Sen. Ron Wyden, D-Ore., says the current health care proposals in Congress don’t do enough to slow spending, grant workers new choices in coverage or guarantee that middle-class Americans will be able to afford insurance. But, the longtime health policy guru says, there are ways to fix the legislation.
While Wyden would prefer that Congress turn to the bipartisan bill that he and Sen. Robert Bennett, R-Utah, introduced two years ago, he’s not counting on that. Instead, he wants to add a "free choice" amendment to Senate Finance Committee Chairman Max Baucus’ proposal. Wyden’s amendment would allow more workers with job-based insurance a chance to reject workplace offerings and pick a plan from among those sold on state or national exchanges that will be set up in the legislation. Under his amendment, workers whose employers didn’t offer at least two choices for coverage – one a lower-priced plan – could go onto the exchange and pick from among a variety of options sold by private insurers. Employers, too, could opt to move all their employees to the exchange, so long as they pay at least 70 percent of the average cost of the three least expensive plans available. That’s different from current legislation, which would keep most people with employer-based coverage from using the exchange.
Wyden spoke Friday to Kaiser Health News reporter Julie Appleby.
Q. Your proposal would allow more people, specifically those with job-based insurance, to use the exchanges. Why is that important?
A. Unfortunately, the bills being written in the U.S. Congress not only don’t give people the choices that members of Congress have; they also don’t give Americans -- more than 200 million (of them) -- choices at all. It’s choices that will allow them to hold insurance companies accountable, that will give them more affordable options.
Q. How would your amendment change that?
A. We would, in effect, put a comma in and say you can keep the coverage you have, but if you don’t like the coverage you have, you will be in a position to go into the marketplace and have other options.
Q. Isn’t there a caveat? If your employer offers two plans, you can’t go onto the exchange.
A. If your employer offers a lower cost plan and a higher cost plan, you would need to choose one of those. What we tried very hard to do in drafting the free choice proposal is to be sensitive to concerns of employers. If employers would like to go to the exchange they could have that kind of opportunity.
Q. Aren’t employers going to worry that all their young, healthy workers will go to the exchange to buy coverage?
A. There are very significant questions about who if anyone would decide to leave their employer (coverage). Those who might be most likely to leave would be older employees looking for a bargain, rather than younger ones who say they have a million (other) things to do … (and are) not sure if they will call HR or go to the exchange and look at (their) options. No one knows for certain how events will play out once you have a marketplace. The risk adjustment process ensures you have a safety valve so at the end of the year there is a way to make adjustments (based) on who might stay with the employer and who might decide there are competitive alternatives.
Q: Turning to overall reform now. There is a lot of division, even among Democrats, about what should be in the legislation. What will it take to get enough votes for passage?
A. At the end of the day, a member of the U.S. Senate has got to be able to look a middle-class family in the eye and say 'I think this will deliver real health security for you.' If that family … ends up paying considerably more than they do today, plus faces the prospect of penalty if they don’t comply or gets an exemption that leaves them uninsured, I think they’ll have some real concerns. If you have a family making, say $66,000, and you look at a cost of a basic package for many of those people, it could be 13 percent of their income for the premium. On top of that, they have co-payments, deductibles (and) out of pocket costs. That’s got to be a very significant hit on them.
Q. How can that be fixed?
A Choice and affordability are two sides of the same coin. Choice is all about creating competition, which can make coverage more affordable.
Q. You can say there’s choice and competition in Massachusetts, but there are still a lot of folks in there who can’t afford coverage. Is it not working?
A. Massachusetts and all the states don’t have the tools for individuals to take control of health care. They can’t touch the federal tax rules, which are a major factor in people’s decision making. I think asking states and individuals by themselves to control costs is like asking someone to play in the NBA with lead in their shoes.
Q. Does the Baucus proposal reduce spending over time or have cost controls you think will be effective?
A. It wouldn’t be my first choice. My choice was to convert the (current law that allows workers to get health benefits tax free) into a deduction or a credit of close to $18,000 so individuals who shopped would actually get a tax cut. The proposal in the Baucus bill seeks to tax high-cost policies, which means individuals would not have same the direct ability to benefit from shopping wisely.
Q. Would the Baucus proposal reduce the deficit? The Congressional Budget Office says it would reduce the deficit.
A. There’s debate about the ramifications of the deficit. Until (CBO Director Douglas W.) Elmendorf goes through this carefully, the committee deliberations will (have) a lot of questions with respect to long-term financial implications. There are a number of provisions there that will pay off in the long term. But economists say if you don’t give individuals more control over health decisions, especially the 160 million who have coverage, not much changes anytime soon.
Q. If the measure that ultimately comes before the Senate doesn’t allow you to look people in the eye and say this is affordable, you might then be trying to decide if you’ll vote for this or not. But you will get a lot of pressure from the party and president saying, "You can’t stand in way of 60 years of progress on this, you have to vote for this." How would you respond?
A. If it’s not possible to explain to middle-class folks across the county how health reform is affordable for them, there will be a lot of senators saying. "That doesn’t cut it, let’s go back and get it right."