The biggest problem with the public option opt-out idea is that it would deny the public option to those people who need it most. Most of the states with the highest percentage of uninsured residents tend to be Republican states.
The top ten states with the highest percentage of residents without health insurance in 2008 were, in order: TX, NM, FL, AK, LA, AZ, CA, MS, NV, GA.
Of these states, only one (New Mexico) has a Democratic governor. Four of the states have their state legislature controlled by Republicans in addition to a Republican governor (TX, FL, AZ, GA). These four states alone have a combined population of roughly 59 million, that is 19% of the people living in this country. New Mexico is the only one of the ten with both a Democratic governor and Democratic control of the state legislature.
If we assume Republicans continue their near universal opposition to a public option, four of the worst states, where the residents are most in need of a public option, would be denied one. I thought the goal of progressives was to help everyone to get a fair deal, especially those most in need.
NB: If the public option were an "opt in" program (or if the governor could act without the state legislature to "opt out" their state), New Mexico might be the only one of the bottom ten to offer the public option.