On May 13, 2019, Washington State Governor Jay Inslee signed Senate Bill 5526 into law, creating a “public option” health insurance plan for Washington residents. The plan, titled “Cascade Care,” will make Washington the first state in the nation to offer a voluntary public option for health insurance. Under Cascade Care, the Washington State Health Care Authority (HCA) will contract with private health insurers to administer the plans but will control the terms to manage costs. The idea is for the government to create a health insurance program to compete with the private marketplace and to expand coverage and affordability . . .

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Health Care System

The United States health care system encompasses a mixture of private and public entities that are either non-profit or for-profit. Health care coverage may be financed through federal and state government programs or can be purchased through the health insurance marketplace. In contrast, a smaller proportion of the U.S. population is uninsured. The resulting effects of a decentralized system has led to considerable challenges for provider organizations—including cost pressures, a push towards alternative payment models, and market consolidation. Despite these challenges, there are opportunities for provider organizations in reducing excess costs and utilization, particularly as payers look for innovative approaches that can demonstrate a return-on-investment in terms of cost and consumer outcomes.


On January 21, 2026, the Maryland Department of Health announced that the state expanded its advanced primary care delivery system to cover approximately 1.2 million residents enrolled in Medicare and Medicaid. The expansion, which took effect January 1, aims to improve preventive care and reduce unnecessary hospital visits by focusing on coordinated care and addressing social determinants of health. The state now operates three advanced primary care programs designed to give care teams more time… Read