The good news on the Senate version of the public option is (beyond the fact that there is one included in the bill, making conference that much easier) that it uses the essential components of the HELP version of the public option, with a few minor changes. The core of the public option remains pretty decent, with a single national plan set up and run by the Secretary of HHS, who has the authority to negotiate reimbursement rates with providers. Not as good as Medicare +5, but could be worse.
The bad news, of course, comes with the opt-out provision of the bill, which makes the public option less than national. When first proposed, the idea was that states would automatically be included, and would have to take action to opt-out sometime after implementation of the program. Unfortunately, that's not how it worked out in the actual language [Sec. 1323, part (a)(3)]
(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.
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).
CBO’s analysis took into account the probability that some states would opt not to allow the public plan to be offered to their residents. Rather than trying to judge which states might opt out, CBO applied a probability recognizing that public opinion is divided regarding the desirability of a public plan and that some states might have difficulty enacting legislation to opt out. Overall, CBO’s assessment was that about two-thirds of the population would be expected to have a public plan available in their state.
You know who the third is going to be--those who need it the most. Check out this map from the most recent Census data, via TWI's Mike Lillis.
(Click on image to enlarge.)
In Texas, for example, the uninsured rate in 2008 was the highest in the nation at 24.1 percent, while just 4.1 percent of Massachusetts residents lacked health coverage, representing the country’s lowest rate, the Census data revealed.
There’s nothing new or unusual about these distinctions. States have their own laws, and some have simply put greater emphasis on getting health coverage for residents. What’s interesting in the context of the insurance reforms working their way through Congress is how the highest uninsured rates are largely concentrated in the South and the Mountain West, where the lawmakers tend to be more conservative — and more likely to oppose the Democrats’ health reform plans.
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.
