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The public option in the merged Senate bill is called the “Community Health Insurance Option.” Harry Reid attached an opt-out provision to the public option. Any state can choose to not allow the public option to be offered their state.
To opt-out, a state must pass a law to stop the public option from being offered in the state. States can opt back in by repealing the opt-out law they previously passed:
(3)STATE OPT OUT.—
(A) IN GENERAL.—A State may elect to prohibit Exchanges in such State from offering a community health insurance option if such State enacts a law to provide for such prohibition.
(B) TERMINATION OF OPT OUT.—A Statemay repeal a law described in subparagraph (A) and provide for the offering of such an option through the Exchange.
Unfortunately, the opt-out provision is an unlimited, pre-reform opt-out. This is one of the worst ways to design the opt-out. There is no restriction placed on when states can start opting out, and, presumably, this will allow states to start opting out right away. That means there will be a three four year window after the bill is passed and before the public option is first made available. That is a huge window in which Republicans and health insurance lobbyists can work to opt a state out of the public option.
The opt-out will quickly become a partisan football at the state level after reform is passed. Expect many red states to start passing laws to opt-out their states right away. I would not be surprised if a dozen red states quickly opted out in 2010. The simple conclusion: If you live in Texas, you are out of luck.
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Thanks, Jon.
Keeeey-RIST, what is wrong with the Dems?!!! I mean, honestly! Make sure that any legislation is as Rightwing as possible.
FunnyWheelieDiva
I actually don’t think this is that bad. It has to go to conference. I think the key here is the house has no opt out. So, in theory, the house would try to find a compromise.
I think the house should accept the Senate’s opt out but make the opt out tougher. I suggested a few ways to make it stronger in another comment but to repeat: opt out shouldn’t begin until 2017 and states should have an alternative plan in place in order to make sure that those who are being insured by the fed plan can be taken care of by the state plan. Oh, here’s a good idea: the state plan that opt outers want has to be scored by the CBO to ensure that it would cover as many people as the federal plan already in place for three years….That would mean Texas would have to think something up…
getting right down to it Jon Walker, excellent reportage and analysis, thank you.
I agree they’ll have to toughen the opt-out to meet the House. But I don’t think it will be contingent on policy substitutes – not enough people care about a good safety net, or else this whole debate would have been different. Instead, I think they’ll make it more difficult to opt out of politically, erecting some hoops they have to jump through.
Another benefit to making it harder for states to opt-out is that it will give the Landrieu/Lincoln/Nelson caucus a good excuse to vote against final passage which is what they want, but for cloture with the opt-out, and then proclaim that they were shocked, just shocked, when it got changed.