Washington » When Senate Majority Leader Harry Reid announced the Democrats' health care bill would include a government-run health plan, he also said it would have an "opt out" provision for states that do not want to participate.
"Under this concept, states will be able to determine whether the public option works well for them and will have the ability to opt out if they so choose," Reid said in late October.
So one would think that conservative Utah, where the so-called public option is likened to socialism, would be first in line to opt out. But that may not be the case.
A Salt Lake Tribune poll conducted last week shows that only 28 percent of registered voters in ruby red Utah like the idea of a public option competing against private insurers. And only 8 percent of Republicans -- the state's dominant political party -- favor that proposal.
So one would think Utah would be poised to leap out of the option at the first chance.
Utah Gov. Gary Herbert says it's not such a simple decision as Reid makes it sound.
"The devil's always in the details. So yeah, it's one thing just to say, yeah, let's opt out because we don't want to have a federal, one-size-fits-all approach out of Washington, D.C.," Herbert said last week. "But what does that opt out mean? Does that mean we still have to pay the bill as taxpayers in Utah and get none of the benefit?"
Herbert isn't alone in hedging on whether his state would want to be part of a federal option for health care. While many conservative governors and state leaders continue to vehemently oppose and lobby against the Democrats' health care plan, they aren't automatically pledging to stay out of a public option if one passes.
South Dakota Gov. Mike Rounds told National Public Radio recently that an opt-out provision wasn't so clear cut.
"We haven't seen a copy of the bill yet," Rounds said. "But as we understand it, all of the states, even if they were to opt out would still be subject to all of the taxes that it's going to take to put together the public plan."
In fact, many federal programs allow states to opt out, but few ever do. Medicaid, for example, is an optional program for a state in which the federal government pays 60 percent of the cost of health care for lower-income people and families. States pay the other 40 percent.
But when Congress passed Medicaid in 1965, not all states initially signed up. Arizona didn't join the program until the 1980s.
Sen. Lamar Alexander, R-Tenn., raised that point on the Senate floor recently, noting that it's not realistic that a state would be able to opt out of a government-run health care program.
"We should wait and see what he proposes, but I think we would be wise to pay attention to the fact that in the current government-run program we have today, no state finds it realistic to opt out," Alexander said.
It's still unclear how the opt-out provision would work and which state branch -- the governor or the Legislature -- ultimately would make the call.
Lawmakers from 11 states are already trying to preempt federal legislation, according to a list of bills tracked by the National Conference of State Legislatures. Several of those bills fight against a mandate that individuals buy insurance coverage.
The fight may be reminiscent in some ways of the dispute that some governors had about whether to accept money from the $787 billion stimulus act passed by Congress in February.
While some state executives initially balked at taking the funds on ideological grounds, all of them ultimately took the federal cash.
That same may happen with the public option.
If Congress passes a bill allowing states to decide whether to have a government-run plan, the pressure from residents may be intense to opt in, says Joe Antos, a health policy expert at the American Enterprise Institute.
"You can just imagine the situation that is very likely in virtually every state, even if the governor and the legislature were relatively unified that 'this wasn't a good thing for my state,' " Antos said. "You're going to have residents who are going to imagine that the promises they see on TV would all come true if the governor and legislature just said 'OK.' "