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Susan Collins and Ron Wyden get to work


Later today, Sen. Ron Wyden and Sen. Susan Collins will release a bipartisan package of amendments to the health-care reform bill. One of them is really good. One of them is harder to evaluate. And one of them is rather small. But all are worth taking seriously.

The best of the bunch is the latest incarnation of Wyden's Free Choice Act, which makes an important tweak to the insurance exchanges. Right now, the exchanges don't permit employee choice. If your company buys into the exchange, it doesn't mean that you and your colleagues get to pick the plan that best fits your needs. It means your HR department picks a plan for everyone. Wyden would let employers choose to give their workers a voucher that the employees could use to choose their own insurance plans. It's a dead-obvious amendment, and it establishes an important principle in the exchanges.

Collins' amendment lowers the floor on insurance coverage in the exchange. Right now, people under 30 can purchase a cheap, catastrophic plan. Collins would extend that plan to people over 30 who aren't on subsidies, too. That is to say, workers with sufficient incomes could purchase extremely cheap health-care insurance that did little save protect them from medical catastrophe.

On the one hand, this poses serious adverse selection problems (the healthy might choose this option while the sick definitely won't) and there will be a lot of people who make a bad decision and find themselves buried beneath medical bills. The out-of-pocket cap for a family is a shade under $12,000, and that's more than a lot of families can afford, particularly when a medical emergency destroys the breadwinner's earning power. On the other hand, people can switch their insurance every year, and it might not be a bad idea to have some cheap options on the exchange until we're sure we've got a mix of subsidies and regulations that ensure people can afford insurance. I'd probably vote against this amendment, but I see the argument.

The final amendment is a tweak to the new tax on insurers. If passed, the fee could vary by as much as 50 percent across insurers, with plans that hold down costs getting relief from the tax and those who fail facing a heavier penalty. It would also severely punish any insurers who attempt to sharply raise fees in advance of the program getting off the ground. I doubt this will do much in the long run -- the fee isn't very onerous one way or the other -- but it's worth trying.

But whether you like these amendments or you loathe them, they're the sort we need more of. The first few days of the bill have been consumed by message amendments and efforts at posturing. The Senate has passed statements affirming its support for entitlement programs and beaten back attempts to erase abortion coverage from primary insurance and endlessly debated whether to render Medicare sacred and untouchable, now and forever, amen.

There have been exceptions, of course. Pryor's insertion of a consumer review into the insurance exchange was a good addition to the bill. But broadly speaking, we've focused on the points of controversy. If the Senate would turn the bulk of its attention to debating what types of plans should be in the exchanges and how they should be chosen, the debate would be somewhat less interesting, but the eventual bill might be a lot better. Collins and Wyden are taking a stab a doing that, and they deserve plaudits for it.

Photo credit: AP Photo/Haraz N. Ghanbari.

By Ezra Klein  |  December 10, 2009; 7:07 AM ET
Categories:  Health Reform  
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I would hope that Reid allows the amendment on medical malpractice lawsuits to be debated and voted upon.
I would hope it is then approved but then the Democrats will probably say no as they are beholder to the trial lawyers.

Posted by: mwhoke | December 10, 2009 8:23 AM | Report abuse

Doesn't this bill already need a good fix for the selection problem? Doesn't it already have one? In the catastrophic plans I've seen, the difference in premium is small, and I suspect if you adjusted the premium to account for risk selection, there'd be little difference after all.

Posted by: windshouter | December 10, 2009 8:37 AM | Report abuse

Ezra, we don't need a full-blown nanny state where the gov't says you can't buy a cheaper insurance policy. Support Collins' ammendment, let people have at least a bit of freedom in choosing what they want to buy. There has to still be some level of personal accountability and responsibility.

Posted by: truth5 | December 10, 2009 9:17 AM | Report abuse

wyden's free choice ammendment will be good to watch who votes for it and against it on each side of the aisle. I hope it passes. There are so many companies out there that are stuck with one insurer because the owner or HR rep chooses it for their benefit while it doesn't benefit each employee because of doctor access, cost, benefit. That's why we need the choice although as expected since its limited to the exchange and the exchange is limited its benefits will be limited in scope. Once people see the benefit of this though they will clamor to open the exchanges to all.

Posted by: visionbrkr | December 10, 2009 9:51 AM | Report abuse

"That is to say, workers with sufficient incomes could purchase extremely cheap health-care insurance that did little save protect them from medical catastrophe."

Don't pretend to be stupid. The catastrophic plans only help you in a catastrophe. There are a lot of people out there that would love to have their out of pocket capped at $12k. If you want it capped at $5k, you just have to pay a little more.

Posted by: mattmcknight | December 10, 2009 10:04 AM | Report abuse

I'm glad to see my senator, Ron Wyden, trying to go bipartisan. But how can Collins seriously try to pass amendments for something she fully intends to defeat?

Posted by: cmpnwtr | December 10, 2009 10:52 AM | Report abuse

I actually like all three of these bipartisan amendments, and I'm glad to see Sen. Wyden getting into the thick of this health care debate (it's unfortunate that this bill mutated from the late Sen. Kennedy's proposal rather than from Wyden-Bennett). I see Sen. Collins's participation as a signpost that she may be willing to cross party lines on the final vote after all, and I appreciate that because I think hers is a valuable legislative voice.

Posted by: markdmiller2 | December 10, 2009 12:52 PM | Report abuse


Posted by: wisewon | December 10, 2009 1:05 PM | Report abuse

Ezra, Jim Bunning offered the same amendment allowing everyone to buy a "young invincible" policy. And of course the Finance Committee, correctly in my view, turned it down. In Massachusetts those policies have a $50,000 annual limit of coverage. They are totally garbage.

If you allow these policies to be sold, people will buy less coverage than they need. The "young invincible" policy defeats the entire purpose of the bill -- which is to create a sustainable health care system that prevents Americans from having large medical expenses, and shields them from its consequences (i.e., bankruptcy, death).

Posted by: BradGabel2002 | December 10, 2009 1:27 PM | Report abuse

Actually, the employer chooses the LEVEL of coverage and the employee is able to choose the actual plan. Of course if you want gold and the employer chooses bronze, that's a problem for you.

Posted by: rachfiles | December 10, 2009 2:21 PM | Report abuse

I think Tort Reform is a great idea. In exchange for Tort Reform the insurers and medical community can reduce their prices by 25% from 2005 levels. The prices are capped at 2% annually or the rate of inflation, whichever is lower.

Let's see how interested the above parties are in real tort reform.

Posted by: Maddogg | December 10, 2009 2:24 PM | Report abuse

I love the idea of a voucher for me to CHOOSE my healthcare.
I have NO choice with my employer. We all have the same lousy plan that is now 44% of my income (between premiums, co-pays, medicines and other out of pockets). For next year, they dropped the spouse and children coverage as well.
I have conditions they won't pay for (which seems to be everything)

I just want a choice. NO MORE OR NO LESS. I don't want FREE health care. I don't want to be a burden. I work very hard, and I just want something that will take care of me and be affordable.

Why that is so hard to understand for some people is beyond me.

Posted by: kare1 | December 10, 2009 2:28 PM | Report abuse

Ezra - Is the first Wyden amendment (choice of plan) really so brilliant when you consider that employers now pay a single, composite rate for each employee on its health plans? (The employer choosing the plan allows the practical continuation of the composite rate concept.) The Senate bill allows 3:1 age rating. So, does that mean an employer gives workers different levels of compensation based on age. Are their ADEA implications associated with that? If the employer gives all employees the same value in voucher, older workers are disadvantaged.

Wyden cosnsistently fails to consider his amendments' impacts on the employment based system. Please don't make the same error.

Posted by: dcinsider1 | December 10, 2009 2:33 PM | Report abuse

This may sound a bit gruff, but who in the h are you to tell me I shouldn't be able to buy the insurance coverage of my choice?

I was led here by your appeasing response to a legitimately concerned citizen about high deductible plans being taken away. I get here and you essentially say it's a bad idea, and those plans should go away.

Your argument seems to be these plans work, until they don't. Ever think about Social Security, Medicare, and Medicaid, in those terms? As far as I understand it, insurance companies are supposed to, by law, be financially capable of paying their bills. The federal government soon won't be able to pay it's bills, and really, it's not doing that even now.

And please explain to me how the federal government has any stake in this. Your and the left's desire that people not be able to cross state lines to purchase insurance would seem to make this pretty clearly not an issue of interstate commerce. Of course the idea that you guys respect that there exists such a thing the commerce clause doesn't touch is laughable.

And your reasoning last time I checked why we shouldn't open up interstate competition to bring about the competition is you claim to want is insurance is regulated at the state level. You say this, with a straight face, as you push for federal takeover of regulation.

You should be embarrassed to be supporting this absolute mess of a bill. I wish you failure in your quest to limit freedom in this country.

Posted by: sarthur1 | December 10, 2009 2:43 PM | Report abuse

How can it be Bi-Partisan when Collins is a Moderate Republican...?

Most conservatives (majority of America) already understand that Moderate Republican = Progressive Democrat and vice versa.

Sorry WaPo... Americans are getting educated about the traitorous and treasonous Marxists in Congress. They will not survive another vote in 2010 which is why they are all rushing to throw everything they can against a wall, in hopes that something will stick.

I smell desperation...Lots and lots of it...

Posted by: ProveMeWrong | December 10, 2009 3:07 PM | Report abuse

No public option .... no peace.

We are three-quarters of America.

We are the vast and overwhelming majority of American citizens.

You either put in a public option and stop with your Big Pharma and Big Insurance tricks or we run OTHER Dems in every district and every state against EVERY Dem who votes against the public option.


Posted by: WillSeattle | December 10, 2009 3:15 PM | Report abuse

How 'cheap' is cheap on the catastrophic?

Posted by: RedBird27 | December 10, 2009 3:22 PM | Report abuse

The most Important #1 PREVENTATIVE for over-All Health is proper "DENTAL" Care!! So "DENTAL" must be included in the Health Reform Bill. - If no "DENTAL", then the Bill will be the same-ol' same-ol' LIES!! CONGRESS & OBAMA talked on-and-on about PREVENTION! - And the #1 most needed Preventative Is "DENTAL" - period!! -- also read:-- President Barack Obama took the first step toward reforming the American health care system by convening a White House summit that brought together many of the top stakeholders in the health care community. An excellent start, to be sure, but there was a conspicuous absence at the summit — out of the 80 organizations present, not one represented dentistry. - This was appalling & stupid!!

The American Dental Education Association strongly supports the president in his efforts to build a more equitable, cost-effective and robust American health care system — but any comprehensive reform of the U.S. health care system should provide universal coverage of and access to high-quality, cost-effective dental services for all Americans.

Oral health is often ignored or overlooked in the debate over health care reform, despite the fact that, as former Surgeon General C. Everett Koop noted, “You are not healthy without good oral health.”

Good oral health has proven to be essential to general health and well-being. Bacteria associated with dental plaque have been linked in studies to cardiovascular disease, diabetes, pneumonia, and pre-term, low-birth-weight deliveries. Mouth lesions may present as early signs of HIV infection. Bone loss in the lower jaws of post-menopausal women may occur before the skeletal bone loss associated with osteoporosis. Poor oral health directly affects an individual’s nutritional state.

Approximately 130 million American adults and children lack dental insurance coverage. There are almost no oral health care services covered under the nation’s Medicare system, and there are no guaranteed oral health care services for adults in the Medicaid program.
-- If no "DENTAL" is in this so-called Health Reform Bill, - then it is Not Reform!! - PREVENTION should be the #1 Priority!! - And "DENTAL" Is the #1 over-All Health PREVENTATIVE!!!!

Posted by: jward52 | December 10, 2009 3:40 PM | Report abuse

Thanks for the info, Ezra, and your intelligent support of this much needed bill.

Posted by: drindl | December 10, 2009 4:02 PM | Report abuse

mwhoke wrote
"I would hope that Reid allows the amendment on medical malpractice lawsuits to be debated and voted."

Why are you under the delusion that tort reform is the THE PRIMARY PROBLEM with medical costs? Who told you this? Where did you learn it?

Perhaps 2% of total costs (two percent). Annual growth in insurance premium is 3-5 times larger. Did your sources tell you this?

Why do you trust those sources who keep emphasizing tort reform as their solution? Why are you allowing yourself to be disinformed?

I'm not an attorney, just a med device inventor. We see that some specialists pay much high premiums - yet in states like California where tort reform was passed, premiums didn't decline in parallel to reduced risk.

Posted by: boscobobb | December 10, 2009 4:27 PM | Report abuse

I also have and amendment, single payer, Medicare for all. Case closed

Posted by: shipfreakbo214 | December 10, 2009 5:29 PM | Report abuse

I like my high deductible plan, which I have through work and also had a few years ago when I was self employed. Because this costs less to my employer, the company pays a personal trainer to meet with each of us for an hour 2x a week. When I was self employed, the lower premiums allowed me to spend more money on building my business and taking care of my own health. I liked that freedom of choice.

BradGabel2002... The high deductible plan is for catastrophe, which is not preventable in most cases.
As for prevention, the senate bill is going to do nothing to make people eat healthier, exercise regularly, practice good hygiene, and manage their own stress. All of those are things that would have the biggest impact on health care costs.
Cheaper prescription drugs may have side-effects that outweigh their benefits, and regular checkups will only be useful in a small number of costly diseases that can be detected by sight or palpation. For diseases where pain indicates visiting a specialist, the high deductible works here too. I saved over $2000 a year on premiums using the high deductible plan, and I put some money into an HSA. When I had shoulder pain, I used the HSA money to pay for a visit a bone specialist.

Like I said, it's not for everyone, but it allows people to take control of their own health, which is an overlooked component of the total cost. I think if you asked many people who have such plans, they would say they are happy with them. Why take them away?

Posted by: zenboz | December 10, 2009 5:37 PM | Report abuse

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