The "opt-out" provision
which would allow states that do not want public health insurance to
exclude themselves from the program, has been called the "silver bullet
that would save the public option. But health care
experts are increasingly wondering if the provision is
anything more than political cover to help Democrats ward off criticism from Republicans and moderates
who are wary of the public option. Why? The concern is that no state could
really choose to opt out of the public health insurance plan, rendering the proposal moot.
- Why No One Will Opt Out Ezra Klein makes the case. "My opinion on this is, I admit, a minority opinion, but I don't think
there will be any real fight over the public option, and I think that
virtually no states will opt-out," he writes. "States wouldn't be able to opt out till 2014. By 2014, we'll be arguing
over all manner of things, but a public insurance option for the small
sliver of the population with access to the health insurance exchanges
will be one of those things. In that scenario, where there's very
little controversy over the public option, I don't believe that state
legislatures and governors are going to go to the trouble of rejecting
it, and I don't believe that anyone will manage to reinvigorate the
controversy around it."
- Opt-Out Would Be 'Nightmare' for GOP The Atlantic's Andrew Sullivan explains
why Republicans are so opposed to the opt-out provision. "Imagine
Republicans in state legislatures having to argue and posture
against an affordable health insurance plan for the folks, as O'Reilly
calls them, while evil liberals provide it elsewhere," he writes. "It's
political nightmare for the right as it is currently constituted.
In fact, I can see a public option becoming the equivalent of Medicare
in the public psyche if it works as it should. Try running against
- Medicaid and Highways Also 'Opt-Out' Liberal blogger Matt Compton notes
that no states have taken advantage of other opt-out provisions. "It's
important to remember that opting-out, as a policy mechanism, is not a
new idea. Medicaid, for instance, is an opt-out program, but no state
has ever chosen to take that step. Federal highways are also an opt-out
program, but we all follow the same speed limits. At worst, we should
expect about as much resistance as we saw with
the federal recovery package earlier this year. Despite a lot of
hand-wringing from conservatives, ultimately, most states took most of
- But That's Not The Same Thing Matthew Yglesias disagrees with Compton. "In the case of Medicaid I believe that Arizona actually held out for
a long time before implementing the program. And to the day, the extent
of the Medicaid benefits offered from state to state vary a great deal.
The 'opt-out' structure of a public option would work differently
since there wouldn't be a net transfer of tax money involved. But for
the federal government to enact a policy that works differently in some
states than in others wouldn't be a breach of any time-honored
principle of government."
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