Among the oddities of the budget deal are those things that have absolutely nothing to do with the budget (the unprecedented congressional removal of gray wolves from the Endangered Species list? Thanks, Jon Tester and Max Baucus!). Here's a surprising one: Sen. Ron Wyden's (D-OR) Affordable Care Act provision that would allow more flexibility for lower-income workers in health insurance has been sacrificed as part of the deal, even though it has no budget impact in this year's budget.
Wyden's Free Choice vouchers would allow qualifying low-income workers access to the health insurance exchange where they could shop for more affordable insurance programs. He writes about it at HuffPo:
Under the new health law, Americans whose income falls below 400 percent of the federal poverty level and whose employer-sponsored health insurance premiums are between 8 and 9.8 percent of their total income will be exempt from having to purchase health coverage but will not be able to access the exchanges or qualify for government assistance to buy insurance.
If an employee's share of their health insurance premiums rise to 9.9 percent of their total income, they would be allowed to shop for more affordable health insurance in the new health insurance exchanges, with a taxpayer-funded subsidy. But again, at 9.8 percent and below their only options will be to pay for their employer-sponsored coverage or to go without health insurance altogether.
Had Free Choice Vouchers survived, they would have given this group a third option: to take the tax free money that their employer would otherwise contribute to the cost of their health insurance and use it to buy a more affordable health insurance plan at the exchange. This provision would have meant that fewer Americans would have to go without health insurance and by leveraging private dollars versus relying solely on taxpayer funded subsidies, it would have ultimately saved money. If employer premiums continued to rise, more and more Americans would have become eligible for this option and more choice and competition would have been injected into the health insurance market....
Not every employer likes this idea that Americans might be able to get good health insurance outside of their job or union. Which is why some of the most powerful interest groups spent most of 2009 fighting the inclusion of even this small version of Free Choice Vouchers into the health reform law.
There's no budget saving in 2011 by sacrificing this program. It's not operational until the exchanges are, in 2014. As far as reform goes, it was pretty small bore, creating a modicum of competition for this group of people. But what it did do was, for the first time, decouple health insurance and the workplace, an idea that many employers objected to on the theory that they'd lose younger and healthier employees in their plans. If health insurance reform works the way it is supposed to, that won't be a problem for employers; they'll still be able to afford coverage for all employees. The real problem seems to be in ceding a captive group of employees, who would have more freedom if they had more choice.