Previously, I addressed what I consider to be the biggest problem with this new public option opt out compromise. It leaves the people most in need without the public option (red states tend to have much higher uninsured rates). I thought the goal of progressives was to give every American a square deal–not just those lucky enough to live in blue states.

The key issue with the public option opt out proposal, however, is who has the power to opt out the state. Does it require a law to be passed, popular referendum, executive order from the governor, act of the legislature? Depending on how the opt-out is structured over half the country could be denied the choice of a public option.

How many Americans would be denied the public option if there was an opt-out? For my calculation, I’m assuming Republicans at the state level will be like their Congressional brethren and be universally opposed to the public option. I’m also assuming Democrats at the state level will not support an opt-out for their state. (I understand in the real world this issue will not be so perfectly divided on partisan lines.)

State legislature and governor’s approval required for opt-out The following ten state legislatures are fully controlled by Republicans and the state also has a Republican governor: AZ, FL, GA, ID, NE, ND, SC, SD, TX, UT. If the opt out required approval by both the legislature and governor roughly 71 million people (23% of the population) live in state where they would be denied the public option.

State legislature’s approval required for opt-out Fourteen states legislatures (AZ, FL, GA, ID, NE, ND, SC, SD, TX, UT, WY, OK, MO, KS) are fully controlled by Republicans. If the opt out only required an act of the legislature, roughly 84 million people (28% of the population) would be in a state without the choice of a public option.

Governor’s decree required for opt-out There are 22 states with Republicans governors (AL, AK, AZ, CA, CT, FL, GA, HI, ID, IN, LA, MN, MS, NE, NV, ND, RI, SC, SD, TX, UT, VT). One hundred and forty-one million people (46% of the population) live in states where the Republican governor could opt the state out by decree.

Either state legislature or governor can opt-out the state A combined total of 154 million people (51% of the population) live in states where Republicans control the governor’s mansion or the state legislature.

If people think my numbers are too “worst case scenario,” remember: there will be four years and two election cycles before the public option is made available. Currently the Republican Party is very close to a historic low and is expect to improve over the next few elections. Republicans (and/or Democrats opposed to the public option) only need be in power briefly at sometime in the next four years to be able to opt out their state. If you don’t think the next four years will see a multi-million dollar surge in donations from health insurance companies to politicians at the state level, you don’t understand politics.

A related issue: What would be the requirement for a state to opt back in if the state had previously opted out? If there is a higher standard to opt back in, that would be a very bad development. It could hamper the possible spread of the public option in the long term.

This opt-out "compromise" is a perfect example of what is wrong with the Democratic party–they are too willing to compromise their ideals. When did the noble cause of “universal health care,” become the goal of some insurance reform which will help some people? The Democrats completely control Washington. There is no need or excuse for compromising their principles.

Jon Walker

Jon Walker

Jonathan Walker grew up in New Jersey. He graduated from Wesleyan University in 2006. He is an expert on politics, health care and drug policy. He is also the author of After Legalization and Cobalt Slave, and a Futurist writer at