Today I had a long conversation with a top staffer to Senator Wyden. It was all encompassing on healthcare, the public option and much more. Here is Sen. Wyden’s position as has been noted very publically. The senator has said he is withholding his vote unless the bill allows for a national insurance exchange with a public option that every American, regardless of their employer, can access.
As he has said on Maddow, in the NYT, on CQ, and so forth there is a major misconception right now about the pubic option. The public option is not INCLUSIVE AS WRITTEN IN THE SENATE BILL NOR IN THE HOUSE. The most the current po proposals would serve is about 3-11 million people, mostly singles, small businesses and likely those who private insurers do not want. The concern of Sen., Wyden and of many other senators on the Hill is that of a PO that is closed off so it only serves very few and won’t really bring down insurance costs because it won’t be fully competing for the 10s of millions of Americans who would be mandated to buy insurance. This is critical.
The senator, as expressed to me and interviews, feels STRONGLY there is little point to a public option unless we have it available to all in a national exchange that you can opt into even if your employer has a plan for its employees. The firewall of the public absolutely must be taken down. We must not call for "a public option." We must ask for a INCLUSIVE PUBLIC OPTION.
Wyden’s Free Choice Amendment would push us much further to the goal of having a real national exchange with a public option that would be competing not for a few million folks, but for 10s of millions across this country. This amendment, to many liberals on the Hill and yes even a few conservatives, is becoming as crucial as the public option itself.
The Senator would appreciate your calls to members of the Fin. Cmte. Also call you member of the House. If the idea here is for real choice, to opt in or out of insurance you want or do not want than this is the solution.
In addition, I was told the senator will lead the charge with Rockefeller to open up MEDICARE for those early retirees 55 and up, which is crucial. He also wants MEDICAID IMPROVED AND EXPANDED LIKE CANTWELL WANTS-200 PCT ABOVE POVERTY LEVEL.
Wyden has revised his amendment, see below. Carrots and sticks here are used. Employers can get major tax incentives to allow their employees use the exchange instead of forcing employees to use whatever the plan their boss picks. Also if an employer offers less than 2 plans which meet a federal standard then they will eb required to allow you into the exchange. Much more detail is below.
SO here we GO:
Background information for you.
On CQ:
On the Ed Show:
On Maddow Sept 22:
Transcript:
... Look, all over America people are carrying these signs, public option, public option or bust. They‘re wonderful activists, but a lot of folks haven‘t been told that the Congressional Budget Office says only about 12 million people in America would actually get to choose the public option. They are likely to be sicker. They‘re likely to be folks who haven‘t had good preventive health care services.
To really put the consumer in the driver‘s seat, to give the consumer clout, to turn the tables on the insurance lobby, you‘ve got to have a really big group. That‘s what I‘m pushing for, and free choice is very compatible with the public option.
MADDOW: So the idea is that anybody should be able to get into the health exchange? It shouldn‘t be that if you already have insurance through your employer, that locks you out of the health exchange? That anybody can be able to join, that creates competition, so that not only do we have a choice for people to get insured who can‘t afford insurance today, but people can also hopefully improve on the insurance they have through competition and that sort of an exchange, is that the overall idea?
WYDEN: It will send a message on day one to the insurance lobby that if you abuse somebody, if you abuse one of your consumers, you rip them off, give them lousy treatment, jack up the rates, they are going to turn the tables on you. They are going to choose another product.
And I think it is so important for folks to understand this is about taking on the insurance lobby with choice rather than tethering somebody to something they don‘t want, something they don‘t like...
... I also think that the typical union member would be pretty shocked to know that their leadership here in Washington, D.C. is lobbying for a public option that would deny more than 200 million Americans the opportunity to get it. That‘s not in line with the public interest.
I want everybody to have real choice. I think our free choice proposal worked very well with the public option. And, by the way, we got some very good news today, Rachel, because the Mayo Clinic says that they would support a public option as long as it gave people choices like members of Congress get, and I‘ve got legislation to do that, too.
MADDOW: In terms of thinking about what‘s ultimately going to happen and how this is going to work for most Americans, when you guys are having these negotiations, particularly among Democrats, is there an awareness that if the end result of this bill is that coverage stays as lousy and expensive as it is today, the Democrats have changed the law so that we‘re all forced to buy that lousy and expensive coverage, that this will be a huge political disaster? Has that-I‘m worried politically that, that‘s going to happen and sink the Democratic Party for generations, but I‘m also worried that‘s going to be what happens to me personally in terms of my health insurance.
WYDEN: Rachel, you‘re being logical, and sometimes, logic doesn‘t break into these political debates. But that‘s the point that I‘m making. I have been saying, folks, choice and competition are magical words in America. They‘re magical words for progressives, but they resonate all across the country.
Here is our chance to link real choice, real consumer choice with the public option and tell people, if you‘re getting hammered today, if you‘re stuck with a product you don‘t like, we‘re going to liberate you. We‘re going to put you in charge. And, you bet, if the Congress passes somehow an anti-consumer, anti-choice, anti-holding insurance companies accountable bill, I think we‘ll pay dearly for it.
MADDOW: And I think the other thing that we‘ve learned tonight is that, right now, there is a rift between some Democratic senators on the Senate Finance Committee and organized labor. And unless that rift closes, it‘s going to be hard to make political progress here. So, I think that‘s going to be one of the major topics in the days ahead.
Senator Ron Wyden of Oregon, good luck with the mark-up this week, and I know it continues tonight. Thanks very much for taking the time.
WYDEN: Thanks for having me.
http://www.realclearpolitics.com/...
Wyden talking about Choice on Rachel Maddow: http://www.msnbc.msn.com/...
The amendment for markup CI:
Wyden Amendment #C1 to Senate Finance Chairman’s Mark
Short Title: To ensure affordable access to health insurance exchange plans for all
Americans
Short Description:
This amendment gives every American the ability to either choose to keep the coverage
they have or pick a plan that works better for them and their family. It guarantees both
choice and portability by creating a path for employers to insure their workers through
the state-based insurance exchange. This amendment also recognizes that employers
play an important role in ensuring that their employees have health coverage and gives
employers a choice in how they fulfill that role. This amendment honors President
Obama’s pledge that everyone can keep the coverage they have while making it possible
for individuals and families who don’t like their current coverage to get a good quality,
affordable alternative at an insurance exchange.
Employer Coverage Options: Under this amendment, employers that offer group health
coverage meeting the minimum requirements under the Act would have the following
options:
- The employer would offer all individuals eligible for coverage under their plan a
voucher equal to the amount that the employer would pay for their coverage under
the plan that they sponsor. These workers would have the choice to:
Forfeit the voucher to take the health plan offered by employer; or
Decline the employer plan and use the voucher to take coverage through the
local exchange. If workers select a plan that costs less than the voucher amount,
they can keep the unspent amount as cash.
- The employer can offer two or more health plans where at least one has a premium
that is less than or equal to the average of the premiums for the two lowest cost
"gold level" health plans in the area exchange. The amount of the employer
contribution must be the same regardless of the plan selected by the worker. If the
employer contribution amount exceeds the premium for the lower cost health plan,
the worker retains the difference as cash.
Tax Treatment of Benefits: Under both approaches, the employer contribution for
health insurance, including the voucher amount, is exempt from taxation except to the
extent that they do not exceed the employer tax exclusion caps under the Act (i.e., $8,000
individual, $21,000 family). However, if the voucher amount exceeds the cost of
insurance purchased in the exchange, the difference is taxable income to the employee.
The employer will continue to be able to deduct the full amount of their costs including
voucher payments.
Risk Adjustment: All employers electing the voucher option would be required to
participate in a reinsurance pool encompassing the plan offered by the employer and the
plans in the exchange. The reinsurance is fully funded with an assessment applied
uniformly to affected employers and exchange plans. Employers that decide to offer a
choice of plans rather than offer vouchers are exempt from participation in the
reinsurance pool.
More Choice for Workers: Workers who don't like their employer plans can choose to
go to the exchange and choose any plan available through the exchange. If their
employer currently provides health coverage, the workers will get a voucher equal to
the money their employer currently pays to help pay the cost of an exchange plan. The
voucher amount would be excluded from the employee’s income and the cost of the
voucher would be deductible by the employer. If the workers choose a plan that costs
less than they have currently, they get rewarded with extra money in their pockets.
More Choice for Employers: Employers also have more choices: they can give their
workers the ability to buy health coverage in the exchange or bring their entire group to
the exchange and get a discount. This choice could be phased in for the mid-sized and
large employers over a few years after the exchange gets going.
Employers with good health plans will be able to maintain their plans because they will
offer their workers better value. Employers with high cost, low value plans can cut their
costs by letting their workers go to the exchange.
Cost Containment: The plan would reward consumers for selecting more efficient lower
cost plans by enabling them to retain the full amount saved by electing a lower-cost
option.
Transition to the Free Choice System
Year 1— People who are currently in the individual market plus small employers with
up to 25 workers and the uninsured have access to the exchange.
Year 2-- Add employers with up to 100 workers to the exchange.
Year 3 – Open exchanges to all employers.
Offset – The Lewin Group has estimated that the Free Choice proposal would reduce
national health spending by $360 billion over the next 10 years and this reduced health
spending would reduce the amount of revenue foregone through the health tax
exclusion by $129.8 billion over that 10-year period. Thus, the amendment should raise
revenue. It should complement and enhance the "stick" provided by the excise tax on
high cost plans by providing a "carrot" to encourage selection of low cost, high value
plans.
http://wyden.senate.gov/...
The text of the amendment:
http://wyden.senate.gov/... (Note there are a few changes to this from earlier versions. Earlier versions had a formula for calculating the voucher amounts. The filed version would just convert the employer subsidy directly into a voucher.)
Excerpt of Wyden Op Ed in NYT:
The various bills making their way through Congress would, as the president explained, provide some consumer choice by establishing large marketplaces where people could easily compare insurance plans and pick the one that best suits their needs. Companies participating in these insurance exchanges would be required to offer coverage to anyone who wants to buy it, regardless of their age, gender or health status, and they would be barred from charging someone more for having a pre-existing condition.
The problem with these bills, however, is that they would not make the exchanges available to all Americans. Only very small companies and those individuals who can’t get insurance outside of the exchange — 25 million people — would be allowed to shop there. This would leave more than 200 million Americans with no more options, private or public, than they have today.
I understand the president’s fear of overreaching. Past reform efforts have failed in part because of the public’s distaste for government-imposed change. But walling off most of the health care system from choice and competition could create greater problems — enough to doom health care reform.
http://www.nytimes.com/...
From Jonathan Cohn at The Treatment:
http://www.tnr.com/...
... That brings us to the other obstacle to his idea: the political one. Many employers are reluctant to cede control over the kind of coverage their employees receive. They are among the groups who have pushed to limit access to the exchanges; and, it’s safe to assume, they would not be happy about this latest Wyden proposal. At a time when Obama and his allies are (understandably) focused on getting whatever they can through Congress, this is no small thing.
Still, there’s a compelling argument that--in the long run--employers and would be better off under this system. The more people shop around for coverage, the more they will seek out better bargains, assuming the market is well-regulated. That will reduce employer costs. Besides, under Wyden's scheme, employers themselves would eventually get the right to buy coverage through the exchanges. (The whole thing would phase in over a couple of years.) That, too, could reduce the burdens on their bottom line.
For any of this to happen, of course, a lot of people would end up moving out of employer-sponsored coverage and into the exchanges. That's the sort of change many people fear--and that opponents of reform are sure to exploit. Again, this is not a minor thing--although Wyden's counter-argument here is also pretty good. If he gets his way, everybody, even people with insurance, would suddenly have new alternatives. And they'd be better alternatives.
It’s worth remembering that Obama, along with other reformers, have frequently suggested reform will offer more choices. If Wyden can perfect his proposal--and, no less important, if he can get his fellow reformers to embrace it, in some shape or form--that promise can be fully realized.
Front Page NY Times piece by columnist David Leonhardt: http://www.nytimes.com/...
David also recently did a blog post with this excellent line about free choice "Is it naïve to hope that the people making the decision will listen to arguments both from special interests and from people who don’t have a financial stake in the outcome?" http://economix.blogs.nytimes.com/...
Ezra Klein calls Free Choice "The Idea that Could Save Health-Care Reform" http://voices.washingtonpost.com/...
Ezra also identified it as one of the "Five Ways to Improve Max Baucus’s Bill" http://voices.washingtonpost.com/...
Ruth Marcus on why people should listen to Ron Wyden: http://www.washingtonpost.com/...
Jonathan Cohn, the author of "Sick," endorses the Wyden’s Free Choice proposal: http://www.tnr.com/...
Matthew Yglesias explains reinsurance ensures that Free Choice would not undermine the employer-based system as those trying to kill it (see attached AFL letter) have argued: http://yglesias.thinkprogress.org/...
MSNBC’s Dylan Ratigan writing in Huffington Post on why Choice matters: http://www.huffingtonpost.com/...
Wyden on Countdown: http://www.msnbc.msn.com/...