Updates from the states as of January 8, 2021.

In the waning days of 2020, Congress enacted a $900 billion COVID-19 relief package and government funding bill (H.R. 133). Included in the measure is the “No Surprises Act”, which contains new protections for consumers from surprise medical bills from out-of-network providers. The new law establishes, for the first time, comprehensive protections in the states without their own balance billing laws and for the nearly 135 million people in self-insured plans beyond the reach of state regulators. This expert perspective summarizes provisions that have particular implications for state regulators.

Faced with significant premium fluctuation and the risk of “bare counties”, many policy stakeholders have turned to the public option as a potential tool to promote stability and affordability in the individual insurance market. Since 2017, nearly a dozen states have considered or passed legislation to study or implement a state-based public option program. Additionally, the 2020 election and transition to a new federal administration marks a pivotal point for state policymakers with interest in fostering new coverage options. An incoming Biden Administration’s support for state innovation will create new state-based coverage opportunities, even as major federal legislation is unlikely under a divided Congress. This expert perspective provides a brief overview of selected states efforts to implement a public option and highlights what to expect in a federal policy environment.