Just in time for the debate over the merits of a state-by-state "opt out" of a national public health insurance option, the Commonwealth Fund has released its 2009 state health care scorecard. As in 2007, the data reveals the critical condition of red state health care. All of which could present Republican governors and legislatures with a dilemma: will they refuse to offer lower cost insurance coverage for their residents by rejecting a system funded in part by blue state taxpayers?

Given the contentious ongoing debate in the Senate, crystal ball-gazing for any public option, whether national, opt-in or opt-out is premature. But the Commonwealth Fund's analysis of health care indicators shows the stakes for its red state opponents. While nine of the top 10 performing states voted for Barack Obama in 2008, four of the bottom five (including Arkansas, Mississippi, Oklahoma and Louisiana) and 14 of the last 20 backed John McCain. (That at least is an improvement from the 2007 data, in which all 10 cellar dwellers had voted for George W. Bush three years earlier.)

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