Ban Private Health Insurance Companies and Establish State-Run Public System

I am writing to urge you to introduce legislation banning private health insurance companies from operating in our state and replacing them with a state-run public health insurance system. The current system is fundamentally broken. Between 2022 and 2023, care denials increased 20.2% for commercial insurance and 55.7% for Medicare Advantage claims. Insurance companies are using machine learning tools to automatically reject claims without clinical review, profiting by denying care they were paid to provide. The five largest health insurers collected $31.7 billion in combined net income in 2024, with UnitedHealth Group CEO Andrew Witty receiving $26 million in compensation including $22 million in stock options. This money comes from premiums paid by people who didn't receive the care they needed. The efficiency gap between public and private insurance is staggering. Medicare spent approximately 1.4% of total expenditures on administration in 2016, while private insurers spend roughly 17% on overhead including marketing, executive compensation, shareholder returns, and lobbying. Research by Woolhandler and Himmelstein found average insurer overhead of 12.4%. A Milbank Quarterly study estimated that standardizing insurance contracts alone could reduce billing costs by 27-63%. States have clear legal authority to ban private insurers. The McCarran-Ferguson Act of 1945 explicitly delegated insurance regulation to states, reaffirmed in the Gramm-Leach-Bliley Act and Dodd-Frank Act. Four states—Ohio, North Dakota, Washington, and Wyoming—already ban private insurers from selling workers' compensation insurance entirely, requiring employers to buy coverage exclusively from state-run funds. We can do the same for health insurance. A state-run system would pool risk and pay claims using actuarial science, but eliminate spending on advertising, executive compensation, shareholder dividends, lobbying, and denial departments. The medical infrastructure would remain unchanged—only the payment system would shift from profit-driven corporations to a public authority focused on delivering care. For a detailed analysis of how this would work, please see https://cmarmitage.substack.com/p/what-would-happen-if-a-state-banned I urge you to introduce legislation banning private health insurance companies in our state and establishing a comprehensive state-run public health insurance system for all residents.