That gives you an essentially national administrative structure, but also gives states the right to reject the option entirely. It means, in other words, that the blue states get the public option at full strength and the red states get to ignore it entirely.
This is a terrible idea. First, there are not "blue states" and "red states." States are populated with actual people with actual healthcare needs and creating a system whereby one state's wingnut governor can deprive his citizens of the public plan is bullshit. Plain and simple.
To put this in terms that maybe Ezra can understand and relate to, what happens if a Republican governor of California opts out? There are over 6 million uninsured in California right now, are they less deserving of a public option than the uninsured in Washington or Oregon? What about when Rick Perry opts Texas out? There are 5.5 million uninsured there.
If there is a right to access to healthcare then that right exists no matter who your governor is or who the head of your state legislature is or, frankly, no matter what a majority of the citizens of your state prefer.
I strenuously object to establishing a system whereby a citizens access to various benefits and rights are not enjoyed generally but rather depend on the specific circumstances of the individual's residency. This compromise would ghettoize our nation's healthcare system.