Which States Will Opt Out of a Public Option?

Harry Reid announced yesterday that the current health care bill will include an “opt-out public option.” In other words, there will be a government-run plan in which every citizen will be enrolled for which every citizen will be eligible if they don’t already have health care, unless their state government chooses to opt their entire state out of the program by 2014. At that point, barring any changes to the law, every state that hasn’t opted out will be part of the national public option.

So, that begs the question, which states will have the political will to opt out of the plan. Let’s be reductive for a moment and assume that Democrats are all for the plan and Republicans are all against it. (Tip of the hat to Michael G. Frank for some of these numbers).  There are currently 17 states where the governor is a Democrat and both houses of the legislature are controlled by Democrats. Twenty four more states have Democratic control of either the state house or one house of the legislature.

The genius (or evil genius) of the opt-out provision is that it potentially allows one part of a state government to hold out—through filibuster or delay—until 2014, when the plan goes into effect, bucking the will of other members of the government and putting their state into the public plan column. Currently, only nine states are fully controlled by Republicans. They are Texas, Utah, South Carolina, South Dakota, North Dakota, Missouri, Idaho, Florida, and Georgia.

Those nine states represent about 25 percent of the U.S. population (and nearly all of that is from Texas and Florida). If the public option is as great as its supporters say it is, will we be looking at a country divided by the health of its citizens, where a vast majority receive cheap and plentiful health care, while insurance companies find profit from a small minority of hold outs? Or will citizens in those states, seeing the public option working elsewhere, demand change of their government?

Then again, the bill is far from passed and 2014 is far away.