Harry Reid says the Senate version will have the opt-out.  Half way there.  I'm guessing the House will go along, reluctantly.

WASHINGTON, Oct 26 (Reuters) - Democratic leader Harry Reid said on Monday the U.S. Senate's healthcare overhaul will include a government-run insurance plan that lets states opt out, handing liberals an early victory on the bill's most contentious issue. ...Reid's compromise decision was praised by many fellow Democrats but condemned by Republicans and the health insurance industry, whose stock prices fell out of apparent concern about the prospect of competition from the government-run plan.  link

(Health insurance stocks drop on the news of competition -- imagine that! )

You know, the only states that will want to opt out are the red states, and who cares if they do?  Just us bleeding heart liberals.  I don't see the Repubs gaining any votes at the state level if they opt out.  Probably, they'd lose a bundle.  And people would think twice about moving to such a state (no doubt, that's what GOPers want), especially if are covered by the public option.