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Redefining the “Public Option”: Lessons from Washington State and New Mexico
Author(s) -
SPARER MICHAEL
Publication year - 2020
Publication title -
the milbank quarterly
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.563
H-Index - 101
eISSN - 1468-0009
pISSN - 0887-378X
DOI - 10.1111/1468-0009.12454
Subject(s) - medicaid , state (computer science) , public administration , federalism , reimbursement , public policy , obstacle , business , political science , health care , economics , public economics , economic growth , law , politics , algorithm , computer science
Policy Points States are enacting a host of policy initiatives designed to reduce the number of Americans without health insurance. Policymakers and policy analysts need to examine whether this “laboratory of federalism” is producing ideas that can and should be replicated on a national scale. This article evaluates reform efforts in two states: Washington state, which enacted what its policymakers call a “public option” and New Mexico, which failed in its effort to enact a Medicaid buy‐in. Some common themes emerge. First, without federal funding, state efforts to aid the uninsured remain limited. Second, the gap between commercial and public insurance reimbursement rates poses an additional significant obstacle. Washington state was able to overcome these obstacles by enacting a law (called Cascade Care) which imposes public sector reimbursement rates in a commercial insurance market (the state's ACA Marketplace). This quasi‐ or redefined public option could become a politically viable model for federal policymakers.