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Following Chris' five process questions yesterday on the news that Reid will include an opt-out public option in the merged bill, I have five organizing questions of my own that I think are critical to making sure this bill is a success. As he wrote, a lot about the opt-out structure remains unclear, and I think the devil is in the details. These should serve as possible targets for amendments during the floor fight.
1. The date in which this starts. Availability of the public option is due to start in 2013. I see this as some bad and some good. On the bad side, there is limited help for people who need it now. It's also not clear to me that the bill itself gives Democrats a lot to work with in the midterm elections in terms to being able to demonstrate how health care is more affordable in November 2010. On the good side, things are going to get worse before they get better, so the "help is on the way" argument is useful, but not terribly compelling. Our side needs to make sure the date is as early as possible.
2. The timeline of opt-out. It is imperative that we push for states only being able to opt-out after the public option starts. People need to try this first before their state makes a decision. If there is no tangible benefit for people who need it, there will be no push to keep one's state from opting out.
And strategically, I prefer to only allow states to opt-out after their fellow residents have suffered under four more years of things getting either somewhat better or dramatically worse. The date in which states can opt out should be as late as possible. Let's dare the teabaggers and conservative legislators to look in the face of those who are getting screwed by insurance companies and tell them they aren't going to try something to help.
3. The ability to opt back in. Perhaps even more important is allowing states the ability to opt back in if results of the public option in other states show that others like it, and that it has improved the situation dramatically. For policy, political and moral reasons, we cannot permanently leave states on the outside looking in.
To some degree, I say this may be even more important than the start date of the public option, because if things are going to get worse before they get better, there may be a clamoring in current "red" states for opting back in, even if a state opted out the first day it could. I am also concerned about the success of the program if lots of states, including places like Florida and Texas, opt out, leaving a smaller pool of people participating. Political situations in states also change- we could see a surge of progressives elected in states that opted out, some running on the platform of doing something on health care. They need to have the ability to opt back in.
4. The manner in which states can opt out. What I've heard so far is that this will be by regular legislative action and gubernatorial signature. What about a requirement for a 2/3 vote in the legislature? What about the ability to put, or not put, the issue on the ballot? This may all be moot if Congress doesn't want to "interfere" in states' rights of passing legislation or whatever, and could mess up the whole fragile package of support in the Senate, but it's worth thinking about. We should try and dictate the manner in which states can opt out as much as possible and set up as many roadblocks as possible.
5. Organizing against opting-out. One of the real disappointments I have with the opt-out is that it means we're going to be now taking the fight to the state level on a number of fronts to ensure states don't opt-out. Lobbying, public pressure, whip counts. Some of you might see this as great fun, but I see it as more expenditure of resources that should be going towards other important fights coming up. This is all in the future, but we should start thinking now about the structure of such campaigns and the role the netroots can take in them. We should also start thinking about the current fight and what we could do better. The fight to keep states from opting out could start as early as next year. Or it could be happening in 2013. Our own self-examination now may help us think about what kind of policy amendments we should be focusing on to make sure we are prepared to fight these battles.
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