Opt Out Public Option: A Red State Reaction

03/18/2010 05:12 am ET | Updated May 25, 2011

The health care reform bill sent to the Congressional Budget Office yesterday contained two key elements: a public option, and a way to opt out of that public option. Senate Majority Leader Harry Reid said he considered having a public option with an opt out clause "fair."

That could be a hard case to make in a red state like Arizona.

If any state is likely to exercise an opt out clause it could very well be the Grand Canyon state. Arizona often displays an independent streak when it comes to adopting federal proposals: Arizona was the 34th state to mandate the use of seat belts, the last state to institute Medicaid, and the second to last state to recognize Martin Luther King Jr. Day as a national holiday, which resulted in the loss of a Super Bowl and a national tourism boycott. Couple that history with the current right-leaning Republican majority in the legislature (dubbed the GOP Insane Clown Posse by one Arizona blog), a Republican governor and a state in financial crisis and you could have the makings of a public option opt out.

Congressman Raul Grijalva (D) agrees with that assessment. The co-chair of the Congressional Progressive Caucus and a vocal and stalwart supporter of a robust public health care option, said bluntly: "My state would opt out immediately." The Congressman's office verified that statement, saying the Congressman believes red states like Texas could follow suit despite the fact that Arizona and Texas have large populations of uninsured citizens. I spoke with a physician in Texas who agreed with the Congressman: "The idea of individual states (like Texas) opting out of a national program is just scary," and then wondered what would happen if Texas opted in but neighboring states opted out: "If Louisiana opts out, are hospitals in Texas supposed to turn people away?" Concern for those who would still be uninsured led Congressman Grijalva to say he would "have a hard time" with an opt out clause, "without protections for the people who would be left behind."

The state GOP office would not officially comment on the opt out clause, other than to say that Arizona's Republican congressmen "have been focusing well on the health care debate" but that the state GOP was "more focused on local elections." Likewise, Governor Jan Brewer's office had no official statement on the opt out clause. But it was not hard to find Arizona residents who echoed Grijalva's concern, like Mohur Sidhwa, a candidate for the Arizona State Legislature. Sidhwa said: "If the current version of the health care bill passes, our current very strange legislature will most likely stay true to form and opt out," adding somberly: "Incrementalism is not a good idea when peoples lives are involved."

Auburn McCanta, a writer in Phoenix, agreed: "Arizonans could certainly be on the chopping block should this opt-out notion be included in the final bill," and thought that could prove devastating to the state in the long run: "Arizona's growth might abruptly end. As a state with an economy significantly dependent on continued population growth, I can't imagine people moving here when other states would be more attractive. If Arizona were to opt out of providing a health safety net for its population, it would also be incentive for many of our residents to leave." A small business owner in Phoenix seemed to back McCanta's warning: "If other states offer this and Arizona doesn't, when it comes time to relocate our factory I'll be looking much harder at other states. We might be a very small employer, but I can guarantee you, we're not alone."

Some in Arizona were resigned to the idea, like Kathy Pastyrk of Oro Valley: "I guess this was the only way it could be accomplished. I should be happy, I guess, but basically I dislike caving in to the kooks of this country, affording them the option of imposing their will on others." Like McCanta, Pastyrk questioned the effect such a clause would have on states that chose to exercise it: "I wonder how many Americans will have to move to another state because of this choice."

But Tucson resident and former candidate for Congress Francine Shacter expressed support for the idea of an opt out clause, not just because it could result in the passage of a health care reform bill but because it could push more people into voting: "It could be the greatest (yes, I do mean greatest) spur for people within states to push back against neanderthalian legislators." Shacter believes an opt out clause might end up having "the unintended consequence of making voters more aware of the power of each vote," adding, "I'm tantalized by the prospect that people who got opted out of a truly good and terribly necessary thing, namely health care, would rise up and say 'Up with this I will not put!'"

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