I'm not clear on the 'solution' part of your post. But the way I understand it the free choice voucher would enable employers to select plans that discriminate against 'high risk' employees. Enabling them to give these folks the vouchers AND avoid paying the penalty could motivate 'dumping' by the employers as it would reduce their premiums based on 'healthy' employees remaining in the group. The potential is especially acute in the small employer arena as their pool/group is small enough that a couple dozen 'high risk' folks would affect their premiums greatly. Larger employers' groups/pools are big enough that I question any potential advantage they would have doing so, which is also why I question Wyden's suspicions but there could be other issues that I'm unaware of.
You have the adverse selection argument backwards. For a company plan of a given cost, the premiums will be a larger share of the income of lower wage/income employees, who are likely to be disproportionately younger (and thus healthier) employees. So, the argument goes, the employees more likely to be pushed above the voucher eligibility threshold are the younger, healthier ones, who can then take the employer contribution and depart the group's risk pool to shop in the open market, leaving behind the older, less healthy employees in the company plan.
It's a scenario in which the young-ish invincibles are flocking to the exchanges instead of remaining in the company plan. Of course, what fear of that would really do is add pressure to keep the employee's share of the premium affordable and offer plans at least as attractive as those in the exchanges.
But there's an additional dynamic at work for small employers, since small businesses
will be able to use the exchanges to do a free choice voucher-like option for
all of their employees by giving them a contribution and letting them shop in the marketplace:
For plan years beginning on or after January 1, 2015, each SHOP would be required to enable an employer to offer employees a choice among all qualified health plans (QHPs) at one level of coverage and would have the flexibility to provide additional methods to offer coverage. . . Following the transition, the Federally-facilitated SHOP will continue to allow small employers to offer a single QHP, but it will add the option of employee choice. Under employee choice, an employer picks a metal level of coverage (bronze, silver, gold or platinum) and defines a contribution towards its employees’ coverage; an employee then will apply that employer contribution toward the premium for the SHOP plan of his/her choice.
The free choice vouchers would've then been an option aimed at those in larger companies' plans or those in a small business where the employer still chooses a company-wide plan instead of allowing employees to shop. Anyway, I won't keep going, other than to say that adding market dynamics to more and more of the health insurance world (particularly to what for decades has been a sector dominated by a sclerotic employer-based system, in which limited choice or choicelessness on the part of the people ultimately buying the product were considered normal) is the future, and I don't see losing the free choice vouchers as particularly helpful for that evolution.
The problem with your assertion is it assumes the providers will merely comply/accept reduced reimbursements. This is a fallacy evidenced by the never-ending 'doc fix'. One also must question the value if insurance if there are no providers who will accept it.
There are larger changes that need to happen in the way insurers and providers each work and how they interact with each other (I imagine we'll be seeing more tiered networks, reference pricing, alternative payment arrangements, etc), and I'm certain there will be some back-and-forth struggles and growing pains as the system sorts itself out into something that works. There aren't any short-term fixes here, this is a process that's already begun but one that's likely to continue for a while. And that means continuing to feel out what can be done with different rates and provider networks and payment models. I have no doubt there will be adjustments from some of the payers and from some of the providers in the second year of the new marketplaces. And the third. And so on.
