Has Single Payer Ever Worked in the US?

Single payer hasn’t made any progress in the United States—but not for lack of trying. Legislation or ballot initiatives to replace all private insurance with a single, public state-run health plan have been introduced in more than half of states, covering more than 60% of the nation’s population. These attempts have spanned more than 30 years, starting in 1986 in Massachusetts.

Yet, amid all that state activity, single payer has never worked in the United States. Legislation has been introduced in 28 states. Single payer bills passed in only three states, but were either vetoed or quickly scrapped.. Legislation in Vermont went further than any other state, with the state government spending three years attempting to implement the legislation. However, the high cost of the single payer proposal made it impossible to implement. The state legislatures in Hawaii and California sent their respective Governors single payer bills, but both state’s Governors refused to sign or implement the bills.

Three states, California, Colorado, and Oregon, voted on ballot initiatives that would have created state-run single payer systems. Strikingly, the initiatives all failed by more than 40% of the vote. In two other states, organizers failed to get the signatures necessary to get the initiative on the ballot.

The map and table below show the furthest states have gotten in implementing a state-run single payer system.

Notes: This table tracks relevant state legislation that would create a state-based single payer system. This does not include bills that would initiate a study or task force on single-payer. This also does not include bills that reference federal legislation.