Health Affairs October 15, 2024
Among the primary goals of the Affordable Care Act (ACA) was to expand access to health coverage and lower health care costs for consumers as well as taxpayers. During the course of the legislative debate over health reform in 2009 and 2010, the “public option”—generally envisioned as a government-administered insurance plan competing against private health insurance plans—was one approach under consideration by certain Members of Congress.
Yet, such a guaranteed nationwide “public option” never came to fruition. Rather, in enacting the ACA, Congress provided a pathway through which states have the flexibility to pursue waivers to expand access to coverage and lower health care costs through various mechanisms, including a public option.
In recent years, a number of states have...
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