Progress check
Percent
100%
Medicare insulin copay
In effect under the Inflation Reduction Act (Part D & Part B).
Lower impact High impact
Current status
$35/month cap
Affordable Care
Health Insurance
Real changes landed: Medicare's insulin cap is law, states capped insulin copays, and two public options are live with two more queued.
Their business model: lawsuits, junk plans, and sabotage
Pharma CEOs, junk-plan brokers, and anti-public-option politicians would rather keep families in billing hell than let competition lower prices.
ACA demolition crew
Republicans keep pushing repeal lawsuits and budget cuts that would end pre-existing condition protections and drive premiums back up to pre-ACA levels.
Source ↓Medicaid work-rule crusaders
GOP states keep trying to impose work requirements that kick tens of thousands of low-income adults off coverage - even when they're already working or caregiving.
Source ↓Pharma lawsuit factory
Drug companies and Republican attorneys general keep suing to block Medicare drug-price negotiations so cheaper insulin and inhalers never reach families.
Source ↓Junk-plan peddlers
They're reviving short-term 'skinny' plans that skip mental health, maternity care, and prescriptions — and bury families in surprise bills when real care is needed.
Source ↓Contraceptive rollback campaign
Party leaders backed lawsuits to weaken contraceptive mandates under the ACA, threatening cost-free access to birth control for millions of women.
Source ↓Public-option saboteurs
Insurance lobbyists and GOP legislators team up to block Washington- or Colorado-style public options that could finally introduce real price competition.
Source ↓Daddy's Plan
Cut the bill shock and grow public options
The Newsom blueprint treats health care like a utility: predictable pricing, universal navigation, and competition that forces insurers to behave. Start by enforcing the insulin cap, scaling state public options, and giving every enrollee a plain-English coverage brief.
No more mystery bills, no more mental-health carve-outs, and no more lobbyist-written plan directories. If a state can run a DMV, it can run a public option.
Solution
Drug affordability
Insulin caps and Medicare price tools that actually lower out-of-pocket costs.
Source ↓Solution
Public options
Washington and Colorado models are live; Nevada and Minnesota are enacted with launch dates.
Source ↓Solution
Navigation
Plain-English plan info that includes mental health and surprise-bill protection.
Source ↓Power metrics
Coverage progress report
Progress you can measure right now.
Verified wins
Closer to national standard = higher bar
Progress check
Percent
60%
States with insulin copay caps
Many state-regulated plans now cap insulin at $35 or below.
Lower impact High impact
Current status
≈30 states + D.C.
Progress check
Percent
50%
Public option status
Two implemented; two enacted with scheduled launches.
Lower impact High impact
Current status
WA, CO live; NV '26; MN '27
Source Library
Receipts for health insurance reform
Skim the citations covering insulin caps, state public options, and plan transparency rules. Each opens in a new tab for quick fact-checks.
- 1. https://www.kff.org/medicare/the-facts-about-the-35-insulin-copay-cap-in-medicare/
- 2. https://www.kff.org/medicare/explaining-the-prescription-drug-provisions-in-the-inflation-reduction-act/
- 3. https://diabetes.org/tools-resources/affordable-insulin/state-insulin-copay-caps
- 4. https://diabetes.org/tools-resources/affordable-insulin
- 5. https://diabetes.org/newsroom/press-releases/american-diabetes-association-applauds-californias-action-cap-copayments
- 6. https://jamanetwork.com/journals/jama-health-forum/fullarticle/2817158
- 7. https://unitedstatesofcare.org/wp-content/uploads/2024/02/2024-Comparison-Chart-of-State-Public-Options.pdf
- 8. https://www.hca.wa.gov/about-hca/programs-and-initiatives/cascade-select-public-option
- 9. https://www.commonwealthfund.org/blog/2023/state-public-option-plans-are-making-progress-reducing-consumer-costs
- 10. https://americashealthcarefuture.org/wp-content/uploads/2024/04/FINAL-REPORT.pdf
- 11. https://www.healthcare.gov/glossary/essential-health-benefits/
- 12. https://www.kff.org/affordable-care-act/health-policy-101-the-affordable-care-act/
- 13. https://www.cms.gov/marketplace/health-plans-issuers/summary-benefits-coverage
- 14. https://www.healthcare.gov/health-care-law-protections/summary-of-benefits-and-coverage/
- 15. https://www.cms.gov/cciio/resources/fact-sheets-and-faqs/indexsummarybenefitscoverage
- 16. https://www.cms.gov/newsroom/fact-sheets/no-surprises-understand-your-rights-against-surprise-medical-bills
- 17. https://www.consumerfinance.gov/ask-cfpb/what-is-a-surprise-medical-bill-and-what-should-i-know-about-the-no-surprises-act-en-2123/
- 18. https://www.dol.gov/agencies/ebsa/about-ebsa/our-activities/resource-center/publications/avoid-surprise-healthcare-expenses
- 19. https://litigationtracker.law.georgetown.edu/issues/medicare-drug-price-negotiation/
- 20. https://medicareadvocacy.org/court-rejects-pharmas-challenge-to-medicare-drug-price-negotiation/
- 21. https://www.reuters.com/business/healthcare-pharmaceuticals/us-court-rejects-novo-nordisks-challenge-medicare-drug-pricing-plan-2025-10-06/
- 22. https://subscriber.politicopro.com/article/2025/09/two-drugmakers-lose-their-medicare-negotiation-challenge-in-court-00544607
- 23. https://www.supremecourt.gov/opinions/20pdf/19-840_6jfm.pdf
- 24. https://www.kff.org/affordable-care-act/explaining-california-v-texas-a-guide-to-the-case-challenging-the-aca/
- 25. https://www.commonwealthfund.org/blog/2021/supreme-court-throws-out-aca-lawsuit-not-aca/
- 26. https://www.cbpp.org/research/health/aca-survives-legal-challenge-protecting-coverage-for-tens-of-millions
- 27. https://www.kff.org/medicaid/an-overview-of-medicaid-work-requirements-what-happened-under-the-trump-and-biden-administrations/
- 28. https://shvs.org/work-requirements-litigation/
- 29. https://www.washingtonpost.com/health/2025/05/16/medicaid-work-trump-cuts/
- 30. https://dailymontanan.com/2025/08/12/new-medicaid-federal-work-requirements-mean-less-leeway-for-states/
- 31. https://www.cms.gov/newsroom/press-releases/biden-harris-administration-protects-consumers-low-quality-coverage-limiting-junk-health-plans
- 32. https://apnews.com/article/biden-insurance-short-term-junk-ff056e344b44d5524210607e4810a191
- 33. https://www.shrm.org/topics-tools/news/benefits-compensation/biden-short-term-health-insurance-plans
- 34. https://www.beckerspayer.com/research-analysis/7-things-to-know-about-short-term-junk-health-plans-going-into-2026/
- 35. https://www.washingtonpost.com/health/2025/11/15/trump-obamacare-health-insurance/
- 36. https://www.washingtonpost.com/wellness/2025/03/28/short-term-health-insurance/
- 37. https://www.investopedia.com/policy-whiplash-how-short-term-health-insurance-may-change-under-trump-again-8747605
- 38. https://www.oyez.org/cases/2019/19-431
- 39. https://www.scotusblog.com/2020/07/opinion-analysis-court-rejects-challenge-to-exemptions-from-birth-control-mandate/
- 40. https://www.fordharrison.com/us-supreme-court-rules-in-favor-of-religious-employers-and-the-trump-administration-in-two-important-decisions
- 41. https://www.theregreview.org/2021/01/09/saturday-seminar-contraceptive-clash/