Since 2010, 23 states have introduced a total of 49 bills to create a public health plan option within their respective marketplaces, according to a report from the Harvard Journal on Legislation.
The report was published in March and analyzed all public option bills introduced in state legislatures from 2010-21 and identified three proposed models: Medicaid buy-in, Marketplace-based and comprehensive.
The report defines a state-sponsored public option as "a state-initiated health insurance plan that is offered to a significant share of the private health insurance market — the individual, small group or large group market — and pays publicly determined rates."
To date, three states have successfully passed and have or will enact a public option: Washington began offering coverage in 2021, Colorado will begin in 2023 and Nevada in 2026.
Proposed Medicaid buy-in plans:
- Connecticut: 2018
- Georgia: 2020 and 2021
- Indiana: 2019
- Iowa: 2018
- Massachusetts: 2017 and 2019
- Minnesota: 2015
- Nevada: 2017 and 2021
- New Mexico: 2019
- Oklahoma: 2021
- Oregon: 2019
- South Carolina: 2021
- Tennessee: 2021
- Texas: 2019 and twice in 2021
- Wisconsin: 2017
- West Virginia: 2020 and 2021
- Wyoming: 2018
Proposed marketplace-based plans:
- Colorado: 2020 and 2021
- Connecticut: 2019, 2020 and 2021
- Illinois: 2014
- Massachusetts: 2011, 2013, 2015, twice in 2017, 2019 and 2021
- Minnesota: 2019
- Nevada: 2021
- New Jersey: 2020
- Vermont: 2011, 2015 and 2017
- Virginia: 2020
- Washington: 2017 and 2019
Proposed comprehensive plans:
- Massachusetts: 2011, 2013, 2015, 2017 and 2019
- Michigan: 2018
- New Jersey: 2016, 2018, 2020 and 2021
- Vermont: 2011, 2015 and 2017
- Washington: twice in 2019