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Lawmakers in 11 states have already introduced measures aimed at blocking other elements of the federal health legislation, like mandates that individuals have insurance and that most employers provide it, according to the National Conference of State Legislatures.

‘Opt-Out’ Proposal Puts State Leaders to the Test
By KEVIN SACK

ATLANTA — In the two weeks since the Senate majority leader, Harry Reid, embraced a proposal that would allow states to opt out of a new government health insurance plan, state leaders have begun debating whether to participate, and the question has emerged as a litmus test in a number of campaigns for governor.

The proposal, which is being woven into the Senate’s health care legislation, would shift some power over restructuring health care to the states and would foist upon state leaders the burden of a choice that, in some instances, could pit principle and politics against pragmatism. States would only be given the right to opt out of the public plan, not from the tax increases needed to subsidize coverage for the uninsured.

The bill that passed the House of Representatives on Saturday night includes a nationwide public plan without an opt-out provision, a difference that would be settled by a conference committee.

Several state officials said that if Mr. Reid’s proposal carries the day, many governors are very likely to accept the new plan rather than incite a bloody ideological battle mirroring the current health care fight in Congress.

Governors have other deep-seated concerns about the health care legislation, particularly whether states will be left holding the bag for a vast expansion of Medicaid. But many see little to gain from denying constituents an insurance option that could help slow the growth of premiums at no immediate cost to the state.

“If there’s something out there that might be beneficial to states, I expect states would likely opt in,” said Gov. Jim Douglas, Republican of Vermont, the chairman of the National Governors Association. “I mean what’s the harm, they likely will conclude, it’s only an option.”