Access to Care and the Public Option

Access to Care and the Public Option

Enrolling might be optional, but no one will be able to opt-out of the Public Option consequences

At A Healthy Future, we believe that healthcare decisions should be made by patients and their doctor, not bureaucrats and that includes coverage.

As the national debate on new government-run insurance systems like “Medicare for All,” Medicare buy-in and the Public Option continues, Governors across the country are racing to create a name for themselves with aggressive healthcare agendas and patients could pay the price.

A Public Option, meaning adding a new government-run health insurance option into the marketplace, could have a significant effect on rural hospital closures across the country, according to a new analysis. The Navigant Consulting analysis found that a  public option could put up to 55 percent of U.S. rural hospitals, or 1,037 hospitals in 46 states, at “high risk of closure.”

Half a dozen states are looking into creating a government-run “public option” insurance system — either as a stand-alone plan, buy-in to Medicare or Medicaid or statewide co-op.

It’s an idea Congress considered but then discarded while writing the Affordable Care Act in 2010, but is increasingly touted by some politicians as a way to achieve Medicare for All.

Even though enrollment in a new ‘Public Option’ government-run insurance system would be optional to start, it could significantly impact every single patient.



Washington state formally approved a public option in May, becoming the first state to test the policy. But the state’s work on executing the public option has just begun, and state officials still need to finalize a plan to make the public option affordable enough to attract new customers, while ensuring enough hospitals and doctors will join its network.

The public option won’t be available until January 2021, and it’s too early to know what exact coverage they will offer or how much it will impact health insurance costs.

Washington state’s experience with the public option could influence how other efforts take shape around the country in the years ahead.



In spite of the fact that 79 percent of Colorado voters rejected a ballot measure to enact a state-based public option just three years ago, the Colorado legislature passed a bill directing state agencies to study and develop a public option plan for the Legislature’s consideration next January, to launch in 2021.

Colorado Gov. Jared Polis is also moving forward with another public option approach, proposing recreating a state-wide purchasing co-op.

New Mexico

New Mexico has formed a working group and set aside $140,000 to examine the idea after abandoning an original proposal to create a Medicaid buy-in.

Other states eyeing a Medicaid buy-in or public plan include Connecticut, Delaware, Illinois, Massachusetts, Minnesota and Oregon.


The Connecticut House passed a public option bill this spring, although it later stalled in the Senate.

Connecticut lawmakers have since changed their strategy for 2020.



The Nevada legislature passed a public option bill two years ago, but it was vetoed by Gov. Brian Sandoval.

Additionally, public option bills have been proposed in Maine, Massachusetts, Minnesota, Missouri, New Hampshire, New Jersey and Oregon.