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All of this is prologue to answering the real question – once the public health insurance option is up and running, can I drop my employer-based coverage, sign up for the Exchange and lock myself into my own little piece of Medicare-like coverage? In the Senate bill, the answer looks to be no – I’d still be “eligible” for my employer’s plan, and so ineligible for the Gateway. This is what Ezra Klein calls “a so-called ‘firewall’”, keeping out large businesses and individuals who could have coverage through their employer. If the House bill is what we get, I have more options. After all, the contract we sign with our employers and their insurer usually has different options for opting out. Some allow for “open enrollment” periods once or twice a year, most allow for “qualifying events” like marriage or divorce to add or remove dependents. A few are even more open-ended. And in many you could sign up for other benefits (401(k), life insurance, etc.) but pass on health coverage.
The success of these Exchanges and the public health insurance option (which would only be offered within these Exchanges) depends largely on how many people can participate. How much choice we’d really have in the new health care system depends on whether the House or the Senate prevail in the fight to come.
http://healthcare.change.org/blog/view/who_will_get_locked_out_of_the_health_exchangeAnd, when I read Obama's word from last night, it looks to me like he supports the Senate version:
Now, I have no interest in putting insurance companies out of business. They provide a legitimate service, and employ a lot of our friends and neighbors. I just want to hold them accountable. The insurance reforms that I’ve already mentioned would do just that. But an additional step we can take to keep insurance companies honest is by making a not-for-profit public option available in the insurance exchange. Let me be clear – it would only be an option for those who don’t have insurance. No one would be forced to choose it, and it would not impact those of you who already have insurance. In fact, based on Congressional Budget Office estimates, we believe that less than 5% of Americans would sign up.
This is important. If Obama really supports the House bill and opening up eligibilty the ball is now in his court to say so. Otherwise, it looks like he's siding with those who are working overtime to keep the Public Option as small as possible.
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