We were somewhere around Barstow, on the edge of the desert, when the universal coverage began to take hold.

Surely there has to be a connection: Wingnut gun-humping idiot Michele Fiore lost her seat in the Nevada state Assembly last year, and now both houses of the state legislature have passed a bill that would allow all Nevadans to buy into the state's Medicaid plan. There's no word yet whether Republican Gov. Brian Sandoval will sign or veto the bill, but if it becomes law, it would place a public option on the Nevada healthcare exchange. Yes, Nevada. We'll give you a moment to pick your jaw off your desk.

The bill would allow any state resident who lacks health insurance to buy into the "Nevada Care Plan," which would put them on the state's Medicaid program pretty much at cost -- the details of premiums, deductibles, and copayments would be worked out through the regulatory process later, to adapt what's normally a benefit for people in poverty into a paid health insurance plan. Democratic state Assemblyman Michael Sprinkle, who introduced the measure, explains,

There is no way people can be productive members of society and take care of their families if health care is a privilege and not a right [...] That’s really where this bill started, thinking through, how do we make health care a right in our state.

People who qualify for the tax credits that subsidize private insurance under the Affordable Care Act could opt to have those credits go toward buying into Medicaid coverage; those whose incomes are too high for the tax credits would be able to buy in using their own money. The bill's one significant difference from regular Medicaid is that unlike Medicaid, it wouldn't cover emergency medical transportation, a Medicaid benefit tailored to that program's low-income population.

And yes, Rep. Sprinkle says some people in Nevada are already calling the proposal "SprinkleCare," which seems inevitable. They may as well embrace it and make a logo with a unicorn and a rainbow.

Vox offers a nice 'splainer on why Medicaid-for-all might make a more attractive option than Medicare for all. The biggest advantage is that states have more power to make changes to Medicaid. Medicare for all would have to be passed at a national level, which seems unlikely with the current Congress. Of course, if Donald Trump continues winning the way he's been winning, the makeup of Congress and the executive branch may be in for big changes in 2018 and 2020. Medicaid is paid for jointly by the states and the federal government, with the feds matching the states on a dollar-for-dollar basis (an arrangement the current version of TrumpCare would jettison for much smaller block grants, and an eventual 50% cut in Medicaid funding, which could seriously screw up any state's Medicaid-for-all plan).

Like Medicare, Medicaid is large enough to negotiate lower prices for medical services with doctors and hospitals, and Medicaid costs less, since its reimbursements to doctors are lower than Medicare's -- which, unfortunately, also means a higher number of doctors refuse to see Medicaid patients:

A recent federal survey estimates that 68.9 percent of doctors are accepting new Medicaid patients, compared to 84.7 percent accepting new patients with private insurance.

Still, Medicaid enrollees generally report being relatively happy with their coverage. They look nearly identical to people with employer-sponsored coverage in surveys about how well they think their health plan works.

Also good: A lot of states already allow a limited form of buy-in for patients who aren't poor; 32 have participated in a Medicaid option allowing people with disabilities to buy into Medicaid even if they wouldn't otherwise qualify for the program. So it may be more adaptable as a public option on the ACA marketplace.

The biggest downside, of course, is that there are already huge differences in how states run Medicaid, and relying on individual states to implement a Medicaid buy-in would just worsen the state-to-state patchwork of decent and crappy care. Also, even if Gov. Sandoval signs the bill, Nevada's (and any other state's) plan to change who Medicaid serves would require federal approval, a huge "if" under the current administration, which seems hellbent on telling people it wants everyone to have "access" to healthcare, for everyone who can pay for it by themselves.

So, no, a state-by state Medicaid public option isn't single payer, and not as good as single payer, but it's one possible step states could take to make sure more people are covered than are now. And OF COURSE single payer makes more sense in the long run -- but it's also harder to pass in a country where the insurance industry has tremendous lobbying power. So we're definitely behind the idea of anything that moves us closer to more universal coverage, even when it's not perfect. Just as long as we keep the ultimate goal of healthcare as a right for everyone in mind.

Besides, we really want that unicorn-themed SprinkleCare logo to be a reality.

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[Vox]