Last updated on: 10/15/2013 | Author:

Can States Set up Their Own Single Payer Systems under Obamacare? – YES

General Reference (not clearly pro or con)

The Patient Protection and Affordable Care Act, Section 1332, “Waiver for State Innovation,” page 85, signed into law on Mar. 23, 2010, available at the Library of Congress website, states:

(1) IN GENERAL.—A State may apply to the Secretary for the waiver of all or any requirements described in paragraph
(2) with respect to health insurance coverage within that State for plan years beginning on or after January 1, 2017. Such application shall—
(A) be filed at such time and in such manner as the Secretary may require;
(B) contain such information as the Secretary may require, including—
(i) a comprehensive description of the State legislation and program to implement a plan meeting the requirements for a waiver under this section; and
(ii) a 10-year budget plan for such plan that is budget neutral for the Federal Government; and
(C) provide an assurance that the State has enacted the law described in subsection (b)(2).”

Mar. 23, 2010 - Patient Protection and Affordable Care Act (HR 3590)

PRO (yes)


Public Citizen, in a report by Taylor Lincoln, Research Director of the Congress Watch division of Public Citizen, stated the following in its July 10, 2013 publication “A Road Map to ‘Single-Payer'” available at

“The law’s prescriptions would be a roadblock to states endeavoring to establish universal care systems [single payer systems] but for its inclusion of a section permitting states to apply for a ‘waiver of all or any requirements…with respect to health insurance coverage within that State for plan years beginning on or after January 1, 2017.’

The criteria for receiving a state innovation waiver include demonstrating that a proposed alternative will provide coverage at least as comprehensive and as affordable as called for in the Affordable Care Act, that coverage will be provided to at least as many people as under the act, and not impose extra costs on the federal government. The waiver provision calls for the federal government to make payments to the state equaling those that the government would otherwise have made pursuant to the Affordable Care Act…

The standards called for in the waiver provision in the Affordable Care Act appear to be easily attainable by a state that wishes to establish a universal care system.”


Margaret Flowers, MD, Co-Director of Its Our Economy, stated the following in her Mar. 2, 2011 publication “State Health Law Waivers: Where Will They Take Us,” available at

“The federal health bill [Obamacare] requires that any state seeking a waiver from the health insurance exchange must at a minimum provide coverage comparable to that specified by the federal bill (Section 1332). It is left to the discretion of the secretary of health and human services to determine if a state meets this requirement.

States that put in place a single-payer health system will surpass the coverage of federal law. A single-payer health system, improved Medicare for all, would be universal and would provide the necessary cost controls and savings that would fund comprehensive coverage, including much-needed mental health, dental and vision care.

States such as Vermont and California…appear to be closer than any others to enacting a state single-payer health system.”


Linda Bergthold, PhD, Research Associate at the Center for Health Policy at Stanford, stated the following in her Sep. 17, 2013 article “Single Payer: Alive and Still Remarkably Well,” available at the Huffington Post website:

“[T]he ACA encourages individual states to experiment with single-payer universal health care. States can apply for an innovation ‘waiver’ and start implementing their own plans starting in 2017. Vermont Governor Peter Shumlin led the way when he signed Green Mountain care into law in 2011, establishing a road map for a state-level single-payer system.”

CON (no)


[Editor’s Note: Based upon a neutral reading of the Patient Protection and Affordable Care Act and bi-partisan third party analysis, this question seems to have a clear and obvious Pro (yes) answer, and has therefore presented the responses in a single column with no opposing perspective.]