Could 'Opt-Out' Save The Public Option?

Democrats think a provision to let states decline the public option could do the trick, but experts are dubious

Democratic Congressional leaders Sen. Harry Reid and Speaker Nancy Pelosi are putting their weight behind a public health insurance option. But Sen. Olympia Snowe, the Republican whose support helped carry the Senate Finance Committee's health care bill, says she will back a filibuster against any bill that includes one. Her opposition, along with that of the GOP and moderate Democrats such as Sen. Max Baucus, could be enough to kill it.

But reform proponents think they may have found the key to pushing the public option through. The 'opt-out' provision would allow states that do not want to participate in the program to exclude themselves. This would mean that Snowe's home state of Maine could choose not to participate, thus making it easier for the state's senators to vote in support of the provision. Democrats only need to recruit a handful of votes to secure the public option. Will the opt-out provision do the trick?

• Moderates Don't See It As Compromise  David Waldman explains at his Daily Kos blog why moderates who oppose the public option will see this as a public option in sheep's clothing. "Despite all the rhetoric, no state's politicians would ever dare to opt out of something so potentially beneficial and popular. And that if indeed a state did opt out, the citizens would become so jealous of their neighbors that they'd shortly demand a reversal," Waldman, who supports a public option, wrote. In other words, they could not realistically opt out.

• Outside the 'Zone of Compromise'  Statistics-crazy Nate Silver lays out the myriad health care proposals on the table and finds that the opt-out plan may still not have sufficient support. "I'm pretty sure that a co-ops provision, with immediate implementation, could pass the Senate (or at least not be filibustered by it). Likewise with Olympia Snowe's trigger. A strong-ish opt-in amendment proposed by Maria Cantwell was approved by the Senate Finance Committee along party lines, but did not get Snowe's vote; it might or might not pass the full Senate," he writes. "The most robust public option available is probably a federally-run program that states would have the right to opt out of and which would have to negotiate its rates in the market."

• Would Snowe Really Oppose 'Opt-Out'?  Liberal blogger Steve Benen is incredulous over Snowe's statement that she would vote against a public option even with the opt-out. "Snowe has demonstrated a genuine interest in health care reform, and that's admirable. But she's willing to defeat a bill she would otherwise consider based on a single provision that most Americans wouldn't be eligible for anyway? Is the popular policy idea really so offensive that it's worth killing the entire initiative, decades in the making, and letting this once-in-a-generation opportunity pass?"

• What About the 'Opt-In' Idea?  Washington Post's liberal health care blogger Ezra Klein explains the growing support for 'opt-in', which "moderate are rallying around" as an alternative to 'opt-out'. "This proposal would allow states to create their own public options for their own exchanges. California, for instance, could decide it wanted a public option, and Alabama could decide it didn't want one, and both could have their way. The downside to this compromise is that many states are very small, so their public options would be quite weak. The upside is that if a state entered into an agreement with other states, you could have Pennsylvania's public option being sold on, say, Delaware's market."