A lot has been made of the fact that the new health insurance exchange would only be open to a small subsection of the population which is uninsured or works for a small business. The new public option will only be available to people on the new exchange. As a result, most people would be denied the ability to choose their own health insurance plan on the exchange and would be denied the ability to sign up for the public option. This is an issue especially important to Oregon Senator. Ron Wyden (D).

The House bill would expand access to the new health insurance exchange fairly rapidly. In year one, 2013, only individuals without employer provided insurance and the “smallest” employers (25 or fewer employees) would have access to the exchange. In year two, 2014, “smaller” employers (50 or fewer employees) could access the exchange. By year three, 2015, all “small” employers (100 or fewer employees) would gain access to the exchange, and the exchange Commissioner could permit larger employers (greater than 100 employees) to be eligible for the exchange.

In theory, by 2015 all employers, and therefore all Americans not on Medicare or Medicaid, could start using the new health insurance exchange for health care. This would give nearly everyone the ability to choose the public option if they wanted. Of course, that would rely on the Commissioner deciding to throw open the exchange to every business, as well as all large employers choosing to provide coverage through the exchange. . . but, I don’t see that happening nearly as quickly as is theoretically possible.