State Efforts

State Efforts

State policymakers continue to experiment and lead the way on public option proposals. To date, several states have enacted public option laws and others are actively studying and debating different proposals. 

Nevada State Legislature building entrance in Carson City

States Advance Public Option-Style Laws 

Three states — Washington, Nevada, and Colorado — have adopted public option-style laws. These laws vary in scope but reflect some similarities, such as relying on partnering with private health insurers to administer and finance the public option plans. CHIR experts have compared these recent laws and provided updates on their implementation for The Commonwealth Fund. Further discussions of these state laws are available in our State Resources.

Featured Resource: Participation, Pricing, and Enrollment in a Health Insurance “Public Option”: Evidence From Washington State’s Cascade Care Program

Aditi Sen and coauthors analyze public option plan participation, pricing, and enrollment from Washington State during the first year the state’s public option law was in effect. The authors discuss challenges that arose from allowing voluntary participation of both insurers and health care providers, while noting that the public option plans introducef a lower-premium choice into a handful of smaller counties that had less competitive markets and higher health care costs. They then highlight lessons that state and federal policymakers can draw from Washington’s experience.

Featured Resource: States Must Prioritize Health Equity as They Expand Coverage through Public Options

In this 2022 report, The Century Foundation highlights how states can and should advance health equity through the implementation of public option programs. Findings from the report informed the development of a Health Coverage Equity Framework that policymakers and other stakeholders can use to measure progress in advancing health equity.

Featured Resource: The Clearest Road to an ACA Public Option Runs Through the States

In a blog post for Health Affairs Forefront, Robert Field argues that public option plans should be advanced at the state level, with regulatory and operational support from the federal government.


Support for State Policymakers

Our experts are here to help policymakers consider and understand public option proposals. We work closely with state leaders and staff to provide legal and policy technical assistance and help identify policies that promote affordability and contain costs. Learn more about how we can help support your policy goals.

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