Comment by WorldMaker

> I'm still baffled why local and state govts aren't easing into a public option.

That's easy enough to answer: lobbying efforts by major insurance companies (and insurance company adjacent companies) prevented it. In many states such lobbying efforts prevented it entirely in the legislature adding direct laws and some state constitutional amendments that states explicitly weren't allowed to build a public option as a part of their healthcare exchanges. It was a big part of the uproar when the ACA was passed at the federal level, a big part of why many states' healthcare exchanges were sabotaged and broken on Day One, and a large part of why the ACA itself made too many compromises in how it established the state-driven healthcare exchanges.