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The Price of Public Option “Opt-Out”: Who Will Pay for Red State Folly?

I’m not talking about who will pay in the political sense. I literally mean who is going to pay the billions of dollars it will cost to let red states opt out of the public option?

We know from the CBO that a public option would save between $25-$110 billion depending on how it was structured. Assume only the reddest states (those with both Republican governors and state legislatures) choose to opt out of the public option that is still 23% of country’s population. Letting the reddest states opt out should therefore make health care reform between roughly $6-$25 billion more expensive. Who is going to pay for that?

Are middle income Americans in blue states going to get their health insurance affordability tax credits cut so Texas can choose to run a more expensive and wasteful health care exchange without a public option? Will the low income Americans in these red states be forced to pay more for their expensive private health insurance? Will everyone in the country see their taxes go up because a few red states refuse to adopt a cost saving public option?

I think the question of who will pay for this opt out is critical. We should not let some Republican governor or state legislature simply pass a resolution opting out of the public option when that opt out will cost the whole country billions. The red states who want to opt out of a public option should be forced to raise their own taxes by several billion to pay for it. We should not let Rick Perry force the rest of the nation foot the huge bill, just so he can score a political point and deny the people of Texas the choice of a public option. The more I examine this opt-out idea, the more problems I see with it.

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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