Throughout the health care debate, Oregon senator Ron Wyden worried whether Americans who will be required to buy health insurance would be able to afford it. In an interview with Campaign Desk a few months before the law passed, Wyden told us that many people will have no choice but to take the penalty for not buying coverage because they would not be able to afford what was offered. “We’re walking into a no man’s land,” Wyden said. “They will have no coverage, pay a penalty, and put off health care concerns.”
So Wyden crafted a plan that would offer an escape hatch—if an employer’s insurance was too costly for a family, they could take the money their employer would have spent on insurance for them and shop in the new state exchanges that will show up in 2014. There they might find something cheaper and perhaps more comprehensive. Despite opposition from businesses, Wyden’s Free Choice Voucher plan made it into the final bill. Its life was short, however. When Congress hammered out the budget package a couple of weeks ago, Free Choice Vouchers were gone—a victim of strong-armed lobbying from both business and labor.
Hurrah for The New York Times’s Eric Lichtblau for telling us what happened. The American Benefits Council, a lobbying group for insurers and employers, didn’t like the choice plan because it would have a “destabilizing” impact on employer insurance. Unions said vouchers would create a “death spiral” of higher costs. A spokesman for House Speaker John Boehner said “the program was eliminated because it costs jobs—and jobs are the American people’s top priority.” It’s hard to see how giving workers a shot at cheaper coverage is a job killer, but then in Washington speak sometimes nothing makes sense.
Wyden told the Times that the ultra-powerful Business Roundtable probably killed the vouchers. “Everyone knows the Business Roundtable wanted this killed, and now they can go back with a trophy to say they protected business as usual,” he said. According to Wyden, the Congressional Budget Office said there were no implications for the federal budget since the only money changing hands comes from employees making use of the employer health care subsidy, which is already part of their compensation package.
What’s really the problem? Writing at the Huffington Post, Wyden noted that “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.” In other words, letting people out of employer plans might undermine the clout of employers and the unions in the health care biz.
Lichtblau asked the Obama folks for their side of the story. An anonymous source in the administration said ending the voucher plan wasn’t its first choice, “but these were tough, tough negotiations, and obviously no one got everything they wanted.” As it became clear what had happened to Wyden’s baby, the same Business Roundtable had just reached an agreement with the president—a “Partnership for Patients Pledge” that was “intended to show commitment to health care,” as the Times put it.
A few days after the agreement was finalized, Donald Berwick, the head of the Centers for Medicare and Medicaid Services, showed up for a newsmaker briefing at a conference of the Association of Health Care Journalists, where he briefed reporters on a business-government alliance and left a fact sheet called the “Partnership for Patients: Better Care, Lower Costs.” Whether the several hundred journos in attendance were impressed with Berwick’s handout is hard to say. It was basically a government blah-blah paper setting out some lofty goals to improve patient care—for example reducing preventable hospital-acquired conditions by 40 percent in the next two years.
My mind went into dot-connection mode. What a disconnect between what Berwick was touting and the Times’s revelations! Pledges of business-government cooperation won’t mean a tinker’s damn if the people Wyden intended to help can’t afford insurance, take the penalty, and go without care. Health reform has now moved big time to the dot-connection stage. Consider this choice thing. We constantly hear from the pols, businesses, and others about consumer choice, but the actions of the budget negotiators lock consumers into expensive plans and legally bar them choosing something different. How’s that for choice? The Times has led the way. It’s up to other health reform eager beavers in the press to take it from there.
Trudy Lieberman is a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for CJR's Covering the Health Care Fight. She also blogs for Health News Review and the Center for Health Journalism. Follow her on Twitter @Trudy_Lieberman.