The news yesterday was the Harry Reid would include a public option with an opt-out provision in the Senate bill. There has been some reporting Reid might not have the votes for the opt-out and might need to water it down to a public option "opt-in," state-based public plans, or trigger. A public option opt-in and state-based public plans are two very different proposals that many in the media seems to be falsely equating.
A true public option opt-in would be a national public option that states would need to actively opt in to. The federal government would create a single public option entity, but it would only be able to sell health insurance in states that passed a law to allow the public option in their state. This would be similar to the opt-out proposal where states would need to pass a law preventing the public option from providing health insurance. Probably only a dozen of the very bluest states would pass a law opting in to a national public option. Compared to the opt-out, where the hope is only a dozen of the reddest states would pass a law opting out. Besides denying the public option to most Americans, the other big potential problem with the opt-in is that too few states will opt-in to the public option, and it would be unable to develop the sufficient customer base needed to be viable.
State-based public plans was an idea proposed by Sen. Thomas Carper. States already have the power to create their own public companies to sell insurance right now if they want. “Allowing” states to create their own public plans would in no way be a “compromise,” it is the status quo. Besides the federal government potentially providing states with a large quantity of seed money to help start up these state-based public plans, there really is nothing to this proposal. Given the strong restrictions it would place on potential state-based public plans, Carper's original proposal would literally be worse than nothing at all.
A public option opt-in would create a single national public option that states would need to opt in to. It would probably be restricted to only a few of the bluer states in the country. A state-based public plan proposal would help states set up public plans if they wanted. They would probably only be established in the same few blue states, but suffer from several additional problems. Many states would probably be too small to properly support a public plan. Having several different state-based public plans would hurt insurance portability and would probably drive up cost since the many different public plans would lack the benefits of scale.
State-based public plans would be a substantially worse idea than a public option opt-in. I suspect the public option opt-in would be able to function (i.e. remain a viable entity that could sell insurance) but its impact would be extremely limited. Since it would operate in only a few states, I can't see it improving our overall health care system or being big enough to really hold down premiums. Many of the state-based public plans, on the other hand, could easily be too small to even get off the ground or ever function properly. Since the state-based public plans would be limited to the roughly 10% of people on the exchange states like Vermont, Rhode Island, Iowa, West Virginia, Montana, Kansas, etc. would be too small to create a truly viable public plan. While some have confused these two ideas, there is a dramatic and important difference between a public option opt-in and state based public plans.
Showing posts with label public option opt out. Show all posts
Showing posts with label public option opt out. Show all posts
Reid Defies Snowe, Chooses Helping Americans Over Veneer Of Bipartisanship
I'm glad to see that Senate Majority Leader has decided to be a real leader and defy Olympia Snowe (R-ME). There is no reason to have a 60 member caucus if you are unable or unwilling to use it to fulfill the top priority of the Democratic party with the best reform bill possible. It is long past time to dethrone Empress Snowe.
It is important that the Senate bill going into conference committee contain a public option, even if it is one far weaker than it should be. But the bigger news seems to be that Snowe will no longer drive the bill, since she will not support a bill with a public option. Her demand that the bill contain a trigger was only one of her many ill conceived proposals.
I hope that including the opt-out public option is just the first of the positive changes which are made because Reid no longer needs to shape the bill to meet Snowe's every whim. Unfortunately, it seems the Senate bill with still contain the very stupid free rider provision, which Snowe wanted, instead of a mild employer mandate. This is a provision that desperately needs to be improved going forward.
There are areas that should be revisited now that Snowe is no longer on board: Strengthening the exchange so that it can negotiate to help individuals get a better bargain on their health insurance is a critical improvement previously opposed by Snowe. John Kingsdale, who runs the current Massachusetts exchange, said that if the exchanges remain how Snowe wants them, it will be a “policy disaster.”
I would like to see the “national plans,” which would gut a state's ability to properly regulate health insurance, revisited. Increasing the actuarial value of the “bronze level” (lowest minimum qualified insurance plans) and expanding Cantwell's “basic health plan” proposal were both ideas opposed by Snowe, but can ideally now be improved. Strengthening the new ombudsman's office and setting a minimum medical loss ratio for health insurance are two additional changes that should be made.
If Reid can convince his caucus to vote as a bloc on cloture, it would be a display of true leadership. Losing Snowe, and being able to pass a bill with only a simple majority, would be the single best development for health care reform yet--far better news than even the addition of a very weak public option with an opt-out. A bill that can pass the Senate without Snowe's vote will likely be a much better bill in the end. Reid has laid down a good marker today, now he needs to deliver.
It is important that the Senate bill going into conference committee contain a public option, even if it is one far weaker than it should be. But the bigger news seems to be that Snowe will no longer drive the bill, since she will not support a bill with a public option. Her demand that the bill contain a trigger was only one of her many ill conceived proposals.
I hope that including the opt-out public option is just the first of the positive changes which are made because Reid no longer needs to shape the bill to meet Snowe's every whim. Unfortunately, it seems the Senate bill with still contain the very stupid free rider provision, which Snowe wanted, instead of a mild employer mandate. This is a provision that desperately needs to be improved going forward.
There are areas that should be revisited now that Snowe is no longer on board: Strengthening the exchange so that it can negotiate to help individuals get a better bargain on their health insurance is a critical improvement previously opposed by Snowe. John Kingsdale, who runs the current Massachusetts exchange, said that if the exchanges remain how Snowe wants them, it will be a “policy disaster.”
I would like to see the “national plans,” which would gut a state's ability to properly regulate health insurance, revisited. Increasing the actuarial value of the “bronze level” (lowest minimum qualified insurance plans) and expanding Cantwell's “basic health plan” proposal were both ideas opposed by Snowe, but can ideally now be improved. Strengthening the new ombudsman's office and setting a minimum medical loss ratio for health insurance are two additional changes that should be made.
If Reid can convince his caucus to vote as a bloc on cloture, it would be a display of true leadership. Losing Snowe, and being able to pass a bill with only a simple majority, would be the single best development for health care reform yet--far better news than even the addition of a very weak public option with an opt-out. A bill that can pass the Senate without Snowe's vote will likely be a much better bill in the end. Reid has laid down a good marker today, now he needs to deliver.
The When, How, Who, What Of The Public Option Opt-Out
Several news sources are reporting that Harry Reid plans to put a national public option with an opt-out provision in the merged Senate bill. So far, there have been almost zero details on how this national public option with an opt-out provision would be structured. I'm going to explain four important variables and how they could affect the success and availability of the public option.
When
When can states first choose to opt out? There are two different opt-out time frames, which I will call “pre-reform opt-out” and “post-reform opt-out.” The public option is not going to be available until most of the reforms really start in 2013. A “pre-reform opt-out” would allow states to opt out anytime before the public option would first be made available in 2013. This would be a “bad” opt-out provision which would probably result in more states opting out. The earlier that states would be allowed to start opting out, the worse it is. Since no one would yet have access to the public option, opting out before reform started would be politically easier.
A “post-reform opt-out” would only allow states to opt-out after first having the public option available in their state for a period of time (say, 1-4 years). This is a “good” opt-out provision, and the longer the delay before a state can opt out, the better. By first making the public option available, states and their residents would be able to better know if it is something people like. If the public option succeeds as progressives hope, it would be politically more difficult to take away something people already have and like.
How
How would a state opt-out? There are several ways a state could be allowed to opt out: the reform package could require passing a law, or it could allow opt out solely by an act of the state legislature, a decree by the governor, popular ballot referendum, an order by a state insurance regulator, or some combination of the proceeding options. I've previously broken down how many people would likely be denied the public option depending on the different opt out mechanisms. The harder it is for a state to opt out, the better. I suspect, based on polling, a popular ballot referendum would be the mechanism to result in the fewest states opting out. The “best” opt out mechanism would require the state to pass a law opting out of the public option, then requiring it be upheld by a popular referendum.
Who
Who will pay for the added cost of states opting out? By holding down cost on the new health insurance exchange, the public option will reduce the amount of tax credits the federal government will need to provide individuals to help them afford health insurance. The CBO expects even a weaker “level playing field” public option would save the government $25 billion over the next decade. (I've examined the issue in more detail earlier.)
If a state opted out of the public option, it could increase insurance rates and the cost of reform to the federal government. Who should pay for this increased cost? The federal government could just pay the increased cost (the “federal government pays”). Uninsured people living in the state which opted out could pay the cost, by the federal government reducing the amount of their tax credits (the “middle-class pays”). Or the state government could be forced to reimburse the federal government for the added cost that resulted from them opting out (the “states pay”). I think it is unfair to force the rest of the country to pay higher taxes because Texas wants to reject a potential cost saver. The only fair solution would be to make states cover the added cost of opting out. This “states' pay” provision should dramatically discourage states from opting out.
What
What kind of public option will it be? From reporting, the public option is likely going to be a “level playing field” public option which must negotiate rates with providers. We still do not know how the public option will be structured, or how it will be run. Will it get to combine its administrative paperwork functions with Medicare for better efficiency? Will all providers need to opt in to the public option or would Medicare providers be presumed to part of the network unless they opted out? Will it be part of the federal government or just have congressionally appointed management? It could be run directly as a part of department of HHS and run by government employees. It could also be structured like a quasi-public government corporations similar to Amtrak, the Federal Reserve, FDIC, or the Corporations For Public Broadcasting. The Senate HELP Committee's public option would have quasi-subsidiaries in each state to slightly customize the public option for local needs. Would this feature be retained?
A public option that most closely resembles Medicare would be the best possible structure. Having a Medicare provider presumed opted in should help the public option get off the ground more quickly. Allowing Medicare and the public option to use a combined paperwork processing system would save the government money, and cut down on paper work for doctors. Preferably, the public option would be part of HHS and not a stand alone public corporations.
These four categories are some of the most important (but not the only) variables which should determine the viability of Reid's public option with an opt-out. It is possible to design an opt-out that would result in very few if any states opting out. It would be a “post-reform opt-out” with a “states pay” provision. It would require a state law to opt out and a ballot referendum.
On the other hand, it is possible to design an opt-out that would result a large number of states opting out of the public option. If it were a “pre-reform opt-out” where the federal government paid 100% of the added cost, that would be a very “bad” opt-out design. Allowing only a decree by the governor or an act by the state legislature to opt-out the state would also dramatically increase the likely hood of states opting out. Like all things, the devil is in the details. We will soon know if Reid scored a real victory or delivered only an empty triumph.
When
When can states first choose to opt out? There are two different opt-out time frames, which I will call “pre-reform opt-out” and “post-reform opt-out.” The public option is not going to be available until most of the reforms really start in 2013. A “pre-reform opt-out” would allow states to opt out anytime before the public option would first be made available in 2013. This would be a “bad” opt-out provision which would probably result in more states opting out. The earlier that states would be allowed to start opting out, the worse it is. Since no one would yet have access to the public option, opting out before reform started would be politically easier.
A “post-reform opt-out” would only allow states to opt-out after first having the public option available in their state for a period of time (say, 1-4 years). This is a “good” opt-out provision, and the longer the delay before a state can opt out, the better. By first making the public option available, states and their residents would be able to better know if it is something people like. If the public option succeeds as progressives hope, it would be politically more difficult to take away something people already have and like.
How
How would a state opt-out? There are several ways a state could be allowed to opt out: the reform package could require passing a law, or it could allow opt out solely by an act of the state legislature, a decree by the governor, popular ballot referendum, an order by a state insurance regulator, or some combination of the proceeding options. I've previously broken down how many people would likely be denied the public option depending on the different opt out mechanisms. The harder it is for a state to opt out, the better. I suspect, based on polling, a popular ballot referendum would be the mechanism to result in the fewest states opting out. The “best” opt out mechanism would require the state to pass a law opting out of the public option, then requiring it be upheld by a popular referendum.
Who
Who will pay for the added cost of states opting out? By holding down cost on the new health insurance exchange, the public option will reduce the amount of tax credits the federal government will need to provide individuals to help them afford health insurance. The CBO expects even a weaker “level playing field” public option would save the government $25 billion over the next decade. (I've examined the issue in more detail earlier.)
If a state opted out of the public option, it could increase insurance rates and the cost of reform to the federal government. Who should pay for this increased cost? The federal government could just pay the increased cost (the “federal government pays”). Uninsured people living in the state which opted out could pay the cost, by the federal government reducing the amount of their tax credits (the “middle-class pays”). Or the state government could be forced to reimburse the federal government for the added cost that resulted from them opting out (the “states pay”). I think it is unfair to force the rest of the country to pay higher taxes because Texas wants to reject a potential cost saver. The only fair solution would be to make states cover the added cost of opting out. This “states' pay” provision should dramatically discourage states from opting out.
What
What kind of public option will it be? From reporting, the public option is likely going to be a “level playing field” public option which must negotiate rates with providers. We still do not know how the public option will be structured, or how it will be run. Will it get to combine its administrative paperwork functions with Medicare for better efficiency? Will all providers need to opt in to the public option or would Medicare providers be presumed to part of the network unless they opted out? Will it be part of the federal government or just have congressionally appointed management? It could be run directly as a part of department of HHS and run by government employees. It could also be structured like a quasi-public government corporations similar to Amtrak, the Federal Reserve, FDIC, or the Corporations For Public Broadcasting. The Senate HELP Committee's public option would have quasi-subsidiaries in each state to slightly customize the public option for local needs. Would this feature be retained?
A public option that most closely resembles Medicare would be the best possible structure. Having a Medicare provider presumed opted in should help the public option get off the ground more quickly. Allowing Medicare and the public option to use a combined paperwork processing system would save the government money, and cut down on paper work for doctors. Preferably, the public option would be part of HHS and not a stand alone public corporations.
These four categories are some of the most important (but not the only) variables which should determine the viability of Reid's public option with an opt-out. It is possible to design an opt-out that would result in very few if any states opting out. It would be a “post-reform opt-out” with a “states pay” provision. It would require a state law to opt out and a ballot referendum.
On the other hand, it is possible to design an opt-out that would result a large number of states opting out of the public option. If it were a “pre-reform opt-out” where the federal government paid 100% of the added cost, that would be a very “bad” opt-out design. Allowing only a decree by the governor or an act by the state legislature to opt-out the state would also dramatically increase the likely hood of states opting out. Like all things, the devil is in the details. We will soon know if Reid scored a real victory or delivered only an empty triumph.
Obama Fighting For To Kill Public Option With Snowe's Trigger
Talking Points Memo is reporting that Obama is now actively working to kill the public option.
Reid and Obama both claim they want a real public option. Now they have a chance to deliver.
The grassroots, House members, senators, and policy experts have all called Snowe's trigger idea worthless. A public option has strong majority support, and is favored overwhelming among self-identified Democrats. If Reid and Obama reject this chance to deliver on both of their promises to provide Americans with a the choice of a public option, it will stand as a monumental betrayal.
If the public option is sacrificed, just to possibly win the support of one unnecessary Republican vote, Harry Reid might as well resign and officially declare Olympia Snowe Senate Majority Leader. In the next few days, if there is a “trigger,” we will know Reid's continued "leadership" is less than worthless to progressives.
Multiple sources tell TPMDC that Senate Majority Leader Harry Reid is very close to rounding up 60 members in support of a public option with an opt out clause, and are continuing to push skeptical members. But they also say that the White House is pushing back against the idea, in a bid to retain the support of Sen. Olympia Snowe (R-ME).Given the reports that Reid is within a vote or two of being able to pass a bill that includes a national public option with an opt-out, a full-court press by both Reid and Obama should be sufficient to insure health care reform contains a public option. Democrats clearly seem to have the power to get a public option with an opt-out provision passed through the Senate using regular order (or, of course, using reconciliation).
Reid and Obama both claim they want a real public option. Now they have a chance to deliver.
The grassroots, House members, senators, and policy experts have all called Snowe's trigger idea worthless. A public option has strong majority support, and is favored overwhelming among self-identified Democrats. If Reid and Obama reject this chance to deliver on both of their promises to provide Americans with a the choice of a public option, it will stand as a monumental betrayal.
If the public option is sacrificed, just to possibly win the support of one unnecessary Republican vote, Harry Reid might as well resign and officially declare Olympia Snowe Senate Majority Leader. In the next few days, if there is a “trigger,” we will know Reid's continued "leadership" is less than worthless to progressives.
Will Reid Dare Defy Empress Snowe On The Public Option Opt-Out
ABC is reporting Reid is leaning towards putting a national, weak, "level playing field" public option with an opt-out provision in the merged bill. The move could be a result of real leadership, terror at the thought of losing his election, courage, profound personal conviction, incredible pressure from inside the caucus, necessity, or a combination of all of the above. Whatever the reason, Reid seems to believe he can get the 60 votes needed for cloture on a bill that includes a weak public option with an opt-out, even if the whole caucus would not end up voting for the bill itself:
Would Harry Reid really defy Snowe? As with all things related to Reid, I suggest waiting until there is solid proof before casting judgment.
Reid is now convinced that Democratic critics of the public option will support him when it counts – on the procedural motion, which requires 60 votes, to defeat a certain GOP-led filibuster of the bill. Once the filibuster is beaten, it only takes 51 votes to pass the bill.This move would be in direct defiance of Empress Snowe's decree that the bill must not have a public option, even with an opt out:
"Would [inclusion of a public option] be enough for you to vote against the cloture motion?" a reporter asked Snowe on her way off the Senate floor Thursday afternoon.Sen. Max Baucus (D-MT) has spent months wooing Snowe by integrating her terrible ideas into the Senate Finance Committee bill. Even a few days ago, Baucus was pushing to water down the bill further to make it more to her liking. It's being reported that, at the thought of losing his prized token Republican support for his bill, “Baucus went to DEFCON 1."
"On the public option? I'd say I'm against a public option, so yes," Snowe said.
"But would it be enough for you to say, 'I'm not going to proceed to this bill?'" the reporter pressed. Snowe nodded on her way into the elevator.
Snowe said she also opposes the opt-out version of the public plan, which would allow individual states to remove their residents from the federal exchange. "I don't support that," she said.
Would Harry Reid really defy Snowe? As with all things related to Reid, I suggest waiting until there is solid proof before casting judgment.
Update: Baucus really wants to keep Snowe on board and/or kill the public option. TPM is reporting that he went to conservative Democratic senators to try to whip them up against the public option with opt out.
This, apparently, didn't sit well with Senate Finance Committee Chairman Max Baucus, who is determined to keep Sen. Olympia Snowe's vote.
"Baucus met with moderates this morning and got them nervous." Or tried at least. Snowe clearly laid down her mark. And Sen. Ben Nelson (D-NE) didn't seem particularly pleased. But of all the Senate's conservative Democrats, none have yet rebelled.
Obama And Reid Maybe Leaning Towards Opt-Out
Sen. Ben Nelson (D-NE) told Poltico that he felt Harry Reid (D-NV) and the White House were leaning toward a national public option with an opt-out:
Many important questions about the opt-out idea remain to be answered. What kind of national public option would it be (negotiated rates or rates tied to Medicare)? How would states opt-out (decree by governor, pass a bill, popular vote by state legislature, state wide referendum, etc.)? How soon could a state opt out (right away or not until 2013)? What would a state need to do to opt back in if it previously opted out? Who will pay for the added cost of states opting out?
Depending on the answer to these question only a few states might opt out, or over half the people in this country might be denied access to the public option.
Finance Committee Chairman Max Baucus (D-Mont.) briefed Nelson and other Democratic centrists on Thursday morning.Sen. Chuck Schumer (D-NY) has been pushing strong for a national public option (presumably his “level playing field” plan) with a provision that would allow states to opt out if they choose. Given how closely Schumer has been working with Jay Rockefeller (D-WV) on the issue of the public option, I assume Schumer's personal push for the opt-out compromise played a large part in Rockefeller's public expression of tentative support for the opt-out.
"I keep hearing there is a lot of leaning toward some sort of national public option, unfortunately, from my standpoint," said Nelson, a key swing senator. "I still believe a state-based approach is the way in which to go. So I'm not being shy about making that point."
Many important questions about the opt-out idea remain to be answered. What kind of national public option would it be (negotiated rates or rates tied to Medicare)? How would states opt-out (decree by governor, pass a bill, popular vote by state legislature, state wide referendum, etc.)? How soon could a state opt out (right away or not until 2013)? What would a state need to do to opt back in if it previously opted out? Who will pay for the added cost of states opting out?
Depending on the answer to these question only a few states might opt out, or over half the people in this country might be denied access to the public option.
Rockefeller Is Looking Into Public Option Opt-Out
The Hill is reporting that Sen. Jay Rockefeller (D-WV) is looking very carefully at the public option opt-out "compromise":
I've personally have been no fan of the opt-out and have laid out several of the problems with the idea. Primarily, it is people in red states who most need a public option and they are the ones most likely to be denied it with an opt-out.
The nicest thing I can say is Rockefeller did use the phrase "there's one way that could work very well." In theory, an opt out could be designed to make it very unlikely a state would opt out. For example, if states that opt out were required to fully reimburse the federal government for the resulting increase in cost, I doubt many would. Given what I know about Harry Reid and the Senate Democrats, however, I'm not holding my breath on that.
I suspect any opt-out compromise Reid would accept would be a weak public option with a very easy opt-out. The result would be hundreds of millions of dollars spent by the insurance industry lobbying to make sure most of the red and purple states opt-out in the next three years--before the public option is even made available. Progressives should be about helping all Americans in need, not just Americans lucky enough to live in blue states. (And even blue states may not be safe with potential Democratic governors like Creigh Deeds.)
"I think there's one way that could work very well and could pick up some of the moderates," Rockefeller told reporters. "I'm looking very much now at this opt-out public option." Under the alternative proposal, the public option would be available nationwide but individual states could decline to participate.So far, Rockefeller has been one of the strongest defenders of a real public option in the Senate, so his openness to the opt-out is clearly a disappointment. It could be a sign that the idea is gaining some traction in the Senate with Reid likely to make a decision about the public option in the coming days.
I've personally have been no fan of the opt-out and have laid out several of the problems with the idea. Primarily, it is people in red states who most need a public option and they are the ones most likely to be denied it with an opt-out.
The nicest thing I can say is Rockefeller did use the phrase "there's one way that could work very well." In theory, an opt out could be designed to make it very unlikely a state would opt out. For example, if states that opt out were required to fully reimburse the federal government for the resulting increase in cost, I doubt many would. Given what I know about Harry Reid and the Senate Democrats, however, I'm not holding my breath on that.
I suspect any opt-out compromise Reid would accept would be a weak public option with a very easy opt-out. The result would be hundreds of millions of dollars spent by the insurance industry lobbying to make sure most of the red and purple states opt-out in the next three years--before the public option is even made available. Progressives should be about helping all Americans in need, not just Americans lucky enough to live in blue states. (And even blue states may not be safe with potential Democratic governors like Creigh Deeds.)
Creigh Deeds Might Opt Virginia Out Of the Public Option
During the final debate in the Virginia Governor's race, Democratic candidate Creigh Deeds opted to share some of his "thinking" with the public:
[Deeds said] he "shared the broad goals" of health care reform, but would "certainly consider opting out" of a public option "if that were available to Virginia."This is stupid on two levels. First, on a policy level, Creigh Deeds said health care reform needs to reduce cost. The CBO has repeatedly concluded that a public option would reduce the cost of insurance for middle class Americans.
"I'm not afraid of going against my fellow Democrats when they're wrong," Deeds said. "A public option isn't required in my view."
The second problem is political. If recent polling data is any indication, a public option is much more popular than Creigh Deeds. Also, in an off year election, turning out your base is critical. Telling progressives that you plan to gut health care reform does not really get them rushing to the polls.
At least Deeds has done progressives one favor. He has shot a giant hole in one of the main arguments for the public option opt-out "compromise." The argument is that no Republican governor (and/or state legislature) would be stupid enough to deny their constituents a public option that could save them thousands of dollars a year. Here we have a Democrat saying he might opt out a purple state. Then again, Deeds is not yet governor--and if he keeps this up, he never will be.
Update: The Deeds campaign is now trying to backpedal somewhat, but they still claim Deeds might consider opting out Virginia, and so would deny people the choice of a public option if he thought they should not have the choice.
The Price of Public Option “Opt-Out”: Who Will Pay for Red State Folly?
I'm not talking about who will pay in the political sense. I literally mean who is going to pay the billions of dollars it will cost to let red states opt out of the public option?
We know from the CBO that a public option would save between $25-$110 billion depending on how it was structured. Assume only the reddest states (those with both Republican governors and state legislatures) choose to opt out of the public option that is still 23% of country's population. Letting the reddest states opt out should therefore make health care reform between roughly $6-$25 billion more expensive. Who is going to pay for that?
Are middle income Americans in blue states going to get their health insurance affordability tax credits cut so Texas can choose to run a more expensive and wasteful health care exchange without a public option? Will the low income Americans in these red states be forced to pay more for their expensive private health insurance? Will everyone in the country see their taxes go up because a few red states refuse to adopt a cost saving public option?
I think the question of who will pay for this opt out is critical. We should not let some Republican governor or state legislature simply pass a resolution opting out of the public option when that opt out will cost the whole country billions. The red states who want to opt out of a public option should be forced to raise their own taxes by several billion to pay for it. We should not let Rick Perry force the rest of the nation foot the huge bill, just so he can score a political point and deny the people of Texas the choice of a public option. The more I examine this opt-out idea, the more problems I see with it.
Problems With The Public Option Opt Out – By The Number
Previously, I addressed what I consider to be the biggest problem with this new public option opt out compromise. It leaves the people most in need without the public option (red states tend to have much higher uninsured rates). I thought the goal of progressives was to give every American a square deal--not just those lucky enough to live in blue states.
The key issue with the public option opt out proposal, however, is who has the power to opt out the state. Does it require a law to be passed, popular referendum, executive order from the governor, act of the legislature? Depending on how the opt-out is structured over half the country could be denied the choice of a public option.
How many Americans would be denied the public option if there was an opt-out? For my calculation, I'm assuming Republicans at the state level will be like their Congressional brethren and be universally opposed to the public option. I'm also assuming Democrats at the state level will not support an opt-out for their state. (I understand in the real world this issue will not be so perfectly divided on partisan lines.)
State legislature and governor's approval required for opt-out The following ten state legislatures are fully controlled by Republicans and the state also has a Republican governor: AZ, FL, GA, ID, NE, ND, SC, SD, TX, UT. If the opt out required approval by both the legislature and governor roughly 71 million people (23% of the population) live in state where they would be denied the public option.
State legislature's approval required for opt-out Fourteen states legislatures (AZ, FL, GA, ID, NE, ND, SC, SD, TX, UT, WY, OK, MO, KS) are fully controlled by Republicans. If the opt out only required an act of the legislature, roughly 84 million people (28% of the population) would be in a state without the choice of a public option.
Governor's decree required for opt-out There are 22 states with Republicans governors (AL, AK, AZ, CA, CT, FL, GA, HI, ID, IN, LA, MN, MS, NE, NV, ND, RI, SC, SD, TX, UT, VT). One hundred and forty-one million people (46% of the population) live in states where the Republican governor could opt the state out by decree.
Either state legislature or governor can opt-out the state A combined total of 154 million people (51% of the population) live in states where Republicans control the governor's mansion or the state legislature.
If people think my numbers are too “worst case scenario,” remember: there will be four years and two election cycles before the public option is made available. Currently the Republican Party is very close to a historic low and is expect to improve over the next few elections. Republicans (and/or Democrats opposed to the public option) only need be in power briefly at sometime in the next four years to be able to opt out their state. If you don't think the next four years will see a multi-million dollar surge in donations from health insurance companies to politicians at the state level, you don't understand politics.
A related issue: What would be the requirement for a state to opt back in if the state had previously opted out? If there is a higher standard to opt back in, that would be a very bad development. It could hamper the possible spread of the public option in the long term.
This opt-out "compromise" is a perfect example of what is wrong with the Democratic party--they are too willing to compromise their ideals. When did the noble cause of “universal health care,” become the goal of some insurance reform which will help some people? The Democrats completely control Washington. There is no need or excuse for compromising their principles.
Public Option Opt Out Denies Help To Those Who Need It Most
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.
Subscribe to:
Posts (Atom)
LinkWithin
