Red States To Be Collateral Damage In Public Option Opt-Out?

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Uninsured Texans desperate for health insurance reform may be shut out from participation if the public plan becomes an “option” decided on at the state level. This means that Republicans at the state level might be able to block certain aspects of Federal health insurance reform.

Some Senate Democrats representing Red States (so designated by Presidential preference) are reticent to support a robust public option, the likes of which would let uninsured folks buy in to a government-run insurance plan if faced with a lack of coverage. Meanwhile, Senate Republicans are united in their opposition to a strong public program to give all Americans access to health care. Per TPM, the latest “compromise” to pass any sort of public option might allow individual states to “opt out” of the national plan:

Both conservative and liberal Democrats seem to be open to a new public option proposal floated by Sens. Chuck Schumer (D-NY) and Tom Carper (D-DE) to allow states not to participate in the plan if they decide they don't want to.

Now, most importantly, Red States can't opt out of reforms to the insurance industry, thus making President Obama's overall goals for reform–an end to recission, no denials for pre-existing conditions, caps on out-of-pocket expenditures and premiums–the keys that will force real reform on the corporate insurance providers. These are all really important strides forward for a state that has watched insurance premiums rise 91.6% under Governor Perry. However, this compromise would hurt folks in opted-out states who lack any other choice except for a government-provided plan. The mandate to carry insurance would still exist for Texans, who thus would be forced to buy into a corporate plan.

Admittedly, I have a hard time envisioning a scenario in which the Lone Star State doesn't opt out of the public option. Texas has a preponderance of elected Republicans who simply don't want the people of Texas to have access to health care. Governor Rick Perry openly advocates for leaving the nation. Why should we expect him to opt in to a public option? Whether via the Republican Governor, Republican-majority State House and Senate, or Republican-majority Congressional/Senatorial delegation, I fail to see how Texas–home to the highest rate of uninsured residents of any state in the country–manages to stay opted in. Granted, this proposal is far from being complete or specific. But unless there is a component that strongly compels every state to participate, this latest compromise could end up hurting the Texans who need this reform the most. As a Red State resident, I strongly urge Congress not to let some of the neediest states escape without the reform we need.

People in Red States basically rely on Federal policies to mitigate the harm perpetrated on us by our own elected officials. Because we live in Texas, because we've been gerrymandered into a scenario where both houses of our legislature and Congressional delegations are majority-troglodyte, we might not end up with the same right to access care as folks in states with sane representation at any level. And while this is a pretty strong argument as to why we need to elect more Democrats in Texas at the state and local level, it's not OK for more of our people to suffer needlessly while we work towards doing it.

The graphic to the right shows the rates of uninsured by state. We're the worst. Texas is the worst. The people of Texas need help. We've already been abandoned by our own state officials. We can't let the folks in the Federal level do the same. The people of Texas deserve the same access to health care as any other state in the nation.

Here's what you can do: call your Representative NOW. Urge them to pass real health care reform, that not only includes strong consumer protections and industry regulation, but also doesn't allow individual states to opt out of the public option.

I'm ultimately a pragmatist, a utilitarian. I understand that no public option is far worse for our nation as a whole than a public option for just some of us. I'm just tired of public policy that gives benefits to some, not all. Here in the Red States, things are already pretty bad. Here in Republican-led Texas we're doing pretty terribly on just about every major issue: energy, the environment, education, criminal justice; heck, even the food stamps system is utterly broken. We need to get health care reform right, and especially in the Red States, we need to make sure it's inclusive to all Americans who need it.

But hey, at least schadenfreude-loving UT football fans can take heart: if the opt-out passes, I'm betting Oklahoma doesn't get the public option, either.  


About Author

Katherine Haenschen

Katherine Haenschen is a PhD candidate at the University of Texas, where she studies political participation on digital media. She previously managed successful candidate, issue, voter registration, and GOTV campaigns in Central Texas. She is also a fan of UCONN women's basketball and breakfast tacos.


  1. M. Eddie Rodriguez on

    Let them
    If having a legislature approved opt-out provision the only way to pass real health care reform, I say do it.

    I dare any legislature to turn away helping its citizens on something so fundamental. It may pass some Red state but I guarantee that every elected official who votes for it will have to keep looking over their shoulder in every election they ever run in.

    This might be a way to purge our state legislatures of those who put ideology before the people, life before death.  

    • It might force Dems to actually run a populist campaign
      If Democrats can't win an election on giving working people a choice of Medicare-style insurance instead of private insurance death panels, then they ought to just pack it in.

  2. This is why it is absolutely crucial to elect
    A Democratic governor in 2010.  There is no way Rick Perry, who turned down stimulus money for extended unemployment benefits and who refuses to hire additional state employees to distribute food stamps would never and I mean never in a day allow for a public option if given a choice.

    Nor would Kay Bailey Hutchison.  She voted against the stimulus bill as it is.  She'd be more concerned about the costs and inconveniences to the health insurance companies and any costs to Texas than she would for the uninsured residents.  Indeed, both Hutchison and Cornyn have said on different occasions that the reason Texas has the highest number of uninsured is b/c we have so many illegal residents.

    Really?  California has a much larger population than Texas and very likely has even more illegal residents.   And yet more folks there are able to afford health care insurance.  From the chart above, Texas has 24% uninsured while California has 18%.  People here don't have it b/c they can't afford it.

    There would be a snowball fight in hell before any Texas Republican would for a public option.

    Texans ought to vote for a governor who will deliver what we want and most of us want significant health care reform that includes a robust public option.  

    • M. Eddie Rodriguez on

      Opt-out model
      I think what is being proposed is that any state who does not want their citizens to get option of the public plan would have to actively deny it (i.e. not opt-in scenario) through a 2/3 or 4/5 vote of the state legislature.

      They shouldn't give up on squeezing the Blue Dog Dems to get them to vote cloture and then have an up and down vote. The Blue Dogs should have their leadership positions threatened and yanked if they don't vote for cloture. They can vote whatever they please on the final bill.

      The road to Governor's mansion for a Democrat seems like a pretty tough trip right now from where I'm sitting.

      • I agree
        If they can't behave as true Democrats Blue Dogs have no business serving in leadership positions.  And, unfortunately I agree on a Dem occupying the Governor's mansion too.  

  3. Passing a bill to deny option is tough.. if Democrats stand firm
    As I've always said, it's much easier to kill a bad bill than pass a controversial one.   If the feds require a legislative vote to opt-out, the Republicans would have to pass a bill and the Democrats would have to kill it.  

    We've seen what a unified Democratic delegation can do on issues like voter ID.  It would be the same type battle, but with major lobby groups weighing in on both sides.  

    If, and as soon as,  this issue becomes a part of federal legislation, I challenge all of us to begin a “litmus test” project among our Democrats in the Lege.

    If ANY Democrat cannot emphatically state they will oppose any opt-out bill, then they MUST have a primary opponent filed against them.  No ifs, ands, or buts. Perion.

    • Excellent point.
      This is what representative government comes down to–protecting and providing for your constituents. The people of Texas need coverage, and we need our Democratic Representatives to do all we can to ensure that we get it.

    • Thanks, Glen
      I'm with you.  It is really too bad, knowing what we know about the two Republican candidates for governor, that Texas has such a tough time electing a Democrat.  People sure are good at voting against their own self-interests, if not their very own financial well-being and health.  

    • Just a thought
      Even if TX ended up with a state-level public option, don't you figure the state would contract out with one or more private companies to administer it – just like we do with Medicaid, CHIP and foster care?

      It could still be preferable to straight private insurance, if the state imposed some additional level of requirements and oversight. However, I wouldn't at all be sure that the state would impose any requirements beyond current TX Insurance Code – and state oversight is not always what we might hope it would be.

      In addition, the exchanges envisioned by current proposals will require participating companies to meet certain standards…and a federally-developed set of standards might go beyond what TX would require on its own(although I could see the state possibly just adopting the exchange regulations rather than develop new/different ones). If there is a state-level public plan, would there still be an exchange for Texans — and if so, would the state plan be subject to the same regs as private plans offered via the exchange?

      I'm not sure we really have a level of detail that allows any hard and fast conclusions about what a state-level public option in TX would look like.  

      • I believe
        the exchanges would exist regardless, because their whole purpose is to address the idea that there's a universe of small businesses that could use private plans if they could access the market in a certain way.  The exchange proposal has always been intended to exist alongside the public option (or the co-op in the SFC bill), and in fact is supposed to reduce the overall burden on the public option.

        And regarding regulation, one of the primary reform proposals outside of the public option has been not only preserving but expanding the ability for states to regulate insurance.  Given that, state regulation should be theoretically possible for all the insurance options out there, with the public option being the one possible exception, but it would be each state's discretion as to how much to regulate and what to cover.

        • Its the state discretion that I wonder about
          For example, Medicaid allows states discretion in whether or not to cover certain options services/eligibility groups. Texas doesn't take full advantage of what's allowable under Medicaid. I would expect the state to take a similar approach for a public plan for the uninsured.

          • Well, Medicaid is probably a different case
            because the opt-out provisions were part of the 1996 welfare “reform” package, supposedly designed to reduce dependence on government benefits, and were intertwined with the immigration law changes passed the same year.  The biggest opt-out Texas has with respect to Medicaid is our refusal to allow legal immigrants to participate.  It's also important to note that this doesn't allow the state to regulate the content of Medicaid, just who can participate under what conditions.

            The public option isn't designed to be a “welfare” program, as even the most limited forms of it being discussed would still include access for folks other than the very poor.  The one area where I do see the strong possibility of similarity to Medicaid, however, is with respect to immigrants.  Given the hysteria spurred by folks such as Rep. Joe Wilson, I wouldn't be surprised if the final version not only excluded undocumented immigrants, but legal immigrants as well (or at least gives states the option to not make it available for legal immigrants).

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