# Colorado's public option is reshaping US healthcare > Three states built their own public insurance plans while Congress stalled. Colorado's success shows what's possible, and what it costs to challenge hospitals. - Title: Colorado's public option is reshaping US healthcare · Vox - Summary: Three states built their own public insurance plans while Congress stalled. Colorado's success shows what's possible, and what it costs to challenge… - Keywords: colorado, public option, health insurance, affordable care act, hospital prices, washington state, nevada, healthcare reform, medicaid, news, culture, Colorado's - Source: Vox — https://vox.com/policy/506744/healthcare-democrats-public-option-obamacare-aca-insurance-colorado - Author: Rachel Cohen Booth - Published: 2026-10-19T10:00:00+00:00 - Read time: 4 min - Topics: colorado, public option, health insurance, affordable care act, hospital prices, washington state, nevada, healthcare reform, medicaid, news, culture ## Colorado's public plan covers 139,000 people Enrollees in Colorado's state-designed public option pay zero dollars for primary care, mental health visits, prenatal and postnatal care without meeting deductibles first. ## Premiums fell and out-of-pocket costs dropped Enrollees in Colorado's public plans pay an estimated fourteen to thirty three dollars less monthly in premiums than comparable plans, with annual out-of-pocket spending down fifteen percent. ## Obama wanted a public option in 2009 President Barack Obama supported a government plan to keep insurance companies honest by giving them a government-backed competitor, but Senate leaders stripped it from the Affordable Care Act. > keep insurance companies honest ## Biden campaigned on it but didn't prioritize it Joe Biden campaigned for president on reviving a public option in twenty twenty, but he never prioritized it once in office, and progressive activists turned to single-payer healthcare instead. ## Three states built their own public options While Congress stalled, Washington state launched a public option in twenty twenty one, Colorado in twenty twenty three, and Nevada earlier this year, all using an Affordable Care Act provision. ## Colorado's mountain counties had the highest premiums Dylan Roberts, the Colorado state senator who sponsored the bill, represents mountain counties with some of the highest individual-market premiums in the United States. ## Governor Polis made healthcare his priority Colorado Governor Jared Polis created an Office of Saving People Money on Healthcare run out of his lieutenant governor's office as one of his first acts in office. ## The entire healthcare industry opposed it Hospitals, insurers, doctors and pharmaceutical companies lined up against Colorado's public option proposal, representing basically anybody in the status quo healthcare industry. ## Colorado changed course to act faster Colorado first proposed a state-run insurance plan but concluded it would not sell a single policy until twenty twenty five or twenty twenty six, so officials rewrote the bill. ## Private insurers had to sell the state's design Instead of running insurance itself, Colorado required private insurers already operating in the state to sell a marketplace plan the state designed, which launched in twenty twenty three. ## The key was forcing hospitals to cut prices Colorado gave insurers a target: by twenty twenty five, state-designed plans had to cost fifteen percent less than that insurer's plans cost in twenty twenty one, adjusted for inflation. ## Public hearings forced hospitals to negotiate If an insurer missed the target, Colorado's commissioner could haul both the insurer and hospitals into a public hearing to defend their prices, then order hospitals to take less. > No one wants to be called in front of a public hearing where press are going to be there ## Enrollment grew from fourteen percent to half Enrollment in Colorado's public option went from about fourteen percent of the state marketplace in twenty twenty three to a third in twenty twenty four to roughly half today. ## Savings spread across the entire market Researchers at Brown University found the cheapest silver plans across Colorado's individual market now cost more than one hundred dollars a month less than equivalent plans in similar states. ## Washington required hospitals to participate Washington state passed its law in twenty nineteen but asked hospitals to participate voluntarily, and many did not. The legislature passed a second law in twenty twenty one requiring hospitals to contract. ## Washington's enrollment climbed after mandate Washington's public option was available in every county by twenty twenty five. About one hundred fifteen thousand people signed up for twenty twenty six, roughly forty percent of the marketplace. ## Nevada gave itself the least leverage Nevada's plans went on sale this year. The state sets premium targets but cannot set hospital rates and suspended its provider participation requirement for the program's first year. Enrollment came below projections. > The story is unfinished here ## States fear fighting hospitals and Medicaid cuts Michael Conway, Colorado's insurance commissioner, says other states lack appetite to challenge hospital prices because they are bracing for Medicaid cuts. ## Federal government has tools states lack Medicare is a price setter, not a price taker, meaning it can announce what it will pay rather than negotiate for it. Some proposals would let people buy into Medicaid through the marketplace instead. > a price setter, not a price taker ## Democrats could expand public options next year With Democrats potentially set to expand their statehouse presence after the midterms, there may be more room to act on healthcare in other states. ## Key takeaway Colorado, Washington and Nevada created state-run public insurance options after Congress failed to include one in the Affordable Care Act, with Colorado's plan now covering half its individual market by forcing hospitals to lower prices.