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The Senate bill would give more small businesses access to the new exchanges quicker than the House bill. In the Senate bill, any business with 100 or fewer employees could use the new exchange. Starting in year four (2017), individual states could choose to allow larger businesses to also use the exchange.
Conversely, the House bill only allows businesses with 25 of fewer employees access to the new exchange in the first year. That is upped to 50 employees the second year, and 100 employees for year three. In year three, the new commissioner could choose to start allowing even larger employers to use the exchange.
The Senate bill would open up the exchange to more small businesses when it is first created. It would unfortunately delay the possibility of opening up the exchange to all employers by one extra year. It is important to remember that the House bill would start most reforms in 2013, while the Senate bill delays the start of the reforms until 2014, purely to make their bill look cheaper. So, in theory, there really is only one year (2015) when some small businesses (those with 50-100 employees) could not use the exchange under the House bill, but could under the Senate bill.
When/if the bills are merged in conference, I would like to see the Senate provision giving all businesses with 100 or fewer employees access to the exchange right away preserved. The three-year phase-in in the House bill seems an unnecessary delay in expanding access to the exchange and potentially the public option, which would only be available on the new exchange.
In the end, the practical effect may be very small. The CBO predicts that only a tiny fraction of eligible employers will take advantage of letting their employees select insurance on the exchange. Unless the exchange is improved, no one is really going to want to get insurance there. If you really want to increase the number of people using the exchange, you don’t just need to increase potential access, you also need to give businesses and individuals a strong incentive to use it.
Read Part 1 Wavier For State Innovation and Part 2 Cantwell’s Basic Health Program.
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Why only small employers? Why not ALL employers? From what I hear in the coffee shops and at work, nobody seems to understand how limited this access is. Combine it with the mandates and you will see some verfy angry voters in 2010.
Is the bulk of the Democrtic Senate planning to change parties with the new year, or what?
I think the much more important distinction is between letting states decide if 100+ employer businesses can access the exchange, or let the HHS secretary do it. I would much prefer the latter House version – Obama is pretty likely to win a 2nd term and once it’s opened up to everyone it will never be closed. This is one of the few most important decisions left.
However, it’s quite likely that the private insurance market will continue to dissatisfy people and there will be a persistent strong demand to open up the public option to everyone until that’s done. And once we’re there, around 2015, the majority of corporations will jump on the public option. I can’t track down right now the WSJ op-ed a few months ago that made this point, but the gist is that once the public option actually exists and isn’t just a legislative proposal with partisan and ideological implications, businesses will be agnostic with regards to the public option and just go with whatever plan is the cheapest. Which will be the public option, once the ban on pre-existing conditions, rescisions, OOP expense limits and the removal of caps on coverage, etc., wreak havoc on the private market.
Have Dems put their brains on the shelf? Do they not get that this kind of crappy public option, no cost control and no manifest benefits in 2010 will spell their doom? Is Obama beholden to Rahm the total Corporate Tool? No other logic makes sense.
On Countdown, Sheldon Whitehouse’s announced his capitulation, from Robust Public Option to Trigger is shameful. As Nancy Pelosi said a Trigger is an excuse for doing nothing. Thus Whitehouse joins the ranks of do nothing Dems.