Should We Let Some States “Opt Out” of a Public Sector Insurance Option ?

There is now some talk of finding a compromise to the public option debate by including the public option in health reform legislation—and then letting individual states “opt out” leaving their citizens without the opportunity to sign up for a less expensive public plan modeled on Medicare, and letting private insurers set the market rules in those states. 

(Not long ago, the Washington Post reported that private insurers are already figuring out ways to “shun the sick,” despite health care reform. While they won’t be able to deny care because of pre-existing conditions, they can make their plans less attractive to cancer patients by including fewer oncologists in their networks.)

Let the Red States reject a public option if they choose,  some say, at least the citizens of Blue States will be protected.

As Sam Stein puts it over at the Huffington Post: “For conservative Democrats -- especially those from states with major private health insurance industry interests -- this concession could be key, allowing them to punt a vote on a public plan to local governments. For progressives, it would not be the hardest pill to swallow.”

I disagree. I would find it a hard pill to swallow. I’m not willing to accept the notion that, if you have the misfortune to live in a state where politicians consider the insurance lobby more important than that state’s citizens—I should be willing to cut you loose and say “good luck.”

Once we allow conservative to begin to divide us, we lose the “social solidarity” that will provide the necessary base for healthcare reform. (If states can “opt out” of making an affordable, high quality public plan available to everyone, perhaps some states should also be able to “opt out” of some civil rights laws? That may seem an extreme comparison, but if you think health care is an inviolable human right, there is a parallel here.)

Once again, this is not what I thought we meant when we begin talking about universal coverage.

I also wonder whether insurers would be allowed to sell policies across state lines?  If so, insurers based in red states might will skim some of the cream from the insurance pool in blue states by selling low-cost plans specifically designed for young, healthy, relatively affluent customers. Plans with relatively low premiums, high deductibles, high co-pays, and $200 annual memberships at upscale gyms could appeal to “young immortals” who rarely go to the doctor (or so they hope), and like the idea of working out and socializing at Reebok. Thus, the blue state pool becomes more expensive as it loses some of those healthy customers.

Proponents of this compromise argue that it offers a way to get the needed 60 votes in the Senate for a bill that includes a public option. Moderate will vote for it knowing that there state won’t be bound by the legislation.

But let me say it again: in the end, I don’t think we will need 60 votes to pass a reform bill.

When it comes down to it, I believe that moderate Democrats will vote with liberal Democrats to break a Republican filibuster in the Senate. Otherwise, they risk becoming forever known as one of five or six Senators who allowed Republicans to bury health care reform. If Democrats crack the filibuster, the plan then comes up for a vote.

Moderate Democrats can register their opposition by voting against the bill itself. But at that point, only 50 votes will be needed to pass the legislation. This, I think, is how 50 Senate votes will be sufficient to bring us what we have been trying to achieve for more than half a century: national health reform.

As Sam Stein puts it over at the Huffington Post: “For conservative Democrats -- especially those from states with major private health insurance industry interests -- this concession could be key, allowing them to punt a vote on a public plan to local governments. For progressives, it would not be the hardest pill to swallow.”

I disagree. I would find it a hard pill to swallow. I’m not willing to accept the notion that, if you have the misfortune to live in a state where politicians consider the insurance lobby more important than that state’s citizens—I should be willing to cut you loose and say “good luck.”

Once we allow conservative to begin to divide us, we lose the “social solidarity” that will provide the necessary base for healthcare reform. (If states can “opt out” of making an affordable, high quality public plan available to everyone, perhaps some states should also be able to “opt out” of some civil rights laws? That may seem an extreme comparison, but if you think health care is an inviolable human right, there is a parallel here.)

Once again, this is not what I thought we meant when we begin talking about universal coverage.

I also wonder whether insurers would be allowed to sell policies across state lines?  If so, insurers based in red states might will skim some of the cream from the insurance pool in blue states by selling low-cost plans specifically designed for young, healthy, relatively affluent customers. Plans with relatively low premiums, high deductibles, high co-pays, and $200 annual memberships at upscale gyms could appeal to “young immortals” who rarely go to the doctor (or so they hope), and like the idea of working out and socializing at Reebok. Thus, the blue state pool becomes more expensive as it loses some of those healthy customers.

Proponents of this compromise argue that it offers a way to get the needed 60 votes in the Senate for a bill that includes a public option. Moderate will vote for it knowing that there state won’t be bound by the legislation.

But let me say it again: in the end, I don’t think we will need 60 votes to pass a reform bill.

When it comes down to it, I believe that moderate Democrats will vote with liberal Democrats to break a Republican filibuster in the Senate. Otherwise, they risk becoming forever known as one of five or six Senators who allowed Republicans to bury health care reform. If Democrats crack the filibuster, the plan then comes up for a vote.

Moderate Democrats can register their opposition by voting against the bill itself. But at that point, only 50 votes will be needed to pass the legislation. This, I think, is how 50 Senate votes will be sufficient to bring us what we have been trying to achieve for more than half a century: national health reform.

Comments

[spinnikerca]

Where does the federal government get the Constitutional authority to even be involved in health insurance mandates? The reasons insurance companies don't sell 'across state lines' is that they are regulated by the individual states under our Constitutional separation of powers and reservation of powers to the states. Likewise, doctors, nurses and health professionals are licensed at the state level.

Individuals can better impact policy to serve their diverse preferences at the state level. It takes 3/4 majority of individual states voting for it to give the federal government more power than does the Constitution. I don't see that happening, particularly to let the federal government force people to buy awful, government designed insurance they don't want.

No matter how much you think you know best what everyone else should have, you have no moral nor legal right to demand that they accept it.

[Michelle Weckwert]

I am predestined for screening cancer.It exists in both sides of the gene pool. Can we group the folks such as myself in a plan for screening with insurance? Preventative counseling for the on said type of cancers that cause the death of close genetic links; start with young children with out a panic or stigmata tied to it. Let kids be kids, but parent be involved and in tune a lifestyle to not getting what the family has or may have. No DNA imprint. Common sense living and updates at screening. How far off am I?