Western states' public options gaining steam

Interesting tidbit in article today about Colorado's Affordable Care Act marketplace today:

Individual health insurance rates in Colorado could see below-average increase in 2025

The second major Polis administration program is the Colorado Option, which created a state-designed insurance plan that private insurers are required to sell. To keep prices of the Colorado Option low, state law gives Conway a limited ability to dictate hospital contract prices with insurers if the insurers’ Colorado Option premiums don’t meet certain targets.

Conway has never used that authority, but he said that’s because hospitals and insurers are negotiating lower prices on their own.

“We’re bending the cost curve with the Colorado Option,” Conway said.

About a third of insurance plans purchased for this year through the state’s insurance exchange were Colorado Option plans, up significantly from the 13% for 2023, the program’s first year.

Conway said the Colorado Option’s proposed lower-than-average rate increases for 2025 are a testament to its success. Non-Colorado Option plans look set for a 6.2% increase.

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Right now, the U.S. has two public options: the Colorado Option and Washington's Cascade Select plans (Nevada should have one kicking off in 2026, though their GOP governor perhaps complicates the implementation). The former launched last year, so we've only got two years of information to go on so far. Washington's launched in 2021 and was a bit underwhelming at first due to its miniscule enrollment.

But premiums for Colorado's public option went from ~2% below non-public option plans last year to ~10% below this year (a gap that will grow next year), and over the past two years Washington's public option premiums have been 30%+ below non-standardized non-public options. At the same time the geographical presence of each plan has been steadily growing. And enrollment has been commensurately growing for each, to the point that public option enrollment is a significant sliver of the marketplaces already:

Public Option Enrollment as a Percentage of Total Marketplace Enrollment

A good reminder that a couple of years of data is usually needed to get a sense of how something is going. And it looks like these public options have some legs.

Resurrecting this old thread because the Century Foundation has an interesting piece on this topic this week, with 2025 numbers and some spiffy graphics. In brief, lower premiums than the competition (in many cases) have led to continued expansion, with the surge in public option uptake continuing this year.

How to Create a Public Health Insurance Plan: Lessons from States

In the first two years Cascade Select plans were available, Washington lacked a requirement for providers to contract with the public option plans,19 Along with a system that automatically re-enrolled marketplace enrollees into their existing plan, this resulted in only 1 percent of enrollees choosing a Cascade Select plan in its first year.20 The problem of limited availability persisted in 2022; Cascade Select plans were available in only twenty-four counties. Despite their limited availability statewide in this year, Cascade Select plans’ premiums decreased by 5 percent and were the lowest premiums for Silver plans in thirteen counties.

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In response to this challenge, Washington lawmakers passed new legislation nicknamed “Cascade Care 2.0” requiring that hospitals contract with at least one public option plan by 2023.21 Since this change, the public option has performed significantly better, with plans offered in more counties in each subsequent year with slower premium growth than in other plans. In 2025, Cascade Select plans are available in every county in the state for the first time (see Map 1) and have the lowest premium of all Silver plans in twenty-six counties.22 As a result of this improved availability and lower premiums, enrollment has increased, as shown in Figure 1, below.

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The corresponding increase in the percent of buyers choosing it:

The Colorado Option had a stronger start than Cascade Select, with 27,965 people (around 14 percent of the state’s marketplace enrollment) choosing a Colorado Option plan in 2023.40 In 2024, enrollment increased to 80,655 people, more than one-third of the state’s marketplace, and in 2025, enrollment increased to 132,791 people, which is just under half of all marketplace enrollment in Colorado.41 Figure 2 shows this enrollment growth.

One analysis found that the Colorado Option was associated with $100 in monthly savings in premiums for the lowest- and second-lowest-cost Silver plan relative to comparison states.42

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Almost half of Colorado marketplace shoppers choosing the public option is really something.

Greenbeard said:

Resurrecting this old thread because the Century Foundation has an interesting piece on this topic this week, with 2025 numbers and some spiffy graphics. In brief, lower premiums than the competition (in many cases) have led to continued expansion, with the surge in public option uptake continuing this year.

How to Create a Public Health Insurance Plan: Lessons from States



The corresponding increase in the percent of buyers choosing it:





Almost half of Colorado marketplace shoppers choosing the public option is really something.

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I like the public option. It gives people a choice between private and public financing of their healthcare.

Phys251 said:

I like the public option. It gives people a choice between private and public financing of their healthcare.

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Buyers seem to be voting with their feet/wallets. After a slow start, the public option plans are really starting to take off.