States that have proposed public option health plans

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:

  1. Connecticut: 2018
  2. Georgia: 2020 and 2021
  3. Indiana: 2019
  4. Iowa: 2018
  5. Massachusetts: 2017 and 2019
  6. Minnesota: 2015
  7. Nevada: 2017 and 2021
  8. New Mexico: 2019
  9. Oklahoma: 2021
  10. Oregon: 2019
  11. South Carolina: 2021
  12. Tennessee: 2021
  13. Texas: 2019 and twice in 2021
  14. Wisconsin: 2017
  15. West Virginia: 2020 and 2021
  16. Wyoming: 2018

Proposed marketplace-based plans:

  1. Colorado: 2020 and 2021
  2. Connecticut: 2019, 2020 and 2021
  3. Illinois: 2014
  4. Massachusetts: 2011, 2013, 2015, twice in 2017, 2019 and 2021
  5. Minnesota: 2019
  6. Nevada: 2021
  7. New Jersey: 2020
  8. Vermont: 2011, 2015 and 2017
  9. Virginia: 2020
  10. Washington: 2017 and 2019

Proposed comprehensive plans:

  1. Massachusetts: 2011, 2013, 2015, 2017 and 2019
  2. Michigan: 2018
  3. New Jersey: 2016, 2018, 2020 and 2021
  4. Vermont: 2011, 2015 and 2017
  5. Washington: twice in 2019

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