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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

Scoop: White House eyes vaccine mandate for migrants

A migrant receives a COVID-19 vaccination in Mexico before continuing to the U.S. border. Photo: Luis Barron/Eyepix Group/Future Publishing via Getty Images

The White House is considering requiring migrants aged 5 and older to receive a coronavirus vaccination as a condition for crossing the U.S.-Mexico border to await court hearings, Axios has learned.

Why it matters: The Biden administration has been offering the COVID-19 vaccine to people in immigration detention centers or shelters but hasn't yet offered it to other migrants who've crossed the border — much less required it.

Updated 1 hour ago - Politics & Policy

Omicron dashboard

Illustration: Brendan Lynch/Axios

  1. Health: The end of the Omicron wave is in sight — Transplants rebound from COVID lull — Omicron hits American hospitals disproportionately hard
  2. Vaccines: WHO: No evidence that healthy children, teens need boosters — Kids' COVID vaccination rates are particularly low in rural America — Starbucks drops worker vaccine or test requirement after SCOTUS ruling
  3. Politics: Biden concedes U.S. should have done more testing — Arizona says it "will not be intimidated" by Biden on anti-mask school policies— Government website for free COVID tests launches early
  4. World: WHO: COVID health emergency could end this year — Greece imposes vaccine mandate for people 60 and older
  5. Variant tracker

Highlights from Biden's marathon 2-hour press conference

President Biden answers questions during a news conference in the East Room of the White House on Jan. 19. Photo: Chip Somodevilla/Getty Images

President Biden Wednesday marked the end of his first year in office with a marathon press conference from the White House East Room, during which he defended his record in office and made headlines on several fronts.

Why it matters: It was only Biden's second solo presser while in office. The president said he would support splitting his flagship budget bill, the Build Back Better Act, to pass it in increments. He also called on the Federal Reserve to do more against inflation, and predicted that Russia will invade Ukraine.