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Fix Needed for State Opt-Out Provision of Public Option

McJoan at Daily Kos explains what needs to be fixed in the Senate version of the public option in the health care bill: It's the date on which the states can opt out. First,

There's no requirement of a waiting period before states can opt out, which in this political environment means the battle is taken directly to the states, because insurers will have until 2014 to get state legislatures to pass those laws. That could lead to as much as a third of country being left out, according to CBO estimates [pdf] (h/t Jon Walker).

[More...]

Here's the current language:

(3)STATE OPT OUT.

(A) IN GENERAL.—A State may elect to prohibit Exchanges in such State from offering a community health insurance option if such State enacts a law to provide for such prohibition.

(B) TERMINATION OF OPT OUT.—A State may repeal a law described in subparagraph (A) and provide for the offering of such an option through the Exchange.

By 2014, states will have had plenty of time to pass legislation opting out, which means the public option won't ever go into effect in them.

McJoan says:

Changing the opt-out date is an amendment waiting to happen when this bill hits the Senate floor (probably) early next week, and a barring a fix there, a priority for conferees when we finally get to that point.

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  • Display: Sort:
    The perverse incentive not to hire the poor (5.00 / 7) (#2)
    by fairleft on Fri Nov 20, 2009 at 12:30:19 PM EST
    needs to be removed from the bill as well (and maybe just maybe is more important than 'saving' an already feeble (no Medicare+x rates) public option.) That nightmarish provision is still in Reid's bill. From Ezra Klein, who called it possibly the worst provision in any bill ever:

    Baucus's bill retains the noxious "free rider" provision on employers. Rather than a simple employer mandate that forces every employer over a certain size to provide health-care insurance or pay a small fee, the free rider approach penalizes employers for hiring low-income workers who are eligible for subsidies. That will create an incentive to do one of two things: Don't hire low-income workers (hire a teenager looking for a job rather than a single mother, or hire a housewife looking for a second job rather than an unemployed breadwinner), or hire illegal immigrants.

    And it actually gets worse. The employer pays more if the low-income worker needs subsidies for his family as opposed to just himself. So it not only discriminates against low-income workers, but it particularly discriminates against low-income parents. Single mothers will get the worst deal, as they have lower incomes, and as you might expect, children who need health care.




    I guess Landrieu asked for this: (5.00 / 1) (#3)
    by Dalton Hoffine on Fri Nov 20, 2009 at 01:48:54 PM EST
    From Johnathan Karl at ABC:

    <What does it take to get a wavering senator to vote for health care reform?<p> Here's a case study.

    On page 432 of the Reid bill, there is a section increasing federal Medicaid subsidies for "certain states recovering from a major disaster."

    The section spends two pages defining which "states" would qualify, saying, among other things, that it would be states that "during the preceding 7 fiscal years" have been declared a "major disaster area."

    I am told the section applies to exactly one state:  Louisiana, the home of moderate Democrat Mary Landrieu, who has been playing hard to get on the health care bill.

    In other words, the bill spends two pages describing would could be written with a single world:  Louisiana.  (This may also help explain why the bill is long.)

    Senator Harry Reid, who drafted the bill, cannot pass it without the support of Louisiana's Mary Landrieu.

    How much does it cost?  According to the Congressional Budget Office: $100 million.



    Debate (5.00 / 1) (#4)
    by waldenpond on Fri Nov 20, 2009 at 02:11:49 PM EST
    That's just for her vote to get it to debate.  I wonder what she'll get for a vote for the final bill with a PO.

    Parent
    In the real world, this is (5.00 / 1) (#5)
    by coast on Fri Nov 20, 2009 at 02:14:13 PM EST
    Called a bribe.  In government its called compromise.

    Parent
    This seems to be incorrect. (none / 0) (#7)
    by MileHi Hawkeye on Fri Nov 20, 2009 at 02:43:36 PM EST
    There are many more states that appear to qualify aside from LA...

    49 "major disaster" declarations in '09 alone.

    Parent

    It does seem odd. (none / 0) (#8)
    by Dalton Hoffine on Fri Nov 20, 2009 at 02:51:38 PM EST
    I'm wondering if there's any distinction between the counties being declared disaster areas, and if the entire state of Louisiana was declared major disaster during Katrina. That's the only thing I can think of.

    Parent
    As I recall... (none / 0) (#11)
    by MileHi Hawkeye on Fri Nov 20, 2009 at 03:16:12 PM EST
    ...the entire state of Iowa was declared a disaster area after the '08 floods.  Doesn't sound like the ABC reporter had the most reliable source?

    Parent
    It's a two-page description (none / 0) (#12)
    by Steve M on Fri Nov 20, 2009 at 03:23:41 PM EST
    obviously something appears on those 2 pages that is a little more complex than just the three words "major disaster area."

    Parent
    So you also are not a fan (none / 0) (#16)
    by Cream City on Fri Nov 20, 2009 at 04:20:02 PM EST
    of the sort of reporting that starts sentences with "I am told that. . . ."  Who told him?  What is the source's title, credentials, credibility?  Etc.

    Parent
    Los Angeles Times reported California (none / 0) (#9)
    by oculus on Fri Nov 20, 2009 at 02:57:18 PM EST
    will benefit from thie provision and some other states are not happy because they won't.

    Parent
    Honestly (none / 0) (#10)
    by CST on Fri Nov 20, 2009 at 03:01:28 PM EST
    I'm perfectly o.k. with spending $100 million on just about anything, if it gets the public option passed.  And extra funding for medicaid in LA is pretty low on the list of things that would tick me off.  Is it fair?  No.  But constituent services isn't about "fair", it's about getting what you can for your state.  And she's doing her job.

    Now, I don't know if this gets a public option passed, but if it does, in my mind - totally worth it.

    Parent

    To CST (none / 0) (#17)
    by christinep on Fri Nov 20, 2009 at 04:20:03 PM EST
    My sentiments exactly. Under the circumstance,now is not the time for niceties nor beanbag.

    Parent
    Well, I would draw a line (none / 0) (#18)
    by Cream City on Fri Nov 20, 2009 at 04:46:09 PM EST
    at some of these bribes -- but recovery and rebuilding from what the feds, the Army Corps, did to NOLA is okay by me, if this is how it gets done.

    If it's for other stuff in Louisiana, though, I'd like to know more.  

    Parent

    We need a section of the bill (5.00 / 1) (#23)
    by nycstray on Fri Nov 20, 2009 at 05:31:27 PM EST
    That summarizes all the bribes in the bill and who demanded them . . . and perhaps one that says what we get in exchange . . . . They could prob just toss the rest of the pages in that bill and save us all a lot of time and trees.

    Parent
    Good idea in theory... (none / 0) (#24)
    by christinep on Fri Nov 20, 2009 at 05:35:55 PM EST
    But, would you do that for all the bills in all the congressional sessions.  (Isn't that how legislation gets to be legislation?)

    Parent
    Anytime a bribe is involved :) (none / 0) (#25)
    by nycstray on Fri Nov 20, 2009 at 05:41:05 PM EST
    We could also add their "take" from lobbyists and then have a fun ol' time when they try and get reelected with all that info so nicely put together . . .

    Parent
    Until we see full public funding (none / 0) (#27)
    by shoephone on Fri Nov 20, 2009 at 11:03:01 PM EST
    for campaigns, I consider all 535 Congresscritters to be actively on the "take."

    Parent
    At this point why bother? (5.00 / 7) (#6)
    by BobTinKY on Fri Nov 20, 2009 at 02:37:11 PM EST
    After reading summaries of the Senate bill and Robert Reich's analysis on today's HuffPo, is the bill worth passing? It sure looks like we got the boon for private insurers (30 million new government-subsidized customers) that many of us had been fearing, with little that advances the public interest in return.

    Maybe there's some procedural magic whereby this bill gets a more robust public option in conference, and the conference bill can pass with 50 votes in the Senate.  But that assumes the Dems want that to happen when all indications are otherwise.  

    Link to Robert Reich (none / 0) (#14)
    by fairleft on Fri Nov 20, 2009 at 04:10:59 PM EST
    nothing from nothing leaves nothing (none / 0) (#20)
    by pluege on Fri Nov 20, 2009 at 04:56:10 PM EST
    there is not a 'robust public option' in the House bill, so how exactly is this magical unicorn going to appear in conference?

    the vichy dems are doing their corporate masters' bidding - full stop.

    Parent

    President Snowe now speechifying (5.00 / 1) (#15)
    by Cream City on Fri Nov 20, 2009 at 04:18:26 PM EST
    on CSpan.  It's unsettling to hear her start so many complaints about the Senate bill with "Mr. President" when, in my head, I keep thinking of her as President Snowe.  

    And the longer this cr@p continues (5.00 / 2) (#22)
    by shoephone on Fri Nov 20, 2009 at 05:01:50 PM EST
    I find myself imagining the "Snowe/Lincoln 2012" yard signs.

    I'm with BobT. This fishy health insurance reform is just reeking up the place.

    Parent

    Yikes, Sen. Pat Roberts asks my question (5.00 / 2) (#26)
    by Cream City on Fri Nov 20, 2009 at 06:55:27 PM EST
    "Why trust these tools?"

    Okay, he was talking about medical assessment mechanisms.  But I thought it an apt query re some of these tools in the Senate. . . .

    I saw this (none / 0) (#1)
    by Dalton Hoffine on Fri Nov 20, 2009 at 12:28:03 PM EST
    My immediate reaction is that the Senate bill is setting up some obvious 'compromises' so that both houses will pass the bill in conference. As a carrot for getting votes, they can have a mandatory waiting period until 2015 or so for states to be able to opt-out. This would get votes from the Senate who would otherwise not vote for a full-blown House-esque public option (here's lookin' at you, Blanche Lincoln.)

    How significant is the Wyden amendment, (none / 0) (#13)
    by oculus on Fri Nov 20, 2009 at 04:03:06 PM EST
    which now in the Senate bill?  (See The Hill--TL sidebar.)

    Wal-Mart (none / 0) (#19)
    by waldenpond on Fri Nov 20, 2009 at 04:49:28 PM EST
    I think of Wal-Mart.  Employees are paid such a low rate they qualify for medicaid.  The bill would no longer allow it as it forces individuals to take employee offered insurance.  The subsidies could apply to them and they could use their subsidy to buy into the public option instead of being forced to take Wal-Mart's cr@p coverage.

    Parent
    Call a spade a spade (none / 0) (#21)
    by pluege on Fri Nov 20, 2009 at 04:58:45 PM EST
    I just wish they'd stop calling it HCR and call it what it is: more corporate give away. A little honesty would be so damn refreshing. It would be a great distraction from the pols malfeasance.

    Really (none / 0) (#28)
    by Ga6thDem on Sat Nov 21, 2009 at 10:12:39 AM EST
    It is nothing more than a lobbyist written piece of junk.


    Parent
    It's True (none / 0) (#29)
    by stephhunter on Sat Nov 21, 2009 at 10:20:16 AM EST
    there are improvements that need to be made, one of them is to do away totally with the opt-out.  It's a hedging addition to the bill and one that doesn't add anything except political capital for those who are playing politics.  We need the legislators looking at non-profits like this for guidance!  http://cli.gs/23yYaM/

    11 states are ready to go (none / 0) (#30)
    by jbindc on Sat Nov 21, 2009 at 03:14:27 PM EST
    and to try and pass bills to opt-out, if allowed in the final bill.

    At least 11 states intend to forge ahead in the coming months with bills and ballot questions designed to block some of the healthcare reforms Democrats are trying to pass this year.

    Their efforts could be a harbinger of trouble for the staple feature of Senate Majority Leader Harry Reid's (D-Nev.) newly unveiled healthcare plan: a public option that allows states the ability not to participate.

    Starting as early as this summer, state lawmakers began introducing bills that would shield their citizens from individual or employer mandates, among other key reforms in Democrats' healthcare proposals, according to the National Council of State Legislatures.

    SNIP

    Already, the Congressional Budget Office estimates about one-third of states would back out of the system, limiting the public option insurance pool to about 3 or 4 million Americans. That would make the public plan's enrollment about 1 million smaller than the House's version of the program, according to a cost analysis of the Senate proposal.

    Among those states likely to bow out first could be Virginia and New Jersey, which both recently elected Republican governors.