State Insurance Reforms and the Trade-Offs of a Public Option

June 25, 2020

Ten years after the passage of the Affordable Care Act (ACA), the cost of health care continues to rise faster than wages, and millions of Americans are uninsured or underinsured—a toxic combination during a global pandemic.


While further action on the Hill has stalled, several state legislatures have sought to go beyond the ACA by exploring and enacting a diverse array of public option proposals.

In State Insurance Reforms and the Trade-Offs of a Public Option, Roosevelt Fellow Naomi Zewde and Lafayette College’s Adam Biener analyze these state-level efforts and the policy trade-offs they face. They find that:

  • There are a number of distinct public option proposals;
  • Public options must balance consumer affordability against market stability;
  • Public options can meaningfully lower health care costs for non-group enrollees;
  • Many consumers are poised to switch to public option plans; and
  • Public options may apply further strain to the health care safety net to achieve greater affordability.