A public option for Oregon: Health care policy lessons from other states

Health care costs too much. Insurance premiums on the health insurance exchange in Oregon have risen 77% since 2014, and consumers in the state pay the third-highest average deductible in the nation.[1] These costs lead to negative effects on Oregonians, including medical debt and other financial and emotional burdens. Whether they are stressing about choosing and paying for the right insurance plan, or worrying about paying for services, Oregonians deserve better when it comes to health care and insurance.

Oregon is pursuing various methods to lower the cost of care, from monitoring provider consolidation to banning surprise medical bills. One of the more recent considerations is a public health insurance option. Other states have adopted public option programs, and Oregon can learn from those states’ policies in shaping its own. This paper explores three case studies of public option designs from Washington, Colorado, and Nevada and makes recommendations as to how Oregon’s public option should be structured. Specifially, the report recommends that a public health insurance option should:

  • be offered at least on the individual and small group markets to Oregonians and small businesses
  • lower costs through administrative regulation of rates and use of alternate payment methods
  • require participation from insurance carriers and providers to make it widely available
  • use specific premium reduction targets to measure the program's success
  • prioritize integrated primary care and other essential services to offer a high-quality plan

Read more to see how Oregon can follow the lead of Washington, Colorado, and Nevada in creating our own public option.


1. Rate change calculated by determining the difference between the average approved individual market rates 2014-2022 found at DFR rate filings, archived at

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