The Public Plan You Won’t Have Access To

Ezra Klein defends his longstanding contention that the public plan isn’t the most important aspect of the health care debate by noting that as currently envisioned in even the liberal House version of legislation the public plan is available only to people in the Exchange and most people aren’t in the Exchange:

In all the bills we’ve seen, the public option is on the exchange. It is only available to those who are able to buy into the exchange. But most Americans can’t buy into the exchange. They’re not allowed. To make this very clear, imagine that the House and the Senate both pass Henry Waxman’s proposal tomorrow. Liberals would celebrate. That’s got a good, strong public plan. And I can’t use it. Not even if I want to pay for it out-of-pocket. I work at a large employer and thus I am not allowed to buy into the exchange.

The issue here is that the Obama administration isn’t lying when it tells you that you’re not going to lose your current health insurance. These plans all try really hard to avoid unraveling the employer-based system, meaning most people will be excluded from the exchange and the whole public option issue will be irrelevant.

That said, this also means that Ezra’s love of exchange-talk aside, the exchange isn’t the most important part of the health reform bills either. The most important part of the bills that actually exist — the part that will impact the lives of most Americans — are the new regulations on insurers.


The administration is proposing:

— A ban on discriminating against people with pre-existing conditions.

— Caps on out-of-pocket spending.

— No cost-sharing for preventive care.

— No “rescission” of coverage for people who get seriously ill.

— No gender discrimination.

— No caps on coverage, either lifetime or annual.  — Extension of family coverage for kids up to the age of 26.

— Guaranteed insurance renewal.

The fact that liberals like to talk about the uninsured and Peter Orszag likes to talk about bending the curve and I, personally, like writing about tax policy and don’t like seeing doctors has tended to obscure this whole set of issues. But your typical middle-aged, middle-class voter is going to be impacted dramatically by this stuff and fairly little by all the rest of it. This is also, in political terms, the stuff that polls really well. The “goodies.”