Some states already poised to opt out of government-run public health plan

By Tony Romm – 11/21/09 02:02 PM ET

At least 11 states intend to forge ahead in the coming months with bills and ballot questions designed to block some of the healthcare reforms Democrats are trying to pass this year.  Their efforts could be a harbinger of trouble for the staple feature of Senate Majority Leader Harry Reid’s (D-Nev.) newly unveiled healthcare plan: a public option that allows states the ability not to participate.  Starting as early as this summer, state lawmakers began introducing bills that would shield their citizens from individual or employer mandates, among other key reforms in Democrats’ healthcare proposals, according to the National Council of State Legislatures.   Movement on those issues is not likely for a few more months, as most state legislatures are not in session. Some state constitutions also require ballot measures in order to approve changes of that magnitude, further delaying any local action on the healthcare front.  However, these legislatures’ early moves still offer crucial hints about how many states would similarly exempt themselves from the public option, should the Senate bill’s “opt out” clause remain intact.  Already, the Congressional Budget Office estimates about one-third of states would back out of the system, limiting the public option insurance pool to about 3 or 4 million Americans. That would make the public plan’s enrollment about 1 million smaller than the House’s version of the program, according to a cost analysis of the Senate proposal.  Among those states likely to bow out first could be Virginia and New Jersey, which both recently elected Republican governors.   Both Virginia Governor-elect Bob McDonnell and New Jersey Governor-elect Chris Christie signaled a willingness to exempt their states from a public plan during their respective campaigns, and they could revive their opposition once they assume office in January.  “Turning over the best doctors, the best hospitals, the best pharmaceutical research and development system to the federal government for a co-op or a public option is [an idea] I don’t hear Virginians very excited about,” McDonnell, then a candidate, told Fox News in October.  Similar battles could play out across the country, especially in the 13 states where Republicans dominate both the governor’s mansion and the legislature, or the 10 states now under split-party control.


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