I don't think the feds will be able to allow states to opt out; it will lead inevitably to a series of events until all of the states without a problem will bail out, leaving only states with health insurance problems in the program. and that will result in a poor pool of insureds, and that's the exact opposite of what you are looking for when it comes to insurance.
the opt-out mechanism hasn't been defined yet. will the states be "in" unless they "opt-out", or will it be the other way around?
Some states already poised to opt out of government-run public health planAt least 11 states intend to forge ahead in the coming months with bills and ballot questions designed to block some of the healthcare reforms Democrats are trying to pass this year.
Their efforts could be a harbinger of trouble for the staple feature of Senate Majority Leader Harry Reid's (D-Nev.) newly unveiled healthcare plan: a public option that allows states the ability not to participate.
Starting as early as this summer, state lawmakers began introducing bills that would shield their citizens from individual or employer mandates, among other key reforms in Democrats' healthcare proposals, according to the National Council of State Legislatures.
Movement on those issues is not likely for a few more months, as most state legislatures are not in session. Some state constitutions also require ballot measures in order to approve changes of that magnitude, further delaying any local action on the healthcare front.
However, these legislatures' early moves still offer crucial hints about how many states would similarly exempt themselves from the public option, should the Senate bill's “opt out” clause remain intact.
Already, the Congressional Budget Office estimates about one-third of states would back out of the system, limiting the public option insurance pool to about 3 or 4 million Americans. That would make the public plan's enrollment about 1 million smaller than the House's version of the program, according to a cost analysis of the Senate proposal.
More