What does an opt-out look like?
We now know that the health care bill that reaches the Senate floor will contain a public option with an opt-out provision. That said, if the bill passes, we don't know how the opt-out will work in practice.
Matt Ygelsias appears to have the answer to one of my biggest questions about the process:
To opt out you need a bill based by both houses of the state legislature and signed by the governor.
And while Yglesias is the only source I've seen reporting this, those kind of mechanics certainly make sense. If those are the conditions for opting-out in the final bill, that probably sets up a scenario in which most states actually do join the program.
It's important to remember that opting-out, as a policy mechanism, is not a new idea.
Medicaid, for instance, is an opt-out program, but no state has ever chosen to take that step.
Federal highways are also an opt-out program, but we all follow the same speed limits.
At worst, we should expect about as much resistance as we saw with the federal recovery package earlier this year. Despite a lot of hand-wringing from conservatives, ultimately, most states took most of the money.
That doesn't mean we won't have to listen to Republicans who are determined to grand stand on the issue. In Utah, they're already considering legislation to keep their citizens from having access to a public option:
Utah House Speaker Dave Clark (R) told the (Salt Lake City) Deseret News that “we already have a health-care system in Utah that is bottom three in cost for the nation. As I understand the latest version (of health care legislation) — always subject to numerous changes — I would recommend Utah opt out.”
Utah Senate Majority Leader Sheldon Killpack (R) also expressed skepticism; another Republican state representative, Carl Wimmer, said he will introduce a bill in January “that will get us out.”
While most state policymakers will probably wait to see the final content of the bill before they start drafting laws, these statements from the Utah legislators highlight an important point.
The debate in Washington is about to go on the road -- every state lawmaker in the country is going to get asked what they think about a public option.
Update: There are, of course, plenty of exceptions to speed limits. But states still do what is required of them to receive money from the Highway Trust Fund.