Policymakers are floating several public-option variants, most of which would offer a public plan alongside private plans on the ACA’s insurance exchanges. Although a few of these variants would allow persons to buy in to Medicaid, most envision a new plan that would pay Medicare rates and use providers who participate in Medicare. Positive features of these reforms include offering additional insurance choices and minimizing the need for new taxes because enrollees would pay premiums to cover the new costs. However, these plans would cover only a fraction of uninsured persons, few of whom could afford the premiums (5); do little to improve the comprehensiveness of existing coverage; and modestly increase national health expenditures. The Medicaid public-option variant, which many states might reject, would probably dilute these effects.
Source: Medicare for All and Its Rivals: New Offshoots of Old Health Policy Roots by Steffie Woolhandler, MD, MPH and David U. Himmelstein, MD.