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Key Findings

1. The Washington State Legislature passed a public option bill this past session. This is the first such program in the nation and may serve as a policy template for other left-leaning states or for the federal government.
2. In the broadest sense, a public option is any government, taxpayer-funded health insurance plan that public officials use to compete with private plans. More specifically, the current terminology refers to a government plan that is available in the health insurance exchanges which were created in the Affordable Care Act (ACA).
3. The ACA exchanges are currently in a financial death spiral because of adverse selection.
4. The Washington state public option is very robust in that the premium supports are more generous than the ACA and government officials have more oversight control.
5. The appointed members of the exchange board, along with the insurance commissioner, can decide whether to ban private coverage and allow only the public option in the exchange starting in 2025.
6. The state insurance commissioner will decide what treatments and procedures are included in the public option and whether or not doctors are providing “quality care.”
7. Although a public option is ostensibly designed for people who already use the exchange to find coverage, it is likely that individuals outside the exchange, those in the group market and those in the employer market, will find the public option attractive, simply to get the taxpayer-subsidy support.
8. A public option not only lets state officials compete against their own citizens and businesses, it is an incremental move toward a broader government-controlled, single-payer health care delivery system.

Introduction

Activists on the political left continue to push the U.S. health care delivery system toward a single-payer, government-controlled plan. Many Americans are now debating whether the government should impose a complete nationalized program, or adopt an incremental approach toward socialized medicine. Alternatives such as a Medicare or Medicaid buy-in, lowering the age of eligibility for Medicare, increasing the income threshold for enrollment in Medicaid, and ultimately imposing “Medicare for All” are now being actively discussed.

Creating a “public option” is another incremental move toward a single-payer health care system. The Washington State Legislature passed a public option bill this past session. This is the first such program in the nation and may serve as a policy template for other left-leaning states or for the federal government. This Policy Note describes what a public option is, provides a historic perspective of the plan, and examines the potential ramifications of these new programs for the people of both Washington state and the nation.

Download the full Policy Note