In Washington state, which was the first to pass a public option in 2019, enrollment remains paltry, and while the cost of the health insurance plans has decreased, state health officials said the policies available are still too expensive.
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Ashlen Strong, senior director of government affairs at the Washington State Hospital Association, said the new mandate effectively takes away their negotiating power.

“There’s this thought sometimes that hospitals are making money and there’s profit to be had somewhere, and there really isn’t right now,” Strong said. “It’s a really challenging situation and any opportunity where payers are paying less, it just makes it even more challenging. That’s why we’re concerned.”

In Nevada, health officials are set to meet Tuesday to consider reducing legislatively-set premium reduction targets from 20 percent to 16 percent over four years — a decision state officials said is necessary to reflect the recent spike in medical inflation. The state this month released an analysis from the actuarial and consulting firm Milliman that found public option plans, which will be available starting in 2026, will meet that 16 percent target by 2029.

“Obviously we’ve got a long way to go, but I think that’s a great step in the right direction and a great first step,” said state Senate Majority Leader Nicole Cannizzaro, the Democratic lawmaker who introduced the public option legislation in 2021. “Even [16 percent] is something I’m proud of and I think will make a difference.”

The public option, however, is projected to make only a small dent in the state’s uninsured rate — insuring about 8,500 extra people on the individual market by 2029, if the state uses federal dollars saved as a result of the premium reductions to lower the costs of plans, according to the actuarial analysis. Nearly 115,000 people are enrolled in individual market plans, while nearly 300,000 people in the state are uninsured.

The health care industry remains staunchly opposed to the plan. Holly Silvestri, spokesperson for Nevada’s Health Care Future, an arm of the national organization Partnership for America’s Health Care Future, which consists of some of the biggest players in the health care industry, called it “a political solution looking for a problem” and said the group will push to repeal the law “and instead build on and improve what is currently working in our health care system.”

“If we don’t take a step back and slow down, this unproven and risky policy could hurt the very people it intends to help,” Silvestri said.

Gov.-elect Joe Lombardo has not said whether he will prioritize dismantling the new law. A spokesperson for the Republican did not respond to multiple requests for comment.

Cannizzaro said she isn’t interested in “discussion of repeal of something that is the law of Nevada.”

“We’re just hopeful that a governor-elect who ran under the idea that he is going to uphold the law of the state of Nevada is going to do just that with the public option,” Cannizzaro said. “I’ve every confidence that the governor will make sure that he is executing the law. A failure to do so would obviously be a different conversation.”