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Illustration: Aïda Amer/Axios

Even the most ambitious Democratic-controlled states have ended up with new health plans that are much more moderate than anything being proposed by Democratic presidential candidates — or even what was initially proposed in their states.

Why it matters: States are significantly more limited in their authority than the federal government, but the efforts of Colorado, Washington and California show just how hard massive health care disruption is.

Driving the news: Colorado state agencies last week released their final proposal for the state's public option, which is scheduled to become available in 2022.

  • While an earlier draft had proposed hospital payment rates that were between 175% and 225% of Medicare, the updated version says that each hospital's rate will be determined individually through a formula that is yet to be developed — punting the decision.
  • "Obviously, where those prices ultimately land will have a big effect ton whether this proposal actually reduces spending. If the state cannot hold the line, then the potential for this type of proposal to reduce spending evaporates," the Brookings Institution's Matthew Fielder said.
  • The proposal also relies on private insurers to offer the plan — meaning that while it's highly regulated, it is not a fully government-run plan.

The big picture: Colorado's situation — along with other states' — provides a real-world contrast with some Democrats' plans to eliminate private insurance and slash provider payment rates.

  • Washington's public option is similarly structured as a partnership with private insurers, and while it caps provider rates at 160% of Medicare, this is a higher rate than initially proposed, as the NYT reported. Like Colorado's plan, provider participation is voluntary.
  • California took a different approach, expanding eligibility for Affordable Care Act enrollees and paying for the health benefits of some unauthorized immigrants.

What they're saying: "As much as there was a whole lot of energy behind more government intervention in health care after the 2018 election, I think that energy ran smack into some practical issues," Georgetown's Sabrina Corlette said.

The bottom line: Colorado's public option "demonstrates just how much space there is between doing nothing and implementing Medicare for All when trying to increase access to insurance and reduce costs," said Avalere's Chris Sloan.

Go deeper

Updated 2 hours ago - Politics & Policy

1 dead after pickup truck hits Pride spectators in Florida

Police investigate the scene where a pickup truck drove into a crowd of people at a Pride parade in Wilton Manors, Florida, on Saturday. Photo: Jason Koerner/Getty Images

A driver in a pickup truck hit spectators at a Pride festival in Wilton Manors, Florida, killing a man and leaving another person hospitalized Saturday, authorities said.

Details: Fort Lauderdale Mayor Dean Trantalis told reporters police had "apprehended the driver" and that the vehicle missed a parade car carrying Rep. Debbie Wasserman Schultz (D-Fla.) "by inches."

Updated 5 hours ago - Sports

Uganda Olympic team member tests positive for COVID in Tokyo

The Uganda National boxing team's Catherine Nanziri (L) and others arrive for check-in at Entebbe international airport in Wakiso, Uganda on Friday, ahead of their departure to participate in the Tokyo Olympic Games. Photo: Badru Katumba/AFP via Getty Images

A Uganda Olympic team member tested positive for COVID-19 upon arrival in Japan late Saturday, officials said.

Why it matters: Japan's government has faced criticism for vowing to host the Tokyo Games next month as coronavirus cases rise. The Ugandan team is the second to arrive in Japan after the Australian women's softball players, and this is the first COVID-19 infection detected among the Olympic athletes, Al Jazeera notes.

Updated 9 hours ago - World

In photos: Brazilians rally against Bolsonaro as COVID deaths top 500,000

A June 19 protest in São Paulo, Brazil, against the administration of Brazilian President Jair Bolsonaro, who has railed against precautionary health measures despite the soaring COVID-19 death rate and cases. Photo: Rodrigo Paiva/Getty Images

Demonstrators took to the streets in at least 22 of Brazil’s 26 states to protest President Jair Bolsonaro's handling of the pandemic — as deaths from COVID-19 in the country surged past 500,000 Saturday, per AP.

The big picture: Brazil has the world's second-highest coronavirus death toll and third-highest number of reported cases. Only 12% of the country's population has been vaccinated against the virus, AP notes.