State Single Payer

The first step on a state’s road to a quasi-single payer system is to obtain a waiver from the ACA. This is well within reach because the act includes language that permits a state to receive a state waiver from the ACA’s strictures, beginning in 2017. A state can be granted this waiver if it demonstrates that its alternative would provide coverage at least as good, for at least as many people, as the ACA would, and not add costs to the federal budget. For states that receive waivers, the federal government must provide funds to the state that equal what it would spend pursuant to the ACA. A state promising to provide comprehensive, universal care would easily clear this hurdle.

Achieving integration between a state system and Medicare and Medicaid would be more difficult because the law does not permit a broad waiver from these programs. But the law does provide ample room for the administration of these programs within a state to be altered to align billing systems and prices. This would allow Medicare and Medicaid to appear to providers and patients to be almost seamlessly integrated with a state system, although this strategy would require a state to dedicate resources to reconcile claims with the federal government.

The other major legal hurdle for a state to overcome is posed by the 1974 Employee Retirement Income Security Act (ERISA), which forbids states from regulating employer benefits plans. But a small body of case law provides grounds for cautious optimism that the hurdles of ERISA can be overcome. A state could insulate its system from being struck down on ERISA grounds by legislating alternative funding options, such as payroll, income or sales taxes.

The final major hurdle is determining how to pay for a universal care system. Transitioning from a system largely financed by employer and employee-paid insurance premiums to one likely financed by some combination of taxes would be challenging.
PNHP – How States Can Get Close to a Single-Payer System
PNHP – Single Payer FAQ



  • State Single-Payer similar to Colorado
  • Allow people to buy into the Texas medicaid system similar to Nevada and six other states.

How to finance a Texas single payer health care system?

  • Reallocate some of the $800 million wasted on border security
  • Create a state public bank similar to North Dakota to finance universal healthcare
  • Allow U.S. based insurers and hmo’s to offer Texas-Mexico cross border health plans
  • Close corporate loopholes in the state sales tax
  • Strengthen and reform the state rainy day fund
  • Finance the state portion of the medicaid expansion with tax reform’s such as but not limited to: gas tax, revenue-neutral carbon tax, corporate income tax

NPR – Coloradans Will Put Single-Payer Health Care To A Vote

Politico – Why single payer died in Vermont

USA Today – Vermont is ‘single-payer’ trailblazer

Fareed Zakaria’s Puzzling Take on Health Care in Britain, Taiwan, and Switzerland

VOX – Will the United States ever have a single-payer system, or is that a crazy liberal pipe dream?

Colorado to vote on single-payer state health-care system

Common Dreams – ‘A Better Option’: Colorado Readies Ballot Battle for Single-Payer Solution

Bernie Sanders: Colorado could “lead the nation” with its universal healthcare ballot measure

FORBES – Colorado Puts Single-Payer Healthcare On 2016 Ballot

New York – Assembly passes bill to create single-payer health plan

Physicians for a National Health Program – How single payer health system reform improves quality

Salon – The single payer health care bill has passed both of the California’s legislative branches — twice. Why is it now dead?

Physicians for a National Health Program – Why Did Single-Payer Health Care Fail in California?

Truth Out – Will Colorado Become the First State to Implement Single-Payer Health Care?

Colorado Set to Vote on a Single Payer Healthcare System

Brookings – Why Section 1332 could solve the Obamacare impasse

CBPP – Understanding Health Reform’s Waivers for State Innovation

Huffington Post – Federal employers would be prohibited from asking about a job applicant’s criminal history.

AARP – 5 Myths About Canadian Health Care

Star Tribune – Star Tribune – Governor of Minnesota pitches $500k study of single-payer health care

Worcester Telegram – Massachusetts lawmakers consider single payer health insurance system

New York Times – How to Stop the Bouncing Between Insurance Plans Under Obamacare

Washington Post – Poll: Most Americans want to replace Obamacare with single-payer — including many Republicans

Ledger Enquirer – Medicare expansion versus same worn out platitudes

UCLA Center for Health Policy Research – Public Funds Account for Over 70 Percent of Health Care Spending In California

Amendment 69: Colorado can learn from Vermont’s failed experiment with single payer health care

Delaware could become first state with a “public option” in health care

Medicaid Buy-in: State Options and Design Considerations

%d bloggers like this: