Sending Office: Honorable Ben Ray Lujan
Sent By:

        Request for Cosponsor(s)

Be an Original Cosponsor of the State Public Option Act


Current House Sponsors: Blumenauer, Carson, Cicilline, K. Clark, Y. Clarke, Cohen, DeSaulnier, Doyle, Engel, Fudge, Gallego, Garamendi, Hill, Khanna, Krishnamoorthi, McCollum, Napolitano, Neguse, Norton, Omar, Perlmutter, Roybal-Allard, Schiff, Schrier,
Takano, Titus, Tonko, Watson Coleman, Welch

Current Senate Sponsors: Schatz, Sanders, Baldwin, Booker, Cortez Masto, Gillibrand, Harris, Heinrich, Hirono, Klobuchar, Leahy, Markey, Merkley, Murphy, Reed, Smith, Udall, Warren, Whitehouse


Dear Colleague:

“We think 2019 is going to be the year of Medicaid buy-in.”
-Allison O’Toole, Director of State Affairs, United States of Care.

Please join us as an original co-sponsor of the State Public Option Act to establish a state public option through Medicaid to provide Americans with the choice of a high-quality, lower-cost health coverage.

Even with the progress of the Affordable Care Act, nearly 30 million people remain uninsured, in part due to instability in the insurance markets and the lack of Medicaid expansion in 19 states.  The most common reason people cite for being uninsured is
because the cost is too high.[1]

The State Public Option Act is an innovative solution to expand comprehensive coverage by allowing states to offer Medicaid, an existing efficient, federal/state partnership program, to more people. Allowing all Americans to buy into Medicaid would provide
better options for individuals to get state-driven, high-quality health insurance at a lower cost. Further, increasing competition within the health insurance marketplace will drive down costs for all consumers.

Currently, at least 14 states are exploring implementing a Medicaid public option within their legislatures and a brand-new survey commissioned by United States of Care and conducted by the Harris Poll in November found 78 percent of registered voters across
the country saying that a Medicaid buy-in plan should be a priority for their state lawmakers.[2]Additionally, Kaiser Family Foundation found a Medicaid
public option garnered 75 percent bipartisan support.[3]

As Congress explores all avenues to strengthen the Affordable Care Act by increasing coverage and decreasing costs, the State Public Option Act offers a thoughtful and innovative solution.

Please contact Kimberly Espinosa ( or Aisling McDonough ( with
questions or to sign on to the bill.


Congressman Ben Ray Luján

Senator Brian Schatz              







To establish a Medicaid public option to provide Americans with the choice

of a high-quality, lower-cost health insurance plan.


THE ISSUE—Building on the progress of the Affordable Care Act (ACA)

  • The ACA provided historic insurance gains in the United States, with 20 million more Americans insured.  Additionally, consumers have better protections with coverage for pre-existing conditions and young adults are now able to stay on their parents’ plans
    until age 26.
  • Even with the progress of the ACA, nearly 30 million people remain uninsured, in part due to instability in the insurance markets and the lack of Medicaid expansion in 19 states.  Additionally, some Americans have premiums and cost-sharing
    that they find to be too expensive.

THE SOLUTION—A Medicaid public option

  • Medicaid is an efficient federal/state partnership program that provides comprehensive coverage at relatively lower cost.  It also gets high ratings from patients; has demonstrated effectiveness; and provides state-level flexibilities for innovation.
  • Allowing all Americans to buy into Medicaid would provide better options for individuals to get state-driven, high-quality health insurance at lower cost.

THE BILL—The Medicaid Public Option Act does the following:

  Section 2: Medicaid buy-in

  • Structure:
    • Creates a new state option to expand Medicaid eligibility to all state residents that are not concurrently enrolled in another insurance plan, subject to premiums or other cost-sharing charges (with limitations noted below). 
    • Those residents that would otherwise be eligible for Medicaid under different state option eligibility criteria would have their benefits and cost-sharing protections maintained as under the original Medicaid program.
    • States that take up this option must offer the Medicaid buy-in on the health insurance exchange, and may establish enrollment periods.
    • States would receive a 90 percent increased Federal Medical Assistance Percentage (FMAP) match for administrative expenses associated with the buy-in.
  • Coverage package:
    • The buy-in benefit package must be at least equal to benchmark coverage (similar to the Alternative Benefit Package in Medicaid expansion), with coverage of the ACA’s 10 Essential Health Benefits.
  • Premiums:
    • States may impose premiums, deductibles, cost-sharing, or other similar charges. 
      • The premium rate may only be adjusted based on factors and weighting allowable as under the ACA (including age, tobacco use, family size, and geography).
      • Eligible individuals may apply their exchange subsidies (“Advance Premium Tax Credits” or APTCs) toward the Medicaid buy-in program. 
      • For those not eligible for APTCs, premiums cannot exceed 9.5 percent of household income. 
    • Other cost-sharing protections (out-of-pocket limits) are consistent with those in the ACA.
  • Financing: States must first use their premium revenues and APTCs to pay for buy-in enrollees’ medical assistance expenditures.  They then share risk with the federal government as follows:
    • To the extent that the state has excess expenses associated with the buy-in program (more medical assistance expenditures than premium revenues), the federal and state governments shall share any excess expenses at the regular FMAP rate.
    • To the extent that the state has excess revenues associated with the buy-in program (more premium revenues than medical assistance expenditures), the state shall share the savings with the federal government at a rate of 50 percent of any excess revenues.

  Sections 3 and 4: Improving access in Medicaid

  • Section 3: Data collection: The bill creates a $200M fund for the development of standardized, state-level metrics of access to, and satisfaction with, providers under Medicaid.  The fund would be administered by the Agency for Healthcare Research
    and Quality in consultation with the Center for Medicaid and CHIP Services, state Medicaid directors, and stakeholders.
  • Section 4: Primary care bump: The bill includes the Ensuring Access to Primary Care for Women & Children Act (S. 737, H.R. 2253  in the 114th Congress, introduced by Senator Brown, Representative Castor, respectively), which extends
    the primary care payment increase to Medicare levels, as established under the ACA, for more primary care providers.  However, this bill makes that payment bump permanent (not just extended for two years).

 Section 5: State incentives to take up Medicaid expansion

  • The bill includes the States Achieve Medicaid Expansion (SAME) Act (S. 2787, H.R. 4627 in the 114th Congress, introduced by Senator Warner, Representative Green, respectively), whereby states can get the same enhanced Federal Medical
    Assistance Percentage (FMAP) for expanding Medicaid regardless of which year they expand.
Related Legislative Issues

Selected legislative information: Family Issues, HealthCare

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