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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

8 mins ago - Health

Boris Johnson announces month-long COVID-19 lockdown in U.K.

Prime Minsiter Boris Johnson. Photo: NurPhoto / Getty Images

U.K. Prime Minister Boris Johnson on Saturday outlined his plan for the country's second coronavirus lockdown as the nation topped the 1 million case mark, per Johns Hopkins University data.

Details: Starting Thursday, people in England must stay at home, and bars and restaurants will close except for takeout. All non-essential retail will also be shuttered. Inter-mingling between households and outbound international travel or out-of-home boarding will be prohibited. The new measures will last through at least December 2.

Updated 1 hour ago - Politics & Policy

The massive early vote

Illustration: Sarah Grillo/Axios

Early voting in the 2020 election across the U.S. on Saturday had already reached 65.5% of 2016's total turnout, according to state data compiled by the U.S. Elections Project.

Why it matters: The coronavirus pandemic and its resultant social-distancing measures prompted a massive uptick in both mail-in ballots and early voting nationwide, setting up an unprecedented and potentially tumultuous count in the hours and days after the polls close on Nov. 3.

Updated 1 hour ago - Politics & Policy

Coronavirus dashboard

Illustration: Sarah Grillo/Axios

  1. Health: Ipsos poll: COVID trick-or-treat.
  2. World: Greece tightens coronavirus restrictions as Europe cases spike — Austria reimposes coronavirus lockdowns amid surge of infections
  3. Economy: Conference Board predicts economy won’t fully recover until late 2021.
  4. Technology: Fully at-home rapid COVID test to move forward.
  5. States: New York rolls out new testing requirements for visitors.