State is uniquely suited to pioneer this approach and has hard evidence that it will work.
California’s workers are facing a mounting health care affordability crisis. The cost of insurance for families has grown more than two and half times faster than wages have, putting health care out of reach for more and more people. This gap is even larger for the state’s Black and Latino populations.
We propose a public-option for California that we call Golden Choice. It is based on the ability of the state’s integrated medical groups to provide high-quality care at a lower cost by receiving monthly revenue per enrollee, a payment system known as capitation. The figure would be adjusted for each patient’s age, gender, health status and related characteristics likely to influence need for care.
California already has some experience with a public option: L.A. Care in Los Angeles County. This county-based public plan has been listed since 2014 on the state’s insurance exchange. Our research team found that L.A. Care’s low premiums have had a competitive effect on the market, driving down prices. Premiums of the other plans have declined, and L.A. Care’s enrollment increased to more than 125,000 last year. The estimated savings because of this public option were $345 million as of 2022.
A statewide public option would require little to no new funding from the state. The Department of Managed Health Care already regulates capitated medical groups. We recommend that the state establish an Office of Public Options so that the 18 million commercially insured Californians and the uninsured are able to share the benefits of a public option — particularly lower premiums. The office would organize, implement and promote a statewide public option.
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