Senate Majority Leader Harry Reid announced today that the Senate version of the health reform bill will include an opt-out. This will allow states that want to hurt their constituents and deny them access to health care to reject participation in the national public option.
The opt-out clause should be of some concern to folks like us living in Red States. Republicans in the House and Senate are almost unilaterally opposed to any sort of health insurance reform, choosing to stick up for the insurance companies instead of the 46 million uninsured Americans.
Texas has the highest rate of uninsured residents in the country, as the chart at right demonstrates. Between 2007 and 2008, 9.3 million Texans were uninsured for part or all of the year. It is imperative that Texans have access to real insurance, in order to receive the care they need.
Here are some early specifics about how the opt-out would work, should it make the final bill signed by President Obama. In his press conference, Harry Reid said that states could not opt out before 2014. (Yes, it's a crappy transcript, but that's the best link I can dig up right now.)
- 2011-2012: National insurance exchange is phased in; consumer reforms begin taking effect.
- 2013: Public Option goes into effect. Americans are mandated to have insurance coverage.
- 2014: States can opt out, exact process to be determined.
Apparently, the opt-out will require a 2/3 vote of the state legislature, with the governor able to veto an opt-out. We don't have a link for this yet, but that's what folks close to the process are suggesting to Burnt Orange Report.
Under this scenario, Texans would be able to participate in the public option (if they qualify) in 2013. Legislatures would then have to intentionally deny their constituents insurance by opting them out of the public option.
Importantly, states CANNOT opt out of the consumer reforms that will lower costs, prevent rescission, and stop insurers from denying you coverage for a pre-existing condition. These reforms are huge in making the insurance companies work harder to provide care, rather than just pile up profits.
Other questions that need to be resolved as we work through the sausage-making process:
- As governorships and legislative control pass between the two parties, can states opt out later on?
- Can a state opt in if it previously opted out?
- Are there different processes for states with unicameral and/or bicameral legislatures?
- Can states pro-actively pass legislation to opt out before 2014?
Access to the public option is key to creating real competition with the private insurance companies in terms of lower premiums and better quality of care. Any state that does not have the public option will see its constituents paying more for care than their neighbors across state lines. Texans need real reform, and deserve the choice of a public option. Now, let's make sure that our Legislature knows it.
Update 4:26 p.m. — Rep. Garnet Coleman released the following statement on Sen. Harry Reid's press conference today:
Today, Senator Reid presented a bill that includes a public option, something the American people overwhelmingly support. I commend the Senators for their tireless efforts, and for pushing legislation that will significantly help people in America, and Texas in particular.
The Senate bill includes a provision for states to opt out of the public option. A public option will increase competition and provide more quality, affordable options for middle-income Texans and Americans.
All the more reason we need to make sure Texas stays opted in to the public option.