In midst of national ‘Medicare for All’ debate, one state takes own action

Joanne Kenen

About Joanne Kenen

Joanne Kenen, (@JoanneKenen) the health editor at Politico, is AHCJ’s topic leader on health reform and curates related material at She welcomes questions and suggestions on health reform resources and tip sheets at Follow her on Facebook.

Photo: Stuart Moulder via Flickr

Washington has become the first state to move ahead with a version of a public option – an element of the markets that was part of the original 2009 Affordable Care Act legislation but didn’t survive the U.S. Senate.

The idea was to have one government-run health plan within the exchange to enhance competition with private insurers and keep down costs.

Many Democrats are talking about reviving some form of a public option – including a Medicare or Medicaid buy-in – as a way of building on the ACA to expand coverage without moving (or moving too quickly) into a single-payer “Medicare for All” model. Since that can’t happen with the current political configuration in Washington, D.C., some Democrat-led states have been talking about setting up something on their own. Washington so far is the only one that has embarked on such a plan.

Connecticut also considered a public option this year, but the legislation failed — perhaps not surprising in a state that is headquarters to many private insurers that strongly oppose a nonprofit government-sanctioned competitor. Colorado is studying a public option and expects recommendations in November for a program beginning in 2021. A few other states have looked at adding a Medicaid buy-in – a variant of a public option – but those efforts either have been rejected or postponed.

Under Washington Gov. Jay Inslee – a Democratic presidential candidate running for his party’s nomination on a very climate-changed focused platform but who also is very engaged on health care costs and coverage – Washington is proceeding with “Cascade Care,” a public option variant projected to be available by 2021. It won’t be a fully state-operated plan or buy-in to Medicaid or Medicare. Instead, the Washington State Health Care Authority will contract with private insurers to offer standardized health plans that are supposed to be cheaper and simpler for customers.

The state also is planning to subsidize (in the public option or private insurance plans in the exchanges) ACA customers whose incomes are up to 500% of the federal poverty level, instead of the 400% specified in the ACA. State officials have not yet worked out the funding.

There still are questions about how “Cascade Care” will work, its cost, what will be covered and whether it can build an adequate provider network. The state did specify that primary care providers must be paid at least 135% of Medicare rates but not more than 160% of those rates (drug benefits aren’t tied to the spending caps).

But Inslee is confident.

“Under the Obama administration and the Affordable Care Act, Washington was able to make tremendous progress in expanding coverage and start bringing down costs in our health care system,” he said when the bill was introduced early this year. “Under the Trump administration, all that progress is at risk. Because of the instability they’ve brought to the system, consumers in 14 counties have only one option for coverage, and our ability to rein in costs has been stymied.

“But we’re going to do all we can to protect health care for Washingtonians,” he added. “This public option will ensure consumers in every part of the state will have an option for high-quality, affordable coverage.”

1 thought on “In midst of national ‘Medicare for All’ debate, one state takes own action

  1. Roxanne Nelson

    I live in WA state and this article caught my eye. But then, of course, there is really nothing innovative about this plan. Contracting with private insurers–same old same old, under the guise of a catchy term “Cascade care.” Private insurers are for profit corporations, they answer to their stakeholders and not patients. Having a government contract won’t change that, and it will be the same old song under a new name. Maybe a drop cheaper, but still dramatically overpriced, as insurers need to turn a profit.

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