Support Ron Wyden's Free Choice Amendment - would allow EVERYONE to join the exchange

[liberalpragmatist]

I see a lot of people surprised that the public option and the other plans on the insurance exchange won't be open to everyone. This actually is not new information - it's a feature of all the bills that are currently swirling around Congress, including the relatively liberal House bill revealed in July.

However, Ron Wyden has a proposal to open the insurance exchange - which, again, would include a public plan if one is included - to EVERYBODY. It's called the Free Choice Act. Here's Ezra Klein's description:

The Free Choice Act is not a health-care-reform bill. It is best understood as a reform of the health-care-reform bill. In particular, it reforms the nature of the Health Insurance Exchange. Under the bills being considered right now, the exchange will be limited to the uninsured, the self-employed and small businesses. Maybe it will be expanded over time. Maybe not. In addition, it is barricaded by what's called a "firewall." The firewall essentially bars individuals from entering the exchange so long as their employers offer them a basic level of health-care coverage.

The Free Choice Act starts by setting the rules for the exchange: Within five years the exchange is open to all employers. More importantly, it's open to all people. The firewall is extinguished. But as the late, great, Billy Mays would say, that's not all!

The key component of the Free Choice Act is called "cash-out." Under the Free Choice Act, if I decide that I don't like any of the health-care coverage options being offered by my employer and would prefer to choose from the many options being offered on the Health Insurance Exchange, my employer has to give me a voucher that covers 65 to 70 percent of the cost of the lowest level of exchange plan. (That is the average portion that an employer pays of his employee's health insurance premiums.) I can take that voucher and, along with whatever money I want to throw in, choose a plan on the exchange.

This does a couple of things. First, it changes the health-care system for the currently insured. It doesn't take what they have. But it gives them a choice. If the political yin of health-care reform is that you can keep what you have if you like it, the policy yang should be that you can choose something different if you don't. The Free Choice Act gives the insured something concrete: autonomy. If they don't like what they have, they are assured options. In 1994, Bill Clinton's plan was defeated because people believed it would restrict choice. Given the apparent power of the objection, it makes some sense to try to sell health-care reform atop the concrete promise that it will increase choice.

Second, it gives people an incentive to choose cost-effective plans. If your employer is paying 70 percent of your $10,000 health insurance premium, and you find a $9,000 plan on the Exchange -- maybe it's an HMO rather than a PPO -- you pocket $1,000. Currently, since I pay only 30 percent of my health-care premiums, making the same choice within the HMO and PPO offerings that The Washington Post gives me would only net me $333 dollars. Wyden's plan would put 300 percent as much money in my pocket. That changes behavior. And even the CBO thinks so. This is one of the main reasons the Congressional Budget Office scored Wyden's Healthy Americans Act -- which had a similar provision -- as saving, rather than costing, money.

Third, it begins to build a viable alternative to the employer-based health-care system. Experts think that the exchange will need at least 20 million participants to really start seeing advantages of scale. This will ensure it has much more than that. And if the exchange works? If direct competition between insurers lowers costs and increases quality, if standardized billing and administrative efficiencies save money, if the massive pool of customers helps insurers bargain for discounts with providers, then the exchange will become a progressively better deal, and more people will choose -- there's that word again -- to enter it. And if more people choose to enter it, then that cycle happens again, more people enter, and so forth. Soon, you've built the system we want rather than the one we have.

More from Wyden's proposal here. So call your senators to encourage them to support this, which Wyden plans to offer as an amendment. In particular call the Finance Committee Democrats, as Wyden plans to offer this as an amendment to the Finance Committee bill next week when it's marked up. Hell, even call Olympia Snowe's office - though she's still pushing the trigger crap, she actually has expressed interest in making the exchanges larger, so she could be a vote for this too.

Max Baucus: [phone]
Jay Rockefeller: [phone]
Kent Conrad: [phone]
Jeff Bingaman: [phone]
John Kerry: [phone]
Blanche Lincoln: [phone]
Chuck Schumer: [phone]
Maria Cantwell: 202-224-3441
Bill Nelson: 202-224-5274
Bob Menendez: 202.224.4744
Tom Carper: [phone]
Olympia Snowe (R): [phone]

UPDATE: On edit, I thought I'd add a few points. The first is that, from what I can tell, it should not increase the cost of the current bills. One of the reasons the exchange has been firewalled is because if it were open to everyone, the government would have to pay subsidies to many people. The Free Choice Proposal still leaves employers footing most of the bill for most people's health insurance, so it shouldn't increase costs to the government. In fact, by giving the exchange and the public plan more customers, it should allow them to bargain lower prices and save more money in the long term.

Second, don't confuse this with Wyden's other bill, the Healthy Americans Act aka Wyden-Bennett. That's an ostensibly bipartisan bill that would replace the entire employer-based system with a private market. If that passes, the tax exclusion for health benefits would be phased out, people would instead be given a raise with a progressive tax deduction, and would have to purchase coverage in a national exchange composed entirely of private plans. It's actually not a bad plan - it would save much more money than the current proposals and essentially replicate the Swiss and Dutch systems. But it would not include a public plan.

The Free Choice Act is not the same thing. It is simply an amendment that would open the exchange to everybody. Period. (Whether it includes a public plan or not is dependent entirely on whether a public plan is included in the existing bills. So, in other words, keeping fighting for a public plan, which is a separate issue, but also fight to include this because it would mean that an insurance exchange - preferably with a public plan - would be available to everyone.)

[Junkdrawer]

1. Big K&R

Thanks

[KittyWampus]

38. This is the sort of PRO-active stuff DU could use more of.

[Junkdrawer]

53. But all it takes is one or two disinfo agents...

to knock the wheels off the cart.

Sad, really.

[aquart]

2. Republicans are always against choice.

They only like the word when they use it to justify privatization.

[Oregone]

3. At first glance, this would VASTLY boost the current drafts

Opening up the "public option" to everyone (and rewarding people for switching in some scenarios) will cause a drastic shift that will ensure the viability of any option.

[Junkdrawer]

4. Come on - This one should be at the top of the Greatest Page...

Recs away...

[ProSense]

5. What a complete distortion

Yeah, let's throw out a public option and implement an all private giveaway to the insurance companies

[Oregone]

8. Your post is quite a distortion

Look, "The Free Choice Act is not a health-care-reform bill. It is best understood as a reform of the health-care-reform bill."

This can co-exist WITH whatever plan comes out of Congress. IT IS AN AMENDMENT (unrelated to the link you provided). It is there to allow the exchange (which will include a public option) to be accessible to all.

Why is that a private giveaway? Why? Can you back this up and just explain it?

[liberalpragmatist]

9. Two DIFFERENT Plans

You're confusing the Healthy Americans' Act (Wyden-Bennett) with the Free Choice Proposal.

Wyden-Bennett is a completely different piece of legislation. It's an ostensibly bipartisan plan that replaces the entire current system with a tightly-regulated private market. I actually think it's a pretty good plan, personally, but you're right that it does not include a public option. (It's essentially similar to what they have in Switzerland and the Netherlands.)

The Free Choice proposal is entirely different. It's an amendment that would be affixed to the current health care bills. It says nothing about the public plan - all it says is that the exchange (whether it includes a public plan or not) needs to be opened to EVERYBODY.

[Oregone]

10. Exactly

Im not sure how anyone who calls themself a Democrat or liberal could possibly not support this. It could potentially fix a broken bill and make it work for everyone.

If the public option is designed for everyone, it isn't needed. As of now, we are given every indication that this will not be the case

[Blasphemer]

13. Yep... this amendment is critical... nt

[ProSense]

12. "(It's... similar to...Switzerland and the Netherlands.)" Which is private insurance.

Wyden simply repackaged his plan

The Free Choice Act starts by setting the rules for the exchange: Within five years the exchange is open to all employers. More importantly, it's open to all people. The firewall is extinguished. But as the late, great, Billy Mays would say, that's not all!

The key component of the Free Choice Act is called "cash-out." Under the Free Choice Act, if I decide that I don't like any of the health-care coverage options being offered by my employer and would prefer to choose from the many options being offered on the Health Insurance Exchange, my employer has to give me a voucher that covers 65 to 70 percent of the cost of the lowest level of exchange plan. (That is the average portion that an employer pays of his employee's health insurance premiums.) I can take that voucher and, along with whatever money I want to throw in, choose a plan on the exchange.

This does a couple of things. First, it changes the health-care system for the currently insured. It doesn't take what they have. But it gives them a choice. If the political yin of health-care reform is that you can keep what you have if you like it, the policy yang should be that you can choose something different if you don't. The Free Choice Act gives the insured something concrete: autonomy. If they don't like what they have, they are assured options. In 1994, Bill Clinton's plan was defeated because people believed it would restrict choice. Given the apparent power of the objection, it makes some sense to try to sell health-care reform atop the concrete promise that it will increase choice.

<...>

That is not to say there are no problems with this idea. The primary one is adverse selection: What's to stop all of a company's young employees from buying their way out and leaving their employer with bad health risks and high premiums? According to Wyden's office, risk adjustment. And they say they'll risk adjust back to the employer level, potentially. It's hard for me to imagine how that would work. But it's also hard for me to imagine a flood of young people who don't care much about having good health insurance going through the process of contacting HR, attaining the voucher, going to the exchange, comparing plans, and so forth.

Wyden is giving people more choice between insurance companies.

[liberalpragmatist]

14. As long as the insurance exchange includes a public option...

... Wyden's proposal would allow anyone to buy into it. Period.

Whether the insurance exchange includes a public option is a separate issue.

[ProSense]

15. "Whether the insurance exchange includes a public option is a separate issue."

Like I said, it's private insurance.

[Oregone]

16. Seriously...You don't like this?!? You want a firewalled, insignificant "public option"/"exchange"

Im aghast! What is your real agenda? To push the shittiest plan fervently?

Shouldn't the "public option" (or "exchange" for that matter) be open to everyone? Shouldn't it be an option?!?

This is simply an amendment to allow everyone in the exchange. WHY IS THAT BAD?!?

[liberalpragmatist]

17. No you're missing the point

Wyden's proposal has nothing to do with whether the exchange has a public option or not. All the bill says is that the exchange will be open to everyone. Period.

The point is that whether the exchange includes a public plan or not is an entirely different battle. What we know is that the bill will include an insurance exchange. There are two separate issues: one, is it going to include a public option, and two, how many people can access the exchange. Wyden's proposal deals only with the second question, not the first.

[Junkdrawer]

18. Just throwing up dust...

to preserve the "Everyone can choose the Public Option" talking point.

The existence of this amendment shows that that's a lie.

[ProSense]

19. No, I think you're missing the point

access to health insurance is going to do nothing to drive down cost. More choice between insurance companies does nothing. The insurance companies would be competing with themselves.

That is the crux of his plan. Without a public option, this is simple more access to private health insurance.

[Oregone]

20. So you want the "exchange" to be insignificant and limited?

Even if a "public option" ends up being provided by it? Even since subsidies will only cover those in the exchange?

What do you want? Everyone having access to this regulated, subsidized exchange (that may end up with a public option) or only a few?

[ProSense]

22. Here is the proposal

Transition to the Free Choice System

Year 1- People who are currently in the individual market plus small employers with up to 10 workers and the
uninsured have access to the exchange.
Year 2-- Add small employers with up to 25 workers to the exchange.
Year 3-- Give State Medicaid programs the choice to be in exchange.
Year 4-- Open up the exchange to medium sized employers with up to 250 workers using the Free Choice
approach.
Year 5 - Open exchanges to all employers.

Now compare that to the current bill with a public option:

Health Insurance Exchange is opened to small employers first (those with 10 or fewer employees in the first year, and 20 or fewer in the second year) and to larger employers over time.

[Oregone]

24. So you are against this because....?

In 5 years all employers will have access to the exchange, and those that don't choose it will have to give the 70% voucher to their employees, making it a universal option.

Why are you against this?

[ProSense]

26. Access to more private insurance in five years vs. access to a public option

hmmm, let's see?

[Oregone]

28. ITS THE SAME THING!

The "public option", if available, will be available through the subsidized exchange only!

If you do not qualify for the exchange, you will not qualify for the "public option". Its firewalled.

Providing UNIVERSAL access to the exchange IS providing UNIVERSAL access to the "public option".

Are you this dense? What is your issue?

[ProSense]

31. Wait, how is transitioning to private insurance choice

universal access?

"ITS THE SAME THING!"

If it's the same thing, why should I care about more choice between private insurance when a plan exist to transition to more choice including a public option?

[Oregone]

35. If you are an average American, then your country deserve its fucked health system

The exchange may be private. It may be private with a public option. That debate isn't over yet.

IF THE PUBLIC OPTION IS INCLUDED, THE ONLY WAY TO ACCESS IT IS TO BE QUALIFIED FOR THE EXCHANGE. THE ONLY WAY TO BE SUBSIDIZED IS TO BE IN THE EXCHANGE.

Either you are for universal access to the exchange (and hence, the public option), or you are against it.

And while all employers may choose the public option in some time currently, their employees CANNOT if their employer remains private. This fixes that.

Only a Republican would dislike this amendment

[ProSense]

37. " THE ONLY WAY TO BE SUBSIDIZED IS TO BE IN THE EXCHANGE." Wrong

And access is not the only issue.

"Only a Republican would dislike this amendment"

Right, because preferring the bills that include a public option, subsidies and increased accessed to a public option is so Republican?

[Oregone]

39. "preferring the bills that include a public option, subsidies and increased accessed to a public"

This is an AMENDMENT to that sort of bill, that just ensures that if an employer doesn't choose the "public option", the employee still can. This ensures everyone will be able to get into the "public option" if it exists.

END OF STORY.

Further lies not needed

(BTW, according to HR3200 at least, subsidies are only for people in the exchange)

[Oregone]

25. BTW, that isn't the proposal. That was a distortion on your behalf

You should of pasted the following:

"Under this proposal:

1) Employers that offer group health coverage must offer the equivalent of a minimum benefit plan,
contribute at least 70% of the premium, and offer at least one other health plan of greater actuarial value;
or

2) Employers that do not offer the choice of a low cost option must offer workers a voucher worth at least
70% of the average of the three lowest cost plans in the exchange; or

3) With an adequate transition, employers can take their entire group to the exchange where they would
receive a group discount so long as they provide at least 70% of the cost of average of the three lowest
cost plans in the exchange; or

4) Employers that do not offer health insurance choices, a voucher, or go to the exchange, would have to pay
a “fair share” fee which would be a percent of the national average of the three lowest cost plans in each
state."

You posted details on part 3 of the proposal. You didn't post the entire proposal.

[ProSense]

27. What the hell are you talking about. That's directly from Wyden's site. n/t

[Oregone]

29. Its a disingenuous distortion

And only a liar would disagree.

What I posted is from his site, below "Under This Proposal"

You went below and posted details of a subsection of the proposal as the actual proposal.

You are so fucking transparent. You have no credibility.

Only a mole would insist on continuing this behavior.

[Junkdrawer]

32. Told ya...n/t

[liberalpragmatist]

23. How would supporting this kill a public plan?

These are not mutually exclusive things. Right now there's an exchange but, again, there are two different debates right now: (1) Will the exchange include a public plan, and (2) will the exchange be open to everybody.

These two debates are NOT MUTUALLY EXCLUSIVE; all this says is that the exchange will be open to everybody. If public option supporters can win debate #1, then Wyden's proposal would also provide everybody access to the public option.

[Oregone]

30. Its clearly becoming obvious what their agenda is

Distort, lie, and advocate for shit. In the end, the Democrats lose even if they win.

[Oregone]

6. Anyone know if this voucher is taxable?

Wasn't that in Wyden's original plan? Everyone just get paid more and buy their own with credits

[liberalpragmatist]

11. I don't believe it is

From what I can tell, unlike Wyden-Bennett, this does nothing to the health benefits tax exclusion. An employer mandate still exists. It's just that if you'd rather get something else, you could ask for a cash payout and buy coverage on your own.

[depakid]

7. Since a robust public option's been thrown under the bus- I guess folks ought to sign on with Wyden

He's looking pretty prescient at the moment.

[Inuca]

40. Two comments

1. the PO has NOT been under any metaphoric bus
2. Wyden's plan is not an alternative to the PO. It is about a different way to determine, control and finance access to these new exchanges. As has been said repeatedly upthread, the PO can be one of the options in the exchange, as Obama suggested yesterday.

[wildflower]

21. K&R...thank you! n/t

[TheKentuckian]

33. Good call. This opens the exchange to everyone regardless of the option's fate

I'm shocked so many just came out shooting on a great idea within the context of what is going on.

[ProSense]

34. Except that article is from July, it's a plan for private insurance and it transitions to access

Transition to the Free Choice System

Year 1- People who are currently in the individual market plus small employers with up to 10 workers and the
uninsured have access to the exchange.
Year 2-- Add small employers with up to 25 workers to the exchange.
Year 3-- Give State Medicaid programs the choice to be in exchange.
Year 4-- Open up the exchange to medium sized employers with up to 250 workers using the Free Choice
approach.
Year 5 - Open exchanges to all employers.

Now compare that to the current bill with a public option:

Health Insurance Exchange is opened to small employers first (those with 10 or fewer employees in the first year, and 20 or fewer in the second year) and to larger employers over time.

[Name removed]

36. Deleted sub-thread

Sub-thread removed by moderator. Click here to review the message board rules.

[liberalpragmatist]

41. The current bills do NOT let everyone join the public option

Every proposal calls for the public option to remain within the insurance exchange.

As the President himself pointed out yesterday, access to the the public plan is going to be limited to a very small number of Americans, according to the current bills. You would not be able to purchase coverage from the public option unless your employer signed up for the exchange or unless you were self-employed.

All Wyden's proposal does is OPEN THE EXCHANGE to everybody. If there is a public plan, it would also be open to everybody.

Not supporting this proposal means that only a very small number of people would be able to join the public plan.

[Oregone]

44. From HR3200 DIV A,100.a.3.B: creates a new Health Insurance Exchange, with a public health insurance

(B) creates a new Health Insurance Exchange, with a public health insurance option alongside private plans;


Uhhhggg... Duh.

[liberalpragmatist]

47. This does NOT contradict Wyden's proposal

How are these mutually exclusive? All Wyden's proposal says is that the insurance exchange be open to everybody. Period.

If there is a public plan, it will exist on the exchange - that's a feature of all the current bills. Without Wyden's proposal, not everyone could join the public plan.

In HR.3200, over time, yes, larger employers could purchase coverage from the exchange, but if your employer does NOT sign up for the exchange you'd still be limited to what your employer gave you. If a House equivalent of Wyden's proposal were added to the House bill, it would simply allow ANYONE to buy coverage from the exchange, meaning ANYONE could sign up for the public plan.

[Oregone]

48. No it doesn't. I was adding support. :)

I agree on each point. I was pointing out how in that bill, yes, the public option is in the exchange. If you aren't qualified for the exchange, you aren't getting the public option.

[liberalpragmatist]

49. Oh, sorry. Got mixed up for a second

I should probably pipe down. There's only so many different ways I can say the same thing.

[Junkdrawer]

51. That's the game - to make something positive seem controversial....

Sometimes you have to ignore the professional disruptors and trust that DU readers are intelligent. Let them have the last distorted word. Not always easy, but...

"Please don't feed the trolls"

[Inuca]

45. Correct, or at least that's how I understand it as well

and I have been interested in Wyden's proposal for quite some time now.

[Inuca]

42. I really do not understand

where you see the contradiction between what Wyden suggests and a public option. Even if the PO is not specfically mentioned in Wyden proposal, having it as one of the options in the exchange is consistent with what he proposes. I very seldom disagree with your point sof view, but I do not understand you on this one.

[Oregone]

46. Its hard to understand make-believe

[Doctor_J]

43. Now THIS is something I can get behind

I would be paying 30% of the CHEAPEST Medicare-like program. I want Blue Cross out from between me & my doctor.

[Oregone]

50. No you wouldn't. I don't think thats how it works:

"If your employer is paying 70 percent of your $10,000 health insurance premium, and you find a $9,000 plan on the Exchange -- maybe it's an HMO rather than a PPO -- you pocket $1,000."

You wouldn't not pay 30%. You would pay whatever is left over after your employer pays 70% of your old premium.

In some cases, you may pay nothing at all if you find a plan 70% the cost of your current employer provided plan.

[Junkdrawer]

52. This is clearly Krytonite to a big push by industry lobbyists to...

1.) Keep the Exchange tiny

--- while ----

2.) Convincing liberals it's current open to all

As you can see, it's No-Holds-Barred to kill this.

[liberalpragmatist]

54. I'm gonna kick this - nt

:kick:

[Luminous Animal]

55. K and R (n/t)