Why hasn't all of Washington state adopted its public-option program?

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Over two years after being the first state to create a public option, Washington state has yet to get over half of its counties to make the plan available to residents, raising questions as to if the program has failed to fix high healthcare premiums. 

The program allows the state to contract with private insurers as long as the plans fit into cost restrictions, according to Crosscut.

Only 19 of the state's 39 counties offered public-option plans, resulting in a total of 2,000 Washington residents enrolling in the program, Crosscut reported. 

Lawmakers cite a lack of hospital participation as part of the public option's limited reach. Others claim that flexibility within payment caps leads to varied payments to health systems. 

However, hospitals are skeptical of rate-setting at all, Crosscut reported, and that builds on hesitancy for the program. 

Now, the state is looking to drive up participation with an April bill that requires hospitals sign on to at least one public option plan in hopes that the move gives life to the initiative. The bill goes into effect in 2023, but some hospitals are already critical of required plans that may give insurers unfair leverage, according to Crosscut.

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