Imagine this scenario:
Your wife has just been diagnosed with an expensive but treatable form of cancer. Thankfully you have good family insurance (either public or private, it was your choice after all) that you selected through an exchange, with a generous payment from your employer to offset some cost of the premium. But three weeks into your wife's treatment, your company goes through a round of layoffs, and you happen to be one of them.
How will you ever afford your health insurance premiums now that you have no employer contribution and no income? Will you be able to afford COBRA payments? How does your wife fare? What happens when you've been unemployed too long to qualify for COBRA?
Find out more after the break.
Fortunately, the situation is not nearly so grim: you bought your insurance through the exchange, so your insurance is the same as an individual policy and you can keep it even after being fired. Not only that, but because you now have no income, an automatic government subsidy kicks in, paying for the majority of the premium and reducing cost sharing in order to reflect your new income situation. Your wife's therapy continues as planned, with the same insurance policy and the same doctor. With the government subsidy, your insurance policy is stable. If your savings dwindle so low that your generous policy does become unaffordable, at least you are now guaranteed instant access to medicaid if you drop your current insurance plan, but for now, because of the government subsidy, you are able to afford what little is remaining of the premium on your unemployment benefit alone.
Two months later, you finally receive a job offer. But will your insurance policy be canceled, forcing you to go on a company plan that may disrupt everything in a way that even getting fired didn't?
Disrupt health care just because you have a new job? Why, not in a civilized country like the United States! Your new employer is a small business that also contracts its insurance through the insurance exchange. Your policy remains the same, and because of the incentive of a large tax credit, your new employer is able to afford to pay for part of your insurance premium, just as your old employer did.
You've just gone through job loss, unemployment, and re-employment, all without changing your insurance plan once. There was no disruption in coverage. No change in doctors. No having to face an individual insurance market where a pre-existing condition can mean complete bankruptcy. And there was no point where you were unable to pay for your insurance.
We talk a lot about the importance of a strong public option. This scenario illustrates the importance of something equally important: a strong insurance exchange. An exchange that gives you a viable alternative to being locked into a single insurance plan that your employer chooses, and then being unable to quit work because you can't afford to find a new policy. A strong insurance exchange system would constitute the beginning of truly portable insurance in the United States. And it's more important now than ever, as the average American holds more and more jobs in a lifetime. Access to the insurance exchange will also define access to choice, access to the public option, and access to portability, making it possibly the biggest lasting benefit for the middle class. This one issue could by itself define success or failure of health care reform.
As I understand the different plans, the House Tri-Committee plan holds the path forward for a system where the above is possible. In the Tri-Committee bill, employers are allowed to give employees insurance through the insurance exchange. The Senate committees are making it hard to even enter the exchange as an individual. In order to prevent insurance companies from seeing real competition and make it more difficult to receive government subsidies, they are creating a "firewall" that puts a barrier between the insurance exchange and employees of companies that offer their own group insurance plan.
We need to start lobbying our congressional representatives for a STRONG insurance exchange, with no firewall to prevent employees of large companies from accessing high quality, portable insurance through the insurance exchange. We need to ask our congresspeople to implement a plan that allows large employers to contract with the insurance exchange, just as small businesses will be able to do.
With enough support, perhaps we can create a better future, where we don't need to worry about our insurance being taken away every time our jobs are threatened. Perhaps recessions will no longer need to be health care disasters in addition to employment disasters.
Good luck to everybody, and let's pray for a better future!