Every state that receives federal medicaid money administers their own state run health insurance

The program is partially funded and primarily managed by state governments, which also have wide latitude in determining eligibility and benefits, but the federal government sets baseline standards for state Medicaid programs and provides a significant portion of their funding. States are not required to participate in the program, although all have since 1982.

I’m going to go out on a limb and say that it’s because if that happened someone who’s nest is currently being feathered by the inequity of the present system would receive less feathers for said nest.

it can happen. especially in California, because they have the population size to motivate health providers and pharma companies to negotiate.

it’s not likely in the short term with the way the system is. and the problem which prevents it is not the economics nor legislative lack of will.

it’s the insurance companies’ lobbying and political campaign contributions. many many California legislators’ campaigns are funded by insurance companies. and historically there has been a lot of corruption in the state’s insurance regulator agency.

also the state’s population , for some reason, are easily swayed by political ads in certain issues. like the car-share/delivery gig drivers proposition. i think they flip flopped in successive referendums. apologies if in wrong in that.

Money politicians want to spend on things their constituents want spent on better things.

Part of the problem is Medicare is already taxing for healthcare. A state creating their own system would have to tax on top of that, and duplicate the administration of it.

It’s kind of like states trying to stop using daylight savings on their own. Technically they can, but only after getting all of congress and the president to agree.

Vermont tried for a version of universal healthcare about 10 years ago, and they decided the cost was too high.

Every state has a program for poor people that’s in part funded by Federal tax dollars.

You also have to address the free rider problem by vesting benefits in.