State public options: comparing models from across the country
- Collection:
- Health Policy and Services Research
- Series Title(s):
- Issue brief (California HealthCare Foundation)
- Author(s):
- Ellis, Kyla M., author Ario, Joel S., author Mann, Cindy, author Morgan, Virginia E., author
- Contributor(s):
- California HealthCare Foundation, issuing body.
- Publication:
- [Oakland, CA] : California Health Care Foundation, March 2021
- Language(s):
- English
- Format:
- Text
- Subject(s):
- State Health Plans California United States
- Genre(s):
- Technical Report
- Abstract:
- States face a wide variety of challenges in their health care markets, starting with the fact that after hitting a historic low in 2016, uninsured rates are beginning to grow again — 8% of Americans, or 26.1 million, were uninsured in 2019 — and communities of color are still more likely to be uninsured compared with White people. Other challenges include escalating premiums and even faster growing out-of-pocket costs, wide variations in provider pricing, and less competition in rural areas contributing to high costs. While the full impact of the COVID-19 pandemic on coverage remains unknown, the prepandemic growth in the uninsured rate, as well as the pandemic and associated recession, highlight the need for additional actions to ensure access to affordable health care coverage. Establishing a federal public option has been identified by some as a way to address some of these challenges. During the campaign, President Joe Biden proposed a federal public option, based on the Medicare program, which would require congressional enactment. Given the Democrats’ narrow control of the Senate (50-50 with Vice President Kamala Harris providing the tie-breaking 51st vote), federal enactment of a public option is dependent on eliminating the filibuster or proceeding through budget reconciliation. There are multiple ways to structure a federal public option, many of which would be challenging, but not necessarily impossible, to do under reconciliation. Given this landscape, the design and passage of a federal public option would take time and political will. Further, if passed, a federal public option could take years to implement. Many states are not waiting for federal action. Nearly a dozen states are exploring the concept of a state-based public option or are actively pursuing some version of this approach through legislation. Driven by state-specific policy goals and coverage and by insurance market dynamics, these initiatives are diverse — including private-public partnerships with existing insurance carriers, allowing residents to buy into an existing government program such as Medicaid or the state employee health plan (SEHP), and other arrangements. This issue brief outlines some of the problems states are seeking to address with their public option proposals, reports the proposals’ current status, categorizes the public option proposals into archetypes, and identifies important issues for California policymakers to consider as they explore the use of a state-based public option.
- Copyright:
- Reproduced with permission of the copyright holder. Further use of the material is subject to CC BY-NC-ND license. (More information)
- Extent:
- 1 online resource (1 PDF file (13 pages)).
- NLM Unique ID:
- 9918366888006676 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/9918366888006676