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State Public Health Insurance Options: A Comparison

Published On September 17, 2021

Access to affordable, quality health care is a necessary, yet unmet, component of keeping our nation healthy. The pandemic has illuminated the severe flaws in our current health care system, where health inequities abound, needs are unmet, and health insurance is not always attainable. As millions lost their jobs during the COVID-19 pandemic, their health insurance and sense of security in the face of a public health emergency were lost as well. People believe affordable health care should be a top priority of their elected officials. 

Public health insurance options have emerged to fill the gaps that leave people without access to affordable healthcare. A public health insurance option provides an affordable and dependable, government-regulated health insurance plan that is often privately run. By increasing competition within the market, public health insurance options can lead to more affordable options for consumers. With an eye on health equity, these plans can reduce disparities by improving network adequacy standards, engaging diverse voices, providing additional subsidies for those in need, and expanding access to safety net and rural providers. 

State Public Health Insurance Options: A Comparison

States have been leading the way: Washington, Nevada, and Colorado have each passed a version of a public health insurance option. United States of Care was a foundational partner in the effort in both Nevada and Colorado. Momentum in these states has led state policymakers in other states to look into how a public health insurance option could work for their constituents as well. Although it did not pass, Connecticut, too, put forth a robust public health insurance option, most recently during the 2021 legislative session. Oregon passed legislation directing state agencies to construct a plan for implementing a public health insurance option, setting the stage for passage of an eventual public option.

This state progress is building momentum for creating a public option at the federal level. Senator Patty Murray of Washington and Congressman Frank Pallone, Jr. of New Jersey issued a Request for Information (RFI) in May 2021 to inform their efforts to build out a public health insurance option at the federal level. United States of Care submitted recommendations informed by our expertise gained through groundbreaking state efforts for affordable and dependable health care. Our suggestions center on people’s needs and the lessons we’ve learned to pass public options and other major affordability laws in states, and aims to build a better system in the wake of the pandemic — one where people have more certainty that they can afford their care.

Commonalities among state public options include leveraging state buying power to encourage participation, establishing provider rates, working within existing markets, addressing equity, and seeking pass-through funds from the federal government with 1332 waivers. The table below details the common themes and differences between state-level public health insurance option bills.