States as Policy Laboratories: The Politics of State-Based Single-Payer Proposals

Although the focus for most single-payer advocates is in Washington, DC, and on proposals for Medicare for all, there are also efforts in a handful of states to enact a state-based single-payer program. Moreover, the odds of legislative passage are better in a state like New York than at the federal...

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Bibliographic Details
Published in:American journal of public health (1971) 2019-11, Vol.109 (11), p.1511-1514
Main Author: Sparer, Michael S
Format: Article
Language:English
Subjects:
Activation
AJPH Financing Health Care
Beneficiaries
Congressional committees
Cost control
Employee Retirement Income Security Act - legislation & jurisprudence
ERISA
Federal employees
Government programs
Health care policy
Health Financing
Health insurance
Health Law
Health Policy
Health Reform
Humans
Insurance coverage
Insurance industry
Laboratories
Legislation
Medicaid
Medicare
Political parties
Politics
Proposals
Public health
Referendums
Reimbursement
Retirement
Retirement income
Security
Single-Payer System - legislation & jurisprudence
Single-Payer System - organization & administration
State Government
State programs
Uninsured people
United States
Voters
Waivers
Citations: Items that this one cites
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Summary:Although the focus for most single-payer advocates is in Washington, DC, and on proposals for Medicare for all, there are also efforts in a handful of states to enact a state-based single-payer program. Moreover, the odds of legislative passage are better in a state like New York than at the federal level.Even if enacted, however, state-based single-payer proposals face a distinct set of obstacles, including (1) the need to obtain federal permission (via waivers) to repurpose federal dollars, (2) the federal Employee Retirement Income and Security Act, and (3) the burden of state-only action in an interconnected 50-state economy.The most likely result of the energized single-payer movement will be incremental public insurance expansions at the federal and state levels, including state programs to permit the uninsured to buy into the Medicaid program. Such an outcome is consistent with the most plausible path (incrementalism) to a US version of universal coverage.
ISSN:0090-0036
1541-0048
DOI:10.2105/AJPH.2019.305294