“Opt-In” and Texas: More Must be Revealed

Senate Majority Leader Harry Reid announced this week that the merger of the Senate Finance and Senate HELP bills that will be voted on by the full Senate will include a compromise to create a nationwide public option, but give states the right to opt out.  Other compromise proposals floated have been an “opt-IN” for states to allow their residents to access a public option, and Senator Snowe’s “trigger” proposal to establish public plans only if private insurers fail to provide affordable coverage.

You can read all over the web about all the ways the votes may play out on this.  But what would Texas do in an “opt-out” scenario?  The answer, as usual:  it depends.  We don’t know yet what specific process would be required for a state to opt out.  Will Governors decide?  Must the state Legislature pass a bill opting out, and if so will any special vote margins be required to do that?  Will there be any penalty for a state to opt out?  Any affordability standard to meet, as with the Snowe trigger?  Will voters who cannot afford insurance tolerate their Legislators voting to opt out?  If residents in neighbor states can access affordable comprehensive care from a public plan and Texans cannot, will that situation last very long?

The Center for Public Policy Priorities and TVHR have not made the public option central in our work, but without a public option success at getting affordable coverage for every American will require strong insurance reforms applying to a majority of the market, robust funding for premium subsidies, and strong bargaining powers by health insurance exchange(s).  Every compromise that whittles away at these, makes a public option more important.