The Federalist Public Option: What Would Trigger An Opt Out?

By Big Tent Democrat, Section Other Politics
Posted on Thu Oct 08, 2009 at 10:30:50 AM EST
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One of the key questions to consider about the the Federalist Public Option (BTW, see Ezra Klein's very good post on the subject) is how a state opt out of the federal public option would occur. To wit, what is the trigger for a state opt out of a national public insurance program offered in the national exchanges?

Ezra writes "[w]e can see, over time, what happens to state insurance markets that include the national public option and compare them with those that don't." I agree with that but I am not of the mind to make an opt out a simple exercise, such as a Governor's decision or a referendum. I think a state should be required to pass a law that states that its residents will NOT have the option to select the national public insurance program within the national insurance exchange. Let the removal of the option by a state be explicit, on the record and by the mechanisms of state governance. The opt out trigger should be in the open -- no hiding. Let them do it in the daylight where everyone can see them.

Speaking for me only

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The Federalist Public Option: What Would Trigger An Opt Out? | 32 comments (32 topical)

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I prefer a slightly different question: (none / 0) (#1)
by andgarden on Thu Oct 08, 2009 at 10:34:59 AM EST

What would an opt-out trigger? IMO, it should trigger a loss of access to Medicaid and Federal highway funding.

Oh please (5.00 / 1) (#12)
by Steve M on Thu Oct 08, 2009 at 11:07:54 AM EST

you would destroy the entire political objective of characterizing it as an optional program by imposing onerous conditions like that. In fact, it would be counterprodutive.

We want to show that this program is attractive and desirable to voters. Forcing them to accept it by holding a gun to their heads suggests that we believe it's actually not that desirable.


It is already attractive to voters (none / 0) (#16)
by andgarden on Thu Oct 08, 2009 at 11:21:10 AM EST

but Republicans have their own political reasons to reject it. I want to attach a cost to that.


Well fine (none / 0) (#21)
by Steve M on Thu Oct 08, 2009 at 11:34:15 AM EST

but you want them to do something that is politically indistinguishable from making it mandatory. In other words you're saying you're fine with the compromise, as long as there's not actually a compromise.

The reason why other federal conditions are tied to highway funding is because of constitutional concerns, not because it's more politically palatable. Everyone thinks of 21 as the federal drinking age, period.

If the program is truly desirable, then voters will make the Republicans pay a political cost for opting out no matter what we do.


The reason why it can get around (none / 0) (#22)
by andgarden on Thu Oct 08, 2009 at 11:37:11 AM EST

Constitutional concerns is precisely because it is not, in fact, mandatory. We both agree that there will be some cost to opting out, but I want the cost to be higher than you do. Here's my "compromise:" attach it to Medicaid funding.


The drinking age is not mandatory (none / 0) (#24)
by Steve M on Thu Oct 08, 2009 at 11:49:45 AM EST

in a LEGAL sense. Politically it is indistinguishable from a federal mandate. Whatever political capital the compromisors are acquiring with this opt-out idea, you lose 100% of it if you tie it to highway funding.

When you force states to accept a program by threatening to yank their highway funding, you send the message that "we have to force people to participate in this program, because they wouldn't otherwise." You actually give the the Republicans more room for posturing on the issue rather than less. If you're going to do that route, just advocate that it be a mandatory federal program, no opt-out at all.


Um, I do want it to be politically mandatory (none / 0) (#26)
by andgarden on Thu Oct 08, 2009 at 11:56:40 AM EST

If the argument against that is "get big government out of healthcare," then fine, reject Federal Medicaid dollars too. But I don't want to allow states to decide that this is the place where they draw the line.


Well fine (5.00 / 1) (#28)
by Steve M on Thu Oct 08, 2009 at 12:47:00 PM EST

then you oppose the proposed compromise, but I think you should express it that way.


: I want it to have teeth (none / 0) (#30)
by andgarden on Thu Oct 08, 2009 at 12:50:59 PM EST

If I really opposed the current compromise, I would argue that the states should not have any option to opt out. You can see plenty of that at the orange place.

No doubt (none / 0) (#13)
by TeresaInSnow2 on Thu Oct 08, 2009 at 11:18:29 AM EST

that many Republican legislators would be more than happy to lose highway funding to get rid of that demon Medicaid. Making the poor suffer is not a huge problem for them


: Nah (none / 0) (#15)
by andgarden on Thu Oct 08, 2009 at 11:20:13 AM EST

Nobody is ever going to turn down Federal highway funding. Medicaid is itself optional.

Yes - I want to see President Snowe (none / 0) (#2)
by ruffian on Thu Oct 08, 2009 at 10:49:53 AM EST

push her state legislature to pass an opt-out law. If the public option is as unpopular as she claims, it should be no problem.

Which states might opt out? (none / 0) (#3)
by andgarden on Thu Oct 08, 2009 at 10:54:30 AM EST

I could only imagine it in states with a GOP trifecta. In other words, the relevant red states here. Perhaps the "Democrats" in the deep south would get on board with that too, but I kinda doubt it.


I do not think any will (5.00 / 3) (#5)
by Big Tent Democrat on Thu Oct 08, 2009 at 10:55:40 AM EST

How's that for a prediction?


Probably you're right (none / 0) (#7)
by andgarden on Thu Oct 08, 2009 at 10:57:12 AM EST

But I would want to tie it to something that even the most recalcitrant state would find it difficult to turn down. Even Louisiana eventually imposed 21-to-drink, no?


I want a robust public option (5.00 / 1) (#9)
by Big Tent Democrat on Thu Oct 08, 2009 at 11:01:50 AM EST

In the end this is the vehicle imo.

That said, I think the Left Flank should make noise opposing it.

Makes it easier for Obama to embrace.

So go FDL and Open Left. Oppose this!

But when the Progressive Block does it, if they do, do not say they broke their promise because this indeed delivers a robust NATIONAL public option.

You may not like it, but it does what they said they would do.


"That said,... (none / 0) (#14)
by NealB on Thu Oct 08, 2009 at 11:19:07 AM EST

...I think the Left Flank should make noise opposing it." Funny. Maybe that's what Hamscher's doing with her incomprehensible post against opt-out this morning at FDL.


: I do not know (none / 0) (#18)
by Big Tent Democrat on Thu Oct 08, 2009 at 11:27:53 AM EST

I actually have a problem with her support for Grayson given her stance on the public option.

And BTW (none / 0) (#4)
by andgarden on Thu Oct 08, 2009 at 10:55:34 AM EST

Some of those states have Democratic governors who might veto an opt-out.


I just assumed the legislature would have to vote (none / 0) (#6)
by BobTinKY on Thu Oct 08, 2009 at 10:56:24 AM EST

to opt out and the Governor sign.

I like the idea of right wingers having to affirmatively act to deny citizens the benfit of the federal publci option, benefits their friends in neighboring states may be fully enjoying.

Agree (none / 0) (#8)
by MO Blue on Thu Oct 08, 2009 at 10:57:32 AM EST

State legislators must be responsible for publicly debating the issue on the floor and voting to opt out of a public option. Then the governor must sign or veto the legislation.

Sadly... (none / 0) (#10)
by Dadler on Thu Oct 08, 2009 at 11:03:19 AM EST

...I can actually see Obama right now, worried that this is just too partisan and hardballish, that it would make too many people angry at him, that not enough people are holding hands and bridging our powerful divides. In other words, I'm waiting for him to open his yapper and say something that, yet again, letgitimizes the opposition's nonsense.

I dunno (none / 0) (#11)
by Big Tent Democrat on Thu Oct 08, 2009 at 11:04:38 AM EST

I think they like this one.


: Could be (none / 0) (#32)
by Dadler on Thu Oct 08, 2009 at 02:58:01 PM EST

But what they like changes with the hour, it seems. And he will still have to fight back against right wing stuff to come, when any teeth this thing has are framed by "Federal Gov't Essentially Forces States to Take Socialist Healthcare or Else." Them will be literal fighting words for the kooks. And I don't mean rhetorical fighting either.

It may be better than gaurantied nation-wide (none / 0) (#17)
by BobTinKY on Thu Oct 08, 2009 at 11:25:55 AM EST

access to a federal insurance program.

As I too beleive no state will act to opt out, it would effectively quiet those who would otherweise complain endlessly about the federal mandate, socialism and on and on.

Federal government provided health insurance, love it or leave it.

Maybe someone has covered this, (none / 0) (#19)
by Anne on Thu Oct 08, 2009 at 11:29:03 AM EST

and I've just missed it - trying to deal with a change-of-weather migraine - but if a state opts out of the public component, does this also remove mandates from the package for those states? Because if a state opting out forces those who would otherwise be eligible for the public plan to have to choose only from private plans because they are mandated to have insurance, I can see the insurance companies going to work on state legislators in a big(ger) way.

And if the mandate disappears with the opt-out, I don't see how this helps get costs down if nothing changes for the people in the opt-out states who don't currently have coverage and whose access to care is already limited.

Also, I think that while the Medicare + 5 is indeed a robust approach, it's important to realize that as long as there are limits on who is and is not eligible for a public plan, the size of the pool will diminish its strength.

Finally, because there seems to be a blackout on reminding people that not everyone will be eligible to participate in the public plan, I think support for it will be driven in large measure by people who think it will truly be public, i.e., open to all.

I mean, as long as we might be going to an opt-out plan, why not make the overall plan as good as it can possibly be (without being single payer or Medicare for All)?

[And if none of this makes sense, chalk it up to the migraine]

I don't think that the mandates go away (5.00 / 1) (#23)
by MO Blue on Thu Oct 08, 2009 at 11:41:46 AM EST

if states decide to opt out of the public option. Everything other than how the exchange is structured would remain the same. IOW you either have an exchange that consists of private insurance and a public option or you have an exchange that consists of only private insurance options. That as I understand it would be the only difference in the insurance reform legislation.

I agree there is always the possibility that insurance companies will go to work on state legislators in a big(ger) way.

Migraine or not your comment makes perfect sense.


It should (none / 0) (#20)
by Big Tent Democrat on Thu Oct 08, 2009 at 11:31:43 AM EST

but I doubt it will.

But I also expect there will be no opt outs anyway.


If mandates also go away (none / 0) (#27)
by BobTinKY on Thu Oct 08, 2009 at 12:44:27 PM EST

it would make it easier for state pols to push through an opt out. To maximize the odds no state will opt out, I favor mandates remaining should a state act to opt out.

If that seems a penalty for opting out, well it is.


: Good point (none / 0) (#29)
by Big Tent Democrat on Thu Oct 08, 2009 at 12:48:12 PM EST

I don't actually think this is going to happen (none / 0) (#25)
by lilburro on Thu Oct 08, 2009 at 11:54:17 AM EST

I hope not anyway:

Your readers in South Dakota and Louisiana, unfortunately, would be even more likely to be shut out under an opt-in plan. But there's no reason to think that an opt-out plan would garner many more votes than the other failed proposals. The whole reason Carper was pushing his opt-in plan in the first place was that allowing states to decide their own destiny offers the best hope of passage. The flaw with the Carper plan is that state-level options don't offer much in the way of gains over the present system. A national, opt-in proposal remedies that. I suspect it's where this debate is headed.

If that's where the debate is headed, that's scary. Seems like a dumb empowerment of conservative Dems in the Senate to me.

: Just when I thought it was safe to read TPM.... (none / 0) (#31)
by ruffian on Thu Oct 08, 2009 at 02:11:29 PM EST

I was just about to post a link to that myself.
An opt-IN plan? How idiotic is that?