A robust public option allowing states to opt out? Are the Dems testing every stupid idea?

[ProSense]

Sam Stein

Dems Discussing Public Option With Opt-Out Clause: The Silver Bullet?

Senate Democrats have begun discussions on a compromise approach to health care reform that would establish a robust, national public option for insurance coverage but give individual states the right to opt out of the program.

The proposal is envisioned as a means of getting the necessary support from progressive members of the Democratic Caucus -- who have insisted that a government-run insurance option remain in the bill -- and conservative Democrats who are worried about what a public plan would mean for insurers in their states.

<...>

But instead of starting with no national public option and giving state governments the right to develop their own, the newest compromise approaches the issue from the opposite direction: beginning with a national public option and giving state governments the right not to have one.

"It is being discussed," said one progressive strategist who has been working on reform with both the White House and Congress. "In the end obviously, the goal and near-term exercise is to get to the bargaining table and get to the conference committee between the Senate and House with the strongest position (on the public plan) possible."

<...>

Another Democrat working on reform legislation added, "If everyone gets a plan, and states have to affirmatively vote, preferably by referendum, to opt out. I really don't see a lot of states opting out, for one. And, for two, you get your national (public plan) available everywhere. If a few holes start appearing, it's not nearly as fatal as if you went with the Carper plan, which after a few years might mean 10 or 20 (state-based) public options. If you go the other way, you'll probably have like 47 states. It's a big difference."

more

What exactly does this mean? If a state opts out, does that mean that those who need insurance in those states can tap into the national plan? If so, why the hell are they trying to use shell-game language? If people can't tap into the national plan, then this is completely bogus.

[BzaDem]

1. No. States like South Carolina/Texas/etc would opt out, and people in those states wouldn't be able

to join the public plan. People from the remaining say 30 states would.

The question is, would a huge national public plan with an opt-out clause be better than no public option at all in any state (which is currently what the Senate will accept)?

[Ian David]

4. I actually PREFER that option.

After a few years, the idiots will see that it works in the Blue States.

And they'll start clamoring to have it as well.

And if 24,000 voters have to die each year from lack of insurance, it would be nice if all of them lived in the districts of people who opposed health care reform.

[WonderGrunion]

15. That's how it started in Canada

Only two provinces had universal single payer initially. All others jumped on board at a later date.

[niceypoo]

46. That was my first reaction too

Republicans would block it in their states, then promptly be tossed out by an enraged state populous.

[fiorello]

32. What a great sell: "Come to Arkansas... where you pay double for health insurance"

Not to pick on you, AR, but you've been in the news for having just one monopoly health insurance company (and politicians who want to keep it that way). If your politicians want to protect their poor, starving insurance company from those big bad socialists in D.C.... I guess we'll have to let them.

Now it's true (re. idiot Texas politicians who want to secede) that the 45% of politically conservative states who vote Democratic are full U.S. citizens and deserve the full protection of the U.S. Constitution and should not be screwed by local Neanderthals. But health care isn't a right (yet) so you may have to forgo it while we prove how well it works in other states.

[Ian David]

2. I have NO problem with the red states passing-up more of our federal money.

If Oklahoma wants to kill their grandmas, that's their business.

[babylonsister]

8. There's that compassionate spirit, from someone who lives in a blue state. nt

[Ian David]

10. Not like we're building a wall to keep them out.

If they don't like being in a state run by morons, they can move.

[pot luck]

14. Do you know how poor the red states are?

If we had the resources, don't you think those of us who are sane would have moved a long time ago?

[SIMPLYB1980]

18. A long time ago people with nothing walked all the way

from NC to CA for a new life.

[pot luck]

24. This isn't 19th century America,

and California is no longer the promised land that it once was. Last I checked, they were teetering on financial collapse. A poor Southern who could somehow find their way out West would be worse off than they are now— instead of living in a shabby home, they’d be living in a tent or a cardboard box.

In the best of times, it’s hard for a poor person to just pick up everything and move. In today’s economy, it’s nearly impossible.

[SIMPLYB1980]

25. Mexicans and others manage to do it.

I don't know what else to tell you.

[pot luck]

28. I just feel that people shouldn't have to move

to attain quality helath care. Instead of pushing this weak plan that would exclude millions of Americans, Congress should grow a spine and pass legislation that would help everyone. The American people are overwhelmingly in favor of a public option, yet Congress is still trying to find a way around giving us what we want.

[SIMPLYB1980]

30. Do you believe that your state will opt out.

Think back to the stimulus. This will help congress pass a stronger PO.

[pot luck]

33. I honestly do.

I don't trust the republicans around here to do what's right. Accepting free money is one thing, but opting into a program that FoxNews and our rightwing elected officials have sold as a step toward socialism (and a plan to kill grandma) might be a bridge too far. I was hoping that the Federal government would once again drag the South toward progress instead of waiting around for our state governments to do what's right. It'll be a long wait otherwise.

[SIMPLYB1980]

36. Then I fell sorry for you, and

as a fellow southern whose state went blue only recently I understand, but the rest of the country can not wait for the Deep south to move along with us.

[Ian David]

31. Voting is free. n/t

[pot luck]

34. And we do vote.

There just isn't enough of us to affect statewide elections. My county (and the surrounded counties) went blue during the last election and even though democratic turnout was high, it still wasn't enough to win MS for Obama or Musgrove.

I would just like those who want to punish the South for being heavily Republican to remember that there are Democrats and liberals who live here; we're just in the minority.

[lumberjack_jeff]

19. You can lead a horse to water, but you can't prevent him from drowing himself in it. n/t

[Engineer4Obama]

3. Its better than the opt-in State Wide programs the SFC has

Not a real public option still but better than some of the ideas that are out there (I'm looking at you Co-ops Conrad).

[DrToast]

5. Harder for the Repubicans to argue against that (nt)

[Tom Rinaldo]

6. A better compromise than most I've heard of

That is assuming, and this is a biggie, that the national public option that individual states can choose to opt out is truly a "robust" one, and not dinged by any other significant compromises. That would give political cover to Democrats voting "Aye", who come from States where fear mongering about the public option is carrying the day, without making the whole country accept a watered down bill in order to get those votes.

I doubt more than a dozen states would initially opt out, and from a population perspective they would probably represent far less than a fifth of the entire population of the country. But more importantly, it would clear the way for a true "market test of a real public option in states that did NOT opt out. That part is important. If it works well where it is in place eventually all states will want it.

[Blasphemer]

41. I agree

Compromises like the trigger option are worrisome as the potential (and likely, IMO) result is no public option at all. However a strong public option which can be opted out of on an individual level and/or state-wide level, would ultimately lead to national public insurance. No one can say it's being forced on them (especially if opting in or out comes as a result of a state-wide referendum) but they will also be faced with the reality that it DOES work better and they will have no choice but to eventually opt-in.

[Sky Masterson]

7. This may not be a bad thing

I imagine it could turn a few states blue as well.

[babylonsister]

9. That is one positive I can see from this; the constituents will know

they're being screwn.

Maxine Waters doesn't seem to be in favor of it. :rofl:

[ProSense]

16. If they are going to allow states to opt out, and the logistics still don't make sense,

then they better include the strongest public option possible.

[Sky Masterson]

17. Maybe this will allow them to make the PO stronger?

Who knows :shrug:

[bain_sidhe]

11. Who gets to make the "opt out" decision?

I think the answer to that is key. It's not clear from the article whether an "opt out" method would be prescribed by the legislation, or each state would determine its own method. In general, and without knowing that detail, I like this better than Conrad's "state-run public option." And I suspect the public option created by such an "opt out" provision would be more robust than one that states couldn't refuse.

But... I go back to my original question. Right now, we have a Democratic Governor and Democrats control one chamber of the state legislature. But it's a close thing, and it could easily swing the other way next election, or the one after that. If a Republican governor could simply "opt out" of the public option some time down the road, I'd be agin' this compromise.

[laughingliberal]

20. The article did say the states would have to vote affirmatively to opt out...

preferably by referendum. Guess it's not nailed down, as yet, but referendum would ensure the will of the people of the state and not some damn Republican governor like the corrupt asshole we have in Nevada.

[bain_sidhe]

23. Yes, a referendum woudl be preferable to *us*, but

it also listed a couple of other methods, and wasn't clear about whether the method had yet to be decided on, or whether the idea was that each state could choose its own method.

From the article:

States would then have the right to vote -- either by referendum, legislature, or simply a gubernatorial decree -- to make the option unavailable in their health care exchanges.

[SIMPLYB1980]

12. Let the red states drop out if they don't want it.

I have no problem with that.

[Kurt_and_Hunter]

13. ??? as presented, it makes no sense at all (Must be more than is meeting our eye)

[IndianaGreen]

21. What's next? Give the states the option of opting out from Medicare?

This pandering to one's avowed enemies was called appeasement back in the 1930s.

[andym]

48. Actually it appears that Medicaid is an opt-out program....

see http://www.rbguy.dailykos.com/storyonly/2009/10/7/790795/-No-State-Will-Ever-Opt-Out-of-the-Public-Option

So even though Medicare is national with no escape clause, Medicaid (argubably the more progressive of the two programs) can be opted out of by the states. Of course no state would do so.

[inna]

22. not THE worst idea i've seen being floated, that's for sure. nt

[Scarsdale Vibe]

26. I'm still waiting on states to turn down stimulus funds. No state will opt out of national PO.

[Jennicut]

27. Right, they all blew smoke and then turned around begged for the money.

Being in New England I think we would definitely opt for the public option here. CT residents are like 60% for it but I would worry about the good people that want the po in the red states.

[high density]

29. Perhaps we should also let them opt-out of military funding, interstate roads, Medicare, etc

Let them vote on all federal services as a package. Don't let them pick and choose between when they want to suckle off the teat and when they want to play a libertarian for a day.

[DrToast]

35. Not only do I like this idea, I prefer it.

Let the teabaggers opt out. Let them hold their victory rally about how they stopped big government.

Then, a few years later, when satisfaction rates are much higher for the public option and prices are lower, they'll begin to demand it. Then they'll realize they've been duped to protect corporate interests.

[Orangepeel]

37. the same number of states will opt out as rejected all the stimulus money

Posturing governors will try and state legislatures will override them. If that's what it takes, works for me.

[ProSense]

50. Most likely. n/t

[BeyondGeography]

38. It's evil

[andym]

39. It's actually not a bad idea, if it comes with a robust public option.

It will be a wonderful way to show that the government can be far more efficient than the private sector at least when it comes to health care. The number of blue states that join together (CA, NY, New England, PA, OH, etc) will be more than enough to make this work IF everyone within the states that participate is allowed to join. If it works, all states will join and single-payer becomes more likely as well.

[izzybeans]

40. Let individuals opt out or opt in at their discretion.

It's that simple.

[ipaint]

42. Insurance companies will never allow anything that could potentially

morph into a strong national public option or single payer to gain a foothold. This isn't canada. We don't have a democratic socialist party. Or a government that is capable of regulating major industries, well... except acorn.
Even here the pull yourself up by your bootstrap bullshit is flying against those who are living in red states in every one of these threads. Doesn't take much for the lift all boats democratic principle to be thrown out the window in favor of the I got mine approach.
Both parties are bought off which is the reason why DU'ers from red states have to worry tonight that they and their children will be left behind and that their right to affordable access to healthcare all of a sudden depends solely on the majority vote in their states.

[Guy Whitey Corngood]

43. "Democrats who are worried about what a public plan would mean for insurers in their states."

Wow... just fucking wow.

[WinkyDink]

44. Yeah. Saving the Union is SO 19th Century.

[Mass]

45. and Carper is from DE? Does he understand the strength of the public option is to be able to

negotiate prices with the healthcare and pharmaceutical companies? How does he hope it will work in very small states, where the PO will have few subscribers.

It may work in CA or TX, but his state has the 47th population of the union. How could they create a pool big enough?

[andym]

47. This is a brilliant idea!-- Medicaid is apparently a state opt-out program too

States can opt out of Medicaid, but they don't. It will be difficult for even a red state to opt out of the public plan.
If they do and have increased costs it will destroy the people/party who favored opting-out in that state.
This is great politics toward getting a robust public option. Something like this could be used someday to get single-payer as well!

[and-justice-for-all]

49. What a dumb fucking idea!!

I think it is MY choice if I want in or not, not the damn states!!!