Politico is reporting that Thomas Carper (D-DE) is working on an alternative to the public option opt-out, which would be the public option opt-in. This is would a “national” public option where states must pass a law to join. Joe Lieberman (I-CT) told the AP he was against any federal public option, but might open to the possibility plans set up and run by the states.
As I wrote earlier today, the public option opt-in is a federal public option that would likely be denied in a majority of states. I suspect, at least for the first several years, only a dozen or so of the bluest states would opt-in. The much smaller customer base should seriously limit the ability of the public option to drive down premiums. A public option opt-in would likely produce a technically viable insurance entity, but one with almost no real impact on our health care system, and one only available to few individuals in a handful of states.
As weak and worthless as the public option opt-in idea is, the state-based public plan idea is an even bigger joke. As Sen. Jeff Bingaman (D-NM) pointed out states currently have the power to set up public plans right now. There is nothing legally stopping them. Saying you want to “allow” states to set up state-based public plans is the equivalent to saying you want to do nothing at all. The other big problem with this idea is that the public plans would likely only be available to the roughly 10% of people using the exchanges. Most states have a populations below 3 million and therefore would be unlikely to create state-based public plans with sufficient costumer bases to be truly viable.
Carper's national public option opt-in is a nearly useless “compromise.” While Lieberman's state-based public plans is a complete joke and by definition can't even be called a "compromise" because it is the status quo. If someone tells you they believe state-based public plans are a “compromise,” they are either ignorant, a liar, or likely both.