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Doesn't the Opt-Out Public Option Equal the Public Option?
Well the press is reporting that the opt-out public option compromise proposed by Senator Tom Carper (D) from Delaware is gaining steam. But practical speaking is there any difference between the two. Certainly, moderate Senators can make a claim of limiting government influence on their constituents medical lives by insisting on the Opt-out. But once this legislation passes, which states are going to opt out of the public option? With 65% of the public supporting the option which states governors and/or legislatures are going to reject for their constituents the benefit of lower medical costs and insurance rates? Is there a state that over time has more to gain by opting out?
Maybe our good old governor from Louisiana, Bobby Jindal will find some way to opt-out and opt-in at the same time, similar to what he did with stimulus money. How about our good old trail hiker governor from the South Carolina; he could publicly reject the plan, while his state legislature works to undermine his decision as they did with their stimulus package. Texas? Minnesota?
If in fact some states decide to opt-out how will the surrounding opt-in states deal with border crossers looking for medical care at opt-in rates?
Maybe our good old governor from Louisiana, Bobby Jindal will find some way to opt-out and opt-in at the same time, similar to what he did with stimulus money. How about our good old trail hiker governor from the South Carolina; he could publicly reject the plan, while his state legislature works to undermine his decision as they did with their stimulus package. Texas? Minnesota?
If in fact some states decide to opt-out how will the surrounding opt-in states deal with border crossers looking for medical care at opt-in rates?
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An opt-out compromise might be worthwhile, and ultimately evolve into a universal public option, but the devil is in details. If opt-out is implemented, it will be important for states utilizing the public option to reqire any out-of-state insurers offering policies across state lines to accept all in-state applicants at non-discriminatory rates. That would preclude "cherry-picking" in the participating states that would undercut the public option, given that the latter would be required to accept all comers.
October 8, 2009 5:34 PM | Reply | Permalink
Border crossers would need to establish residency. Imagine realestate values near borders with rising values on the opt-in side and lowering on the opt-out side. Opt out states could lose congressional representation, federal road and school funding...
Some folks might vote with their feet but in the end the residents would boot the obstinant SOBs of the GOP out of office. Except of course in South Carolina where they are proud of just how pig headed dumb they can act.*
*disclaimer: I once lived in SC so I'm biased. Any peple living or dead in SC couldn't possibly be as stupid as I remember them to be.
October 8, 2009 5:38 PM | Reply | Permalink
I would just add that I assume participating states would forbid in-state insurers from cherry-picking out of state applicants, or in any other way, selecting for only low-cost subscribers.
October 8, 2009 5:43 PM | Reply | Permalink
The more I think about it, the more it seems like an approach that would eventually pressure all states to opt in, if done right.
"Done right" is the key, and so the details will be critical. Here is at least one pitfall that must be avoided: an out-of-state insurer cherry picks subscribers in its own state, thereby reducing its average costs and permitting it to undersell the public option in opt-in states. What would be required would be something to eliminate this possibility. That might involve permitting no insurer to sell insurance in an opt-in state unless it accepted all subscribers in every state where it operated, at rates that were non-discriminatory regarding health status.
October 8, 2009 8:43 PM | Reply | Permalink
I thought Bobby Jindal was governor of Louisiana?
October 9, 2009 1:03 PM | Reply | Permalink
You are so right. I thought I edited that before posting. I'll correct it now.
October 9, 2009 1:57 PM | Reply | Permalink