In the ten years since the passage of the Affordable Care Act (ACA), 18 million Americans have gained access to health insurance. In 2019, however, more than 26 million Americans remained uninsured—and people who are Black, indigenous or people of color (BIPOC) are still more likely to be uninsured compared to white Americans. Coverage affordability remains a significant concern and barrier to access for both insured and uninsured people in the United States.

The 2020 election and transition to a new federal administration marked a pivotal point for state policymakers with an interest in the public option. At the federal level, President Biden’s health reform platform included support for a federal public option based on the Medicare program and offered on the ACA Marketplaces. At the state level, Washington implemented the nation’s first public option for the 2021 plan year, and in the first six months of 2021, a number of states made significant progress in advancing public option proposals, including Colorado, Nevada and Oregon.

In an “Expert Perspective” prepared for the Robert Wood Johnson Foundation’s State Health and Value Strategies program, Manatt Health provides a mid-year update on the public option at the state and federal level, and envisions how states may use Section 1332 innovation waivers to partner with the new federal administration moving forward.

Click here to download the full “Expert Perspective.”