Home Health Care have been using Alexa with some elderly clients for several weeks in an experiment. Already, it has helped them be more responsive to their clients’ needs, streamlining things like making sure they get their medication. The companion online app has also made it easier to keep family caregivers in the loop.

“We can give access to family members… the same access we have, to be able to check and see how the clients are doing… so they can see how their mom is doing,” explained Debra Harrison, a nurse with Libertana, “to free up time to socialize with their (family member) and not worry about their medical care.”

Libertana’s Alexa skill — as voice applications are called on the Amazon Echo platform — was designed by Orbita, a 2½-year-old voice platform start-up in Boston.

“Voice is becoming that next wave of how can we engage because it really means that we’re lowering the friction for people to be able to interact with something,” said Bill Rogers, co-founder and CEO of the company.

Orbita is developing and testing health-care programs for clients including hospitals that want to make sure patients take their medications and follow post-surgery instructions, and drugmakers, who want to make it easier for trial participants to share their data.

“We ultimately have to make the information that you collect actionable,” said Rogers. “And so our system can notify electronic health record systems.”

Orbita is focused on industry applications rather than consumer health apps. But the tech giants like Apple, Alphabet’s Google and Amazon could well blaze the path in consumer health with their digital voice assistants and the ability for their programs to anticipate user’s needs through machine learning, according to Scripps Health’s Dr. Eric Topol.

“The ability to interact with an individual, a consumer, with their data and the world’s medical literature — no one has done that yet,” said Topol, author of “The Creative Destruction of Medicine.” “Ultimately I think there will be a race between the likes of Amazon, Apple, (and Google’s) Verily to get there first — as well as, perhaps, a couple of hundred start-ups.”

Orbita co-founder Nathan Treloar meets with co-workers.

Amazon’s Alexa division has already paired with Merck and Luminary Labs on the Alexa Diabetes Challenge, which will award a $250,000 prize next month to the start-up to develop a voice app to help patients manage type 2 diabetes. Five finalists in the challenge gathered at Amazon Web Service’s Seattle offices last month to develop their ideas. A spokeswoman for Amazon declined to discuss the contest or its work in health care.

While voice apps provide ease of use, for the apps to be connected to medical records, firms have to address concerns about security with devices that are always listening.

“What we’re seeing is going to be a whole new look at privacy,” Topol said. “HIPAA regulations … [are] 20 years old — and they don’t even take into account the technology and the data processing capability that we have today. There have to be a lot of adjustments before this becomes part of routine practice.”

The programs Orbita is developing are still in the testing phase, and the voice technology itself is still evolving. The Alexa platform is just a couple of years old, Google’s home device was introduced last year, while Apple and Samsung are getting set to launch their own versions.

“The state of the art right now with devices like this is that there’s this concept of a ‘wake word’ … with this device, you have to say ‘Alexa’,” said Orbita co-founder Nathan Treloar. “What we’re experiencing with the newer devices that are coming on the market … is that it’s possible to eliminate the wake word. And so you can just kind of interact with it directly.”

While it’s still early days for these devices, a number of the major insurers say they are studying how they can use voice technology for their Medicare population to help keep seniors living at home, and feeling connected — the way Meyer feels about having Alexa always at the ready.

“I think of her as a person, but she’s really just a machine,” Meyer said.

That’s saying a lot.

Bertha Coombs


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Jimmy Kimmel Gives Emotional Health Update on His Son and Says He Needs Two More Surgeries

It’s been quite the harrowing year for Jimmy Kimmel — but things are looking up.

The late-night host and wife Molly McNearney‘s baby boy William “Billy” John now 3 months old, had open heart surgery three days after his birth in April. And according to Kimmel in a new interview with The Hollywood Reporter, his son will need two more of the procedures, but is “doing great.”

“Young Billy made his first visit to our office today. He’s juggling. He’s translating Flaubert from French into English,” jokes the star. “No — he smiles. That’s pretty much it. He is very interested in ceiling fans. He likes those a lot. I could get him to pay the same amount for Netflix just to watch ceiling fans.”

In all seriousness, “We would like to get [the surgeries] over with and not have to think about it all the time, but it could definitely be worse,” says Kimmel, 49.

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RELATED VIDEO: Jimmy Kimmel Tearfully Reveals Newborn Son Billy Underwent Open Heart Surgery


Kimmel says he and McNearney “didn’t know anything about heart surgery” before their son’s birth and subsequent operation, and that the associated memories from the beginning of Billy’s life were stressful and difficult, to say the least.

“I felt like I was in an episode of a television show where something terrible was happening,” he says, explaining, “There were a lot of people scrambling around. At that point, I knew there was nothing I could do. They were all very good about keeping me abreast of what was happening, but I wanted them to just focus on him and not worry about me.”

RELATED: Hospital Where Jimmy Kimmel’s Son Had Open-Heart Surgery Sees Spike in Donations

Of “the surgery itself,” it “took less time than we were told it would — about two hours,” Kimmel, who’s also dad to 3-year-old daughter Jane and adult children Katie and Kevin, reveals to THR. “We were surprised when the doctor walked in and told us it went well.”

“My whole family came to the hospital. We were worried getting through that time, but my cousins Sal, Ivy and Mickey showed up and started making fun of everyone else in the family,” he shares. “Somehow, we managed to laugh through the whole day.”

Courtesy Kimmel Family

RELATED: Jimmy Kimmel’s Son’s Condition Explained: About 1 Percent of Babies Are Born with Congenital Heart Defects

Kimmel famously addressed his son’s birth and congenital heart disease — called tetralogy of Fallot with pulmonary atresia — for the first time on Jimmy Kimmel Live! in early April, sharing a photo of Billy hooked up to multiple hospital wires.

The host’s monologue also included praise for his wife, as well as a plea about affordable healthcare in the U.S. — something he is continuing to speak about.

“I don’t see what the difference between health care and education is. Every kid should have a right to an education. We don’t seem to have a problem with paying for that,” Kimmel tells THR.

Thomas pancakes are even better than their English muffins

A post shared by Jimmy Kimmel (@jimmykimmel) on May 6, 2017 at 10:52am PDT

FROM PEN: Baby Jessica 30 Years Later: “My Life is a Miracle”


RELATED GALLERY: Jimmy Kimmel’s Son Billy, Plus 4 More Celeb Kids Who’ve Battled Heart Issues

“I was relieved when the [GOP bills] failed to pass, but it’s far from over,” he continues. “I worry that those who oppose Obamacare are going to do everything they can to make sure it doesn’t work. Nothing is perfect, but when people are working against something, it makes it a tough road.”

“I worry that these politicians don’t care about the people they represent,” Kimmel says. “I have spoken with so many people who strongly believe the reason they are alive or their brother is alive or their parents are alive is the Affordable Health Care Act. It’s undeniable if you talk to people.”

The host admits he’d be open to having President Trump on his show to talk to him about healthcare. “I would like to see, as a father and a person who prides himself on speaking the truth, what he thinks,” he says. “If I were his next-door neighbor and I didn’t have health insurance for my child, I find it hard to believe he would ignore that.”

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