There's a flip side, though: If your employer offers you acceptable care and you reject it, you are barred from buying insurance in the insurance "exchange." In other words, you must take the insurance offered to you at work. And that might have made sense if, as decreed in the House version, employers actually had to offer good care. But in the Senate version passed by the HELP committee, there is no real requirement for employers to provide any kind of minimal level of care. On the contrary, employers who currently offer sub-par coverage will have their lousy plans protected by a grandfather clause. Which means: "If you have coverage you like, you can keep it," says Sen. Sanders. "But if you have coverage you don't like, you gotta keep it."
This grandfather clause has potentially wide-ranging consequences. One of the biggest health care problems we have in this country is the technique used by large employers à ?? Walmart is the most notorious example à ?? of offering inadequate, bare-bones health insurance that forces employees to take on steep co-pays and other massive charges. Low-wage workers currently offered these plans often reject them and join Medicaid, effectively shifting the health care burden for Walmart employees on to the taxpayer. If the HELP committee's grandfather clause survives to the final bill, those workers who did the sensible thing in rejecting Walmart's insurance-in-name-only employer plan and taking the comparatively awesome insurance offered via Medicaid, will now be rebuffed by the state and forced to take the crappy Walmart offering.
This works out well for the states, who will get to purge all those Walmart workers from their Medicaid rolls. It also works great for Walmart, since any new competitors who appear on the horizon will be forced to offer genuine and more expensive health insurance à ?? giving Walmart a clear competitive advantage. This little "glitch" is the essence of the health care reform effort: It changes things in a way that works for everyone except actual sick people.
Veteran legislators speak of this horrific loophole as if it were an accident à ?? something that just sort of happened, while no one was looking. Sen. Ron Wyden of Oregon was looking at an early version of the bill several months ago, when he suddenly realized that it was going to leave people stuck with their employer insurance. "I woke up one morning and was like, 'Whoa, people aren't going to have choices,'" he recalls.
As a means of correcting the problem, Wyden wrote up a thing called the Free Choice Act, which like many of the prematurely sidelined ideas in this health care mess is actually quite sensible. The bill would open up the insurance "exchanges" to all consumers, regardless of who is offered employer-based insurance and who isn't. But Wyden has little hope of having his proposal included in later versions of the bill. Like Sanders, who hopes to correct the committee's giveaway to drugmakers, Wyden won't get a real shot at having an impact until the House and Senate meet to hammer out differences between their final bills. In a legislative sense, the bad ideas are already in the barn, and the solutions are fenced off in the fields, hoping to get in.
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