States Can Opt Out of Public Option Health Insurance Plans

There has been much speculation over the possible inclusion of a public option in the healthcare reform bill. Despite the controversy, Senate Majority Leader Harry Reid plans to ensure that a government-run health insurance program, intended to compete with private health insurance plans, is included–but there’s a catch. The new provision allows states to pass legislation that excludes them from the public option. With this strategy, Democrats in both chambers of Congress are forgoing support from any of the Republicans–although only one, Maine Senator Olympia Snowe, expressed willingness to vote for any version of health care reform with some type of public option (albeit one that first had to be “triggered”). However, it will probably secure the votes of some conservative and moderate Democrats who have been unsure of the public option. However, does this version of the public option defeat the purpose of the public option, and will it meet the goals of its liberal supporters?

The irony inherent in this rule is that while it is more likely to pass, it may be less effective in insuring the most Americans. The strongest opponents of the public option are Republican politicians representing so-called “red states”. Their concerns include the virtual guarantee that reform will add to the nation’s budget deficit, in addition to ideological objections to the concept of health insurance plans provided by the government. Meanwhile, the Census Bureau has found that staunchly Republican states (defined as those that have two Republican Senators and voted for John McCain in the 2008 election) generally have higher populations of the uninsured than either “purple states” that don’t consistently vote for either party or Democratic “blue states”. For example, “blue state” children in Massachusetts were eight times more likely to be insured than children in “red” Texas. While it appears illogical that legislators would ignore the pressing concerns of children and adults under 65 without insurance, it turns out that the Congressional districts with the most uninsured are represented by largely unchallenged Democratic representatives, not to mention predominately populated by minorities. Republican-leaning states are still, on average, less insured after these skewed districts removed from the statistics.

Why would this be the case? It’s possible that even though a significant percentage of their constituents are uninsured, a majority of Republican voters in these states are happy with their existing health insurance plans and see no need to change the current system. Different governing philosophies are part of the cause of this disparity in the first place. Democratic state governments are more likely to have expanded Medicaid to more individuals, increasing income limits to include people who are working at jobs that don’t offer health insurance or wages high enough to buy individual health insurance on the open market. These states have also enacted comprehensive children’s health insurance plans, important as almost 10% are uninsured in America. If state legislatures are allowed to pass laws opting out of the federal public option, this scenario is unlikely to change. President Obama and progressive organizations have expressed support for Reid’s proposal, no doubt justifying it by saying that the perfect is the enemy of the good–but is this actually good, or the worst of both worlds? It remains to be seen if they consider a greater chance of legislative victory worth failing to meet their mission of insuring as many Americans as possible.

(Image: Andrew Aliferis under CC 2.0)

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