Blog posts

Take Action

  • Medicaid
  • Coverage is Good Medicine
  • Donate

The Mysterious Death of Free Choice

By Dr. Evan Saulino

My 9-year old daughter loves reading mysteries.  She says she likes “trying to figure out the bad guy who did it before they tell you in the book.”

Maybe she got that from me - I like mysteries too…that is except when it comes to health care and the budget.

Many Americans probably thought the budget deal between President Obama and the Republicans and Democrats in Congress that narrowly avoided a “government shutdown” last month was about money - the deficit, spending, that sort of stuff.

But of course there was much, much more.

There were plenty of issues that had little or nothing to do with the budget or the deficit tucked into the deal by various legislators and special interests…it was messy, behind-closed-doors politics for sure.  

The Democratic base got fired up and was able to protect Planned Parenthood funding. Wolves were removed from the Endangered Species list.  There were “Big Government” intrusions into the choices the citizens of our nation’s Capitol have.

But while these ideas were readily claimed by legislators happy to tout their effectiveness, a different type of choice was quietly killed in the budget negotiations - the freedom lower and middle-income workers could have to choose more affordable health insurance.

The mystery is: who did it and what was their motive?

Free Choice Vouchers, championed by Senator Ron Wyden (D-OR), were a small part of the Affordable Care Act.  The Vouchers were a (very) scaled back version of Senator Wyden’s original legislative proposal - an approach with bipartisan support that attempted to inject some choice and competition into the health insurance market and decoupled health insurance from employment.  It was this last part that raised the hackles of some big unions and big business organizations.

Senator Wyden explained how the Free Choice Voucher would work in an article for the Huffington Post.

“Under the new health law, Americans whose income falls below 400 percent of the federal poverty level and whose employer-sponsored health insurance premiums are between 8 and 9.8 percent of their total income will be exempt from having to purchase health coverage but will not be able to access the exchanges or qualify for government assistance to buy insurance.

If an employee's share of their health insurance premiums rise to 9.9 percent of their total income, they would be allowed to shop for more affordable health insurance in the new health insurance exchanges, with a taxpayer-funded subsidy. But again, at 9.8 percent and below their only options will be to pay for their employer-sponsored coverage or to go without health insurance altogether.

Had Free Choice Vouchers survived, they would have given this group a third option: to take the tax free money that their employer would otherwise contribute to the cost of their health insurance and use it to buy a more affordable health insurance plan at the exchange. ”

Estimates are the Free Choice Vouchers would have allowed another 300,000 Americans to access health coverage through the Exchanges in 2014, but if employee health insurance costs rise as projected, this number would quickly grow into the millions.

As Ezra Klein discussed in his Washington Post blog, the vouchers would essentially have not cost the government anything, and could have been a potential tool to help drive health care costs lower using “market-forces”.

So, who threw Ron Wyden, the Free Choice Vouchers, and 300,000 low and middle income American workers under the proverbial budget bus?

Was it one of the Administration or Democratic Congressional negotiators with someone from the AFL-CIO in their ear? Or was it a Republican Congressional negotiator with someone from the Business Roundtable in their ear?

Ask around and everyone says someone else did it.

Several weeks have gone by and still no one has stepped forward to claim responsibility.

It’s a good mystery alright.

Maybe I should ask my daughter to figure out who the bad guys are…and when (or if) she thinks the good guys are going to show up and save the day.

Share Your Comments


  1. Let us know what you think!

Your Comment


Join Doctors For America


or skip signup