In my last (first) diary, I noticed a couple of commenters from Texas expressing skepticism about the opt-out clause in the version of the public option that seems to have the best chance of making it to President Obama's desk. Those commenters' fears are not unreasonable: conventional wisdom holds that if one state opts out, it's going to be Texas. But as a Texan, I'm not terribly worried. Here's why.
By now, it is not at all unreasonable to assume that we will be getting some shape or form of a public option in the forthcoming healthcare reform legislation - the real question is what shape, what form. Assuming the Senate Dems can corral the necessary 60 votes for cloture on a potential Republican filibuster (and remember that even Lieberman and Landrieu have already said they're not holding out), Harry Reid's version of the public option will likely pass the chamber. The House's version will probably be somewhat more robust, and the final law would be somewhere in between. But just for the sake of argument, let's assume that the bill Obama signs includes the opt-out clause.
Obviously, we still have a ways to go in the fight for real health care, and it would be a grave mistake to cheer the public option's victory prematurely. Still, a little optimism couldn't hurt - and as far as purely hypothetical situations go, this one could be far worse. Consider the following two points.
1. The public option under Senate consideration, if passed, would go into effect in 2013; states would not be able to opt out until 2014 at the earliest.
As we amateur healthcare policy wonks know by now, Texas has the highest percentage of uninsured residents of any state in the nation, 27% according to Gallup. In absolute numbers, only California is worse off than we are. We are home to the largest and most advanced medical research complex on the planet, yet more than a quarter of us simply cannot afford to experience its benefits. This sad, sordid state of affairs is likely thanks in no small part to our ass-backwards political establishment: one of our senators places the value of her vote at $1.4 million of the dirtiest money the health insurance industry has to offer, and the other is a proud member of the thirty-strong Republicans for Rape coalition; our governor makes Sarah Palin look like a Rhodes scholar, and his predecessor went on to become arguably the worst president in American history.
But if there's one thing the dirty socialists and the racist wackjobs can agree on, it's that health insurance is too expensive. Now, consider the effect that a full year of public competition would have on the prices of private insurance policies in our state. It's simply human nature that a good thing is only a good thing until one gets accustomed to it - then it's a matter of course, it's an entitlement. When costs first go down everybody will cheer, but after a year, likely few people will think about it until the Republicans start making noise about doing something that could push those costs back up. As stupid as many of our fellow Texans can be, I think even the most avid talk radio devotee will be able to make the connection between higher costs with no public option and lower costs with a public option, whether or not they buy into it. And besides, we all know that while the wingnuts despise public healthcare in theory, they can't get enough of it in practice: does "keep your government hands off my Medicare" ring a bell?
2. Opting out would require a 2/3 vote in the state legislature.
The Texas Senate has 31 seats, and the House 150, so opting out would require 21 votes in the Senate and 99 votes in the House. Now, in the 81st Texas Legislature, the Senate is composed of 19 Republicans and 12 Democrats; the House is more evenly balanced, with 76 Republicans and 74 Democrats. Thus, ceteris paribus, and assuming every Republican votes to opt out, they would need to pick up 2 Senate Dems and 23 House Dems in order to successfully opt us out. The Senate situation seems more precarious: only two conservadems would need to side with the GOP for an opt-out bill to pass the chamber. But the fight in the House would be much tougher. The vast majority of the House Democratic caucus represents populous liberal bastions like the cities proper of Austin, Houston, Dallas, and San Antonio, as well as the broadly blue Rio Grande Valley. These are not exactly swing districts: all of those places went decisively for Obama in 2008. That's not to say there aren't any conservadems in the House - it's just that, compared to what the Republicans would need, there are a lot fewer of them.
And that's only a ceteris paribus scenario: the Republicans could face an even steeper uphill battle in 2014 than they would now. True, Texas is red, but not as red as most people think. In 2008, Barack Obama netted 44% of the vote - since our state last went blue, for Jimmy Carter in 1976, only Bill Clinton has fared better. The voting shift between the last two elections was dramatic: regardless of who won the county, 78 of Texas's 254 counties voted more Republican in 2008 than they did in 2004, 2 by a margin of more than 10%; by contrast, 136 of 254 counties voted more Democratic, 12 by a margin of more than 10%. In other words, Texas is almost twice as blue now as it was five years ago. And with two elections to go before 2014, it's very possible that the Republicans could be forced to fight a Democratic majority in the House if they do try to opt us out. (To that end, if you find yourself with a few extra dollars and the idea of a blue Texas appeals to you, please donate to Texas Majority Builders to help retake the House in 2010.)
So, yes, there's much to be done yet. But the way I see it, momentum is clearly on our side, so barring some unforeseen catastrophe (like, say, Olympia Snowe declaring herself Supreme Empress-for-Life of the Senate), things will continue to work in our favor. And for my fellow Texans, don't fear the opt-out - take a deep breath and relax. 2014 is a ways away, and let's face it: Rick Perry's neck can't support the sheer weight of that hair forever.