Abstract
Policy Points States are enacting a host of policy initiatives designed to reduce the number of Americans without health insurance. Policymakers and policy analysts need to examine whether this "laboratory of federalism" is producing ideas that can and should be replicated on a national scale. This article evaluates reform efforts in two states: Washington state, which enacted what its policymakers call a "public option" and New Mexico, which failed in its effort to enact a Medicaid buy-in. Some common themes emerge. First, without federal funding, state efforts to aid the uninsured remain limited. Second, the gap between commercial and public insurance reimbursement rates poses an additional significant obstacle. Washington state was able to overcome these obstacles by enacting a law (called Cascade Care) which imposes public sector reimbursement rates in a commercial insurance market (the state's ACA Marketplace). This quasi- or redefined public option could become a politically viable model for federal policymakers.