A Federal Option as an alternative to state-regulated Obamacare is not the worst idea. Why have two layers of government regulate insurance instead of one? It could end state attempts to inflate APTC subsidies with benefit mandates, silver loading, etc... finance.senate.gov/imo/media…

Supporters and opponents get excited about the prospect that a Federal Option could be used to impose single-payer -- but there's little chance that the healthcare industry would allow that.

Home and Community Based Services have largely replaced institutional care for I/DD Medicaid beneficiaries; but HCBS has mostly just added to institutional spending for elderly and physically disabled benficiaries: medicaid.gov/medicaid/long-t…

Far too often long-term care policy lumps these very two different beneficiary cohorts together, despite their greatly differing needs and lifetime capabilities.

What makes management by private insurance much more problematic in Medicaid than Medicare? paragoninstitute.org/medicar…

2) Medicaid eligibility is much more ambiguous than Medicare. Improper enrollment creates a major risk of overpayment in capitated healthcare benefits. Ambiguity of beneficiaries’ income, enrollment in ESI, and fluctuations of circumstances greatly complicate oversight.

"Linking arbitration records to the national longitudinal provider-insurer network panel and plan design data in the ACA marketplace, we find that the NSA reduced provider network participation in the specialties and states most affected by the reform" nber.org/papers/w35717