WASHINGTON — President Barack Obama and leading Democrats have stressed that people who like their employer-sponsored insurance would be able to keep it under a health care overhaul. They haven't emphasized the flip side, however: that people who don't like their coverage might have to keep it.
Under the main Democratic health bills that are being debated in Congress, many people with job-based insurance could find it difficult to impossible to switch to health plans on a new insurance exchange, even if those plans were cheaper or offered better coverage.
The provisions could change, and there are a few exceptions: Workers would be allowed to buy insurance through the exchange if their job-based coverage gobbled up too much of their incomes or was too skimpy. Also, under the proposal by Democrats in the House, people could get insurance through the exchange if they paid their entire premiums, a cost that would be prohibitive for many.
Democratic lawmakers and administration officials say the restrictions are crucial to maintaining a strong employer-based insurance system, which covers 158 million Americans.
Critics argue, however, that the rules run counter to suggestions that a health care overhaul could provide people with a broader choice of insurance options. The restrictions, they say, could be especially unfair to some lower-income workers who are enrolled in costly job-based insurance.
Jonathan Oberlander, an associate professor at the University of North Carolina at Chapel Hill, said, "The rhetoric is that Americans will gain new alternatives, but the reality is that they are putting up firewalls that are going to restrict the access of people with employer-sponsored insurance to the exchange."
Under the proposals before Congress, people who could go on the exchange include the uninsured, the self-employed and those who aren't offered employer-sponsored coverage.
Most people who use the exchange would get subsidies. Limiting the number of people who could use the exchange, therefore, would hold down the cost.
Lawmakers and some health care analysts say that legislation has to create barriers around the exchange to protect the stability of the employer-provided insurance market. Without them, younger and healthier employees, they say, might find cheaper options on the exchange, leaving older and sicker workers in their employers' plans — and driving up their costs.
"We are trying to provide as much choice as possible and trying to honor the president's promise to protect the employer-based system so that if people have coverage they like they'll get to keep it," said Sen. Sheldon Whitehouse, D-R.I., a member of the health committee.