The fractious debate over health care reform has mostly been a federal affair.
But if the version favored by the top Democrat in the U.S. Senate becomes law, leaders in the states could play a huge role by choosing to opt out of the so-called "public option."
Senate Majority Leader Harry Reid's proposal includes a way for states to opt out of the publicly funded health insurance plan, which Reid calls a "community health insurance option." Reid's bill could come up for a vote in the Senate as early as Saturday. In the version released late Wednesday, in 2013 or 2014, states could opt out by passing legislation that could be signed into law by the governor.
But an opt-out for states is a long way from becoming reality and might be useless in any case, with states unlikely to opt out if they are still required to help foot the bill. Not only must the overall public option pass the Senate -- no sure thing since even conservative Democrats have expressed doubts. But it must also be reconciled with a House bill that does not include a way for states to decline the public option.
But, if Reid's plan eventually becomes law, the next governor of Georgia would have great power to influence the outcome of the legislation and then ultimately decide whether to sign it into law if it reaches his or her desk. That prompted the Atlanta Journal-Constitution to ask the men and women who hope to succeed Sonny Perdue as governor in 2011 about their overall thoughts on the health care reform debate and what they would do if the state opt-out opportunity fell to them.
Not surprisingly, there is near unanimity among Republicans: They'd opt-out, and fast, and the entire exercise is a "boondoggle," as Republican Karen Handel, the current secretary of state, put it. Only state Rep. Austin Scott (R-Tifton) added he would study the bill's effects before deciding, "just to make sure we understand the consequences prior to the signing of any legislation."
But among Democrats, the theme was caution. Of the four major candidates for the Democratic nomination, only former Adjutant Gen. David Poythress said he would not sign a bill that eliminated the public option in Georgia. The other three either couldn't be reached for comment Thursday or said they wanedt to see the final bill before deciding.
The disparity between Republicans and Democrats on the issue is not surprising, said Audrey Haynes, a professor of political science at the University of Georgia.
"I would have predicted that exact same thing," Haynes said.
One reason, she said, is that there is uncertainty about what the final bill would look like. Another is that the forces lined up in opposition to the Democrats' plan have something of an easier time expressing their opposition.
"The anti-health care reform message is one that's easier to get out," she said.
That message can be summed up in the response from the campaign of former state Sen. Eric Johnson, a Republican candidate for governor.
"Eric is firmly opposed to a government takeover of health care," Johnson spokesman Ben Fry said.
Or this, from Republican candidate John Oxendine, the state's insurance commissioner: "Despite the nice-sounding name of the current liberal plan, it is nothing more than a shell game that would harm patients, doctors, nurses -- essentially the entire health care workforce. ... The current plan is not reform, it's socialism."
It's a clear message: A government-run alternative to private health care insurance will lead to a full government takeover of health insurance and that government-run health insurance is "socialism".
On the other side, those who support the Democrats' plan point out that the public option would create a government-sponsored alternative to compete with the private sector, and that's a more difficult message to get voters to accept.
Among Democratic gubernatorial candidates, responses were almost universal on the wait-and-see theme.
"It's hard to come to any decisions on health care at the moment, because the content of the legislation seems to change every 30 minutes or so," said former Gov. Roy Barnes.
Barnes said, however, that he believes everyone can agree health insurance is too expensive and insurance companies should not be able to cancel policies when a customer becomes sick or deny coverage for pre-exisiting conditions.
"But, I will withhold judgment until we have a clear picture of what is proposed."
Attorney General Thurbert Baker, another Democrat in the race, said it would "irresponsible" to rule out a reform plan that delivers affordable insurance "or to embrace a plan that will impose additional costs."
"I will wait for Washington to decide on this issue before making any commitments of my own," Baker said.
Gubernatorial hopeful DuBose Porter, the Democratic leader in the state House, addressed a potential state opt-out by laying out a series of questions he would use if faced with that decision: "Will it bring more jobs to Georgia? Will it help our economy grow? Will it enhance the lives of Georgians?"
Porter said another factor to consider is whether Georgians would pay for the government-sponsored insurance through federal taxes even if Georgia opts out. "That would change everything," Porter said.
Porter raises an important point. This facet of the debate in many ways mirrors that of the fight over the federal stimulus bill early this year. The stimulus delivered billions of dollars to Georgia in direct aid to the government and while many top Republicans here lambasted the proposal, they accepted the money knowing that if they turned it down it would only go to another state and Georgia taxpayers would still foot a share of the bill.
Still, the political dangers for Democrats are clear. In an early November poll of residents of 11 Southern states, including Georgia, researchers at Winthrop University in Rock Hill, S.C., found opinions on the general health care debate split by party identification. The poll of 866 residents age 18 and older has a margin of error of 3.3 percent. While results specific to Georgia were not broken out, the poll is a useful litmus of regional opinions.
Overall, 42 percent of respondents across the South said they would advise their member of Congress to vote against the health care reform bill before Congress, with 32 percent saying they'd advise their representative to vote in favor.
But among Democrats, 56 percent wanted their members of Congress to vote in favor, compared to 13 percent against
Independent voters, however, who are crucial for Democrats in statewide races in Republican-leaning states, more closely represented the overall responses: 32 in favor, 44 percent against.
Republicans are overwhelmingly opposed, 76 percent saying it should fail and 9 percent saying it should pass.
Some Democratic voters and activists in Georgia share the Democratic candidates' concern. Sid Cottingham, an attorney and Democrat in the south Georgia town of Douglas, calls health care "a freight train on the loose, and if we don't (pass reform) none of us are going to be able to afford it."
Cottingham, who publishes a political blog called "Cracker Squire," said the costs of the Democrats plan -- estimated between $900 billion and $1.2 trillion over 10 years -- might be too high coming on the heels of bailouts of Wall Street and automakers and the $800 billion federal stimulus plan.
"Bad facts make bad law and the timing has been bad for Obama," Cottingham said. "If there was ever a time for restraint ..."