In order to states to opt out of the public option in the Senate bill, they must pass a law to ban the public option from being offered in the state. So the opt-out isn't designed to let the voters have their say, but to let state legislators have the final say. And guess what? The opt-out doesn't begin one year after the public plan takes effect. It begins BEFORE it takes effect, so states presumably can opt out next year. As Jon points out:
There is no restriction placed on when states can start opting out, and, presumably, this will allow states to start opting out right away. That means there will be a four year window after the bill is passed and before the public option is first made available. That is a huge window in which Republicans and health insurance lobbyists can work to opt a state out of the public option.
The opt-out will quickly become a partisan football at the state level after reform is passed. Expect many red states to start passing laws to opt-out their states right away. I would not be surprised if a dozen red states quickly opted out in 2010.
And one of the reasons why the cost of the bill is so low is because they pushed back the employer responsibility, individual mandate, and Medicaid expansion, the exchange, and the public option to 2014. The current implementation date is 2013 in the House health bill and in the Senate HELP bill. By delaying the implementation for a year, it brought down the cost of the bill, and that's why they did it to meet the threshold of the $900 billion cap that President Obama had requested during his speech to Congress in September.
However, there is some good news here in the middle of the two glaring deficiencies about the bill. The public option in the merged bill is very similar to the public option in the HELP bill. Here's a list below about the changes made to the public option:
(D) PHYSICIAN NEGOTIATED RATES- Nothing in this paragraph shall prohibit the application of a State law that permits physicians to jointly negotiate with health plans. In such State, physicians may jointly negotiate with a community health insurance option concerning rates paid by the option.
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`(9) OMBUDSMAN- In establishing community health insurance options, the Secretary shall establish an ombudsman or similar mechanism to provide assistance to consumers with respect to disputes, grievances, or appeals.
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`(3) RISK CORRIDOR PAYMENTS-
`(A) IN GENERAL- In any case in which the Secretary has entered into a contract with a contracting administrator, the Secretary shall use amounts contained in the Start-Up Fund to make risk corridor payments to such administrator during the 2-year period beginning on the date on which such administrator enters into a contract under subsection (e). Such payments shall be based on the risk corridors in effect during fiscal years 2006 and 2007 for making payments under section 1860D-15(e) of the Social Security Act.
`(B) SUBSEQUENT YEAR- In years after the expiration of the period referred to in subparagraph (A), the Secretary may extend or increase the risk corridors and payments provided for under subparagraph (A).
`(C) AMOUNT USED TO REDUCE COSTS- The Secretary shall deposit any payments received from a contracting administrator under subparagraph (A) into the Start-Up Fund.
Those are the provisions that were removed from the public option in the Senate HELP bill. The CBO also estimated that the public option in the Senate merged bill will only have 3 million customers at best, because of the opt-out provision which many erroneously supported here on Dailykos. There's also a list of more flaws with the Senate bill which you can read right here.
When I read that many here had jumped onto the opt-out provision the minute it was floated as a trial balloon without pondering whether they might make it into a very bad opt-out provision, I knew that the Senate had seen our weak underbelly on this issue, and that our fellow Democrats in red states would be penalized based on where they lived immediately without the rest of the state experiencing the benefits of the public option first before the state would opt out.
It's why I oppose the opt-out provision, and you should too. It makes the public option into a regional public plan, rather than a national public plan, and it hampers its ability to be an effective competitive player against private insurers which dominate much of the market today. It looks like my predictions in my earlier diary on this subject turned out to be true, and that's regrettable.
If you want to prevent the opt-out from happening along with the trigger, then please HELP Democracy For America, CREDO, and us in our calls to the House to make lawmakers understand how bad the opt-out is under the Senate bill, and whip them into a voting bloc against the opt-out and the trigger!
CALL THE HOUSE NOW TO SHOW YOUR OPPOSITION TO THE OPT-OUT AND TRIGGER!