Matthew Yglesias » Who Opts?

Oct 26th, 2009 at 5:26 pm

Who Opts?

One point I’m not clear on with regard to the idea of an “opt-out” public option is who does the opting? If the way it works is that you need concurrent affirmative action by both houses of the state legislature and the governor, then it strikes me as very likely that the public option that emerges from an opt-out process will be very strong. If governors can do it unilaterally, then you’ll get something with more of a swiss cheese quality to it.

Similarly, if a state has opted out and decides four years later that it wants in, who gets to decide?

Comments
24

24 Responses to “Who Opts?”

Joe Says:
October 26th, 2009 at 5:30 pm
No way that anyone opts out. If the citizens of your state don’t like the public option, then they can get their insurance elsewhere. But if any appreciable number DO like it, it would be political suicide to “opt out.”
Adam Says:
October 26th, 2009 at 5:35 pm
I don’t think we know. All Reid did today was release the broad details, not specifics like that. We should find out in a couple days.

Though I do remember reading they only have until 2014 to opt out.
Jesse Says:
October 26th, 2009 at 5:37 pm
I don’t see it making quite as big a difference – I think only a handful of governors are stubborn and dogmatic enough to actually opt-out, and in most cases they’re in states where the legislature is crazy enough to go along with them.

As for the later opt-in, I would hope that is an option (because eventually, every state will have sane leadership for a least a term or two); the only mistake would be to include a later “opt out” – if a state joins the plan, it shouldn’t be able to walk away from it and un-insure many of its citizens in the process.
scythia Says:
October 26th, 2009 at 5:41 pm
Similarly, if a state has opted out and decides four years later that it wants in, who gets to decide?

According to Article XII of the Constitution, the President is designated as “the Decider.” You should know this, Matt.
Snarky Bastard Says:
October 26th, 2009 at 5:44 pm
According to Governor Rick “Stick a Needle in ‘Im” Perry, we in Texas are going to be “opting out” of the Union anyway, so it’s a moot point.
Paulie Carbone Says:
October 26th, 2009 at 5:47 pm
Just to be clear, we’re talking about a NATIONAL plan that states can opt out of, right? Because Ben Armbruster has a stupid post elsewhere on ThinkProgress treating it as a collection of state-by-state plans. I just want to make sure that Armbruster is in fact stupid like that.
Poptarts Says:
October 26th, 2009 at 5:58 pm
Just to be clear, we’re talking about a NATIONAL plan that states can opt out of, right? Because Ben Armbruster has a stupid post elsewhere on ThinkProgress treating it as a collection of state-by-state plans.

So many stupid posts in the so-called progressive blogosphere it’s nauseating. There are unknown unkowns and people just like the drama and speculate.

Aren’t there laws already where states can “opt out”?
pseudonymous in nc Says:
October 26th, 2009 at 6:00 pm
I think only a handful of governors are stubborn and dogmatic enough to actually opt-out, and in most cases they’re in states where the legislature is crazy enough to go along with them.

One of the provisions being floated was that any opt-out state would have to demonstrate that health insurance was available in that state that at least matched the federal public option’s standards in terms of its premiums and coverage. Which is presumably to prevent state legislatures and governors in states with one or two dominant insurers from being blackmailed into opting out.

This is political catnip, because among the prez. hopefuls for 2012 you have one GOP ex-governor who signed healthcare reform (Romney), one GOP ex-governor who is Sarah Palin, and a couple of sitting GOP governors (Pawlenty, Jindal) who will develop very tight sphincters over the issue.
Miles Says:
October 26th, 2009 at 6:14 pm
Statewide referendum would ensure a Democratic landslide whatever year it happened. Hell, I want Ohio to have a referendum on it in 2010! They have us surrounded, but we have them outnumbered.

There’s no viable way for the opt-out to be permanent; once Mississippi sees how much cheaper insurance is in Arkansas, they’ll demand back in. And guess what? After this August, no Republican will be able to campaign in favor of opting back in!

This is the “turn every state Blue” plan.
Robert Waldmann Says:
October 26th, 2009 at 6:14 pm
I think that rules for opting back in are key as I would guess that people will get irritated at paying more than others right accross the state line.

Poptart states had to opt in to medicaid. That is worse than opt out. Medicaid was available in all 50 states only from 1986 on (ok it was available in 49 long before that — Arizona was the hold out).

I think I know which Armbruster post you are talking about. In the post I have in mind, he butchered a quote from Ivan Volsky (who works right down the hall from Armbruster not to mention Yglesias). Volsky was criticizing the trigger compromise and Armbruster removed necessary context and claimed that Volsky was criticizing opt out. My thoughts here
http://tinyurl.com/yg6nro3 . It does seem that over there at CAP the left hand doesn’t always know what the far left hand is doing.

OK OK I know the range is from left of center to slightly left of left of center.
Anandakos Says:
October 26th, 2009 at 6:15 pm
Matt,

I believe that if a state opts out, it should be for a minimum of ten years. And, like the Medicare Prescription Drug Plan, such a state should make the plan whole at the time it applies for re-entry by paying any back assessments due it skipped during the opt-out.

@Pseudonymous #8,

Such a provision would be seen as bludgeoning the states not to opt out and defeat the purpose of the plan. That purpose is to let the lunatics down south “preserve choice” (except for women that is). They seriously, urgently need the opportunity to commit business suicide by driving away all their (remaining) intelligent citizens. Let the Republicans eat their cooking.
fostert Says:
October 26th, 2009 at 6:42 pm
The opt-out is good in that it appeals to our desire for Federalism. The problem is that federalism doesn’t work very well in practice. The appeal of federalism is that different states use different approaches and then we can get a clear picture of what works and what doesn’t. And that part of it works pretty well. The problem arises when a state has an approach that doesn’t work but is still locally popular. Abstinence education is a good example. States that use this approach have higher pregnancy and disease rates among teenagers. So we know it doesn’t work. Yet few states that use this unworkable approach are willing to change it. We are using federalism to do the experiments, we just aren’t willing to accept the results of the experiments.
Pender Says:
October 26th, 2009 at 7:21 pm
The opt-outs are a clever sop. It undermines the opposition’s arguments with federalism, calls their bluff and stakes their own electorates’ interests on their decisions. It will be much harder to bloviate angrily about how terrible the public option is in a primary since people in the state will pay attention. And no one will opt out. Nothing is scarier for a politician than an extremely angry and highly motivated faction. It’s the special interest problem. The opt-out essentially creates a highly motivated special interest for supporting the Democrats’ health care package in every single state. It’s political genius.

This is all just as true even if a single governor can unilaterally opt the entire state out without recourse. The mandatory period before opting out is allowed ensures that a special interest will form before the decision can be made.
Th Says:
October 26th, 2009 at 7:33 pm
I have been fighting this since the ’70’s and I don’t care about the opt-out, just put a government run option in the marketplace. It will take care of itself from there. The insurance companies have proven they will try to game the system and will be found out by the public. They are addicts that way.

If you want to see liberal stupid, read the Susie Mandrake post on C&L about private companies administering the public option and the comments section. Private contractors have always administered Medicare, why would we think the public option modeled on Medicare would be different, and the public option was never available to people outside the exchanges (what the fuck did they think the Wyden amendment was about).
Craig Says:
October 26th, 2009 at 7:42 pm
In the long run it won’t matter too much because people will demand their governors let them have the plan. Only Republican governors planning on running in 2012 are likely to choose to opt out.
Jason L. Says:
October 26th, 2009 at 7:46 pm
Those of you who aren’t FiveThirtyEight readers should check out this post which graphically displays the “public option playing field” in two dimension, and where various the positions or proposals of various lawmakers fall on it.

Do you think that the added value of opt-out relative to opt-in is worth having a federal program versus having state-run programs that states can cooperate on (Delaware, say, could hitch its public option horse to Pennsylvania’s)? Etc. This bears on what kind of pro-public option pressure we put on our legislators.
zyxw Says:
October 26th, 2009 at 8:49 pm
On the other hand, what if this is just a smoke-screen to keep progressives quiet for now?
joe from Lowell Says:
October 26th, 2009 at 11:50 pm
Is there any way they can write the bill so that states have to hold public referenda on opting out every two years, to coincide with federal elections?

You know, to avoid imposing the cost of a whole separate election on the states and municipalities.
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October 27th, 2009 at 3:51 am
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chris Says:
October 27th, 2009 at 10:17 am
@17: On the other hand, what if this was what Obama had in mind all along when he said he was in favor of the public option, but didn’t want to jeopardize the whole bill over it? Will any of the people who accused him of being a traitorous sellout admit that they were wrong and his plan worked? (My prediction: not a chance in hell.)
StevenAttewell Says:
October 27th, 2009 at 10:59 am
According to the NY Times:
“A state could refuse to participate in the public insurance plan by adopting a law to opt out.” That means legislature + governor.
Jason L. Says:
October 27th, 2009 at 11:39 am
States with Repub governors and Repub control of state legislatures are:

UT, AZ, ID, ND, SD, NE, TX, FL, GA, SC.

I don’t see someone like Charlie Crist opting out (in any case, he’ll be out of office by the time the bill comes through). If the currently most well-known Repub candidate for Crist’s seat, Bill McCollum, wins, however, it’s a possibility (to the extent that it’s a possibility anywhere). WP: “McCollum voted eight times to cut Medicare [and] voted to raise the eligibility age for Medicare and Social Security.”
Matthew Yglesias » Out From What Options Will States Opt? Says:
October 27th, 2009 at 2:53 pm
[...] details are emerging on the “opt-out” public option. For one thing, my question of who does the opting has been answered—to opt out you need a bill based by both houses of the state legislature and [...]
JonF Says:
October 27th, 2009 at 9:41 pm
Re: No way that anyone opts out.

The GOP is nutty enough these days that where the control the entire state government they may well opt out. Andrew Sullivan has pointed out that this could have ruinous political consequences for the Republicans if A) the Public Option actually works OK in other states and B) health insurance costs soar in the opt out states.

Matt Yglesias

Who Opts?

24 Responses to “Who Opts?”

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