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Colorado's Senate advanced another piece of Democratic Gov. Jared Polis' health care agenda on Tuesday by tentatively endorsing a study on creating a state-run health insurance option.

The bill would direct state agencies to recommend a plan that would compete with existing private insurance plans and those offered on Colorado's health care exchange. Another Senate vote sends the study bill to the governor. It's already  cleared the House on a bipartisan 46-17 vote.

Backers say it's designed to curb some of the nation's highest insurance premiums in mountain and other rural areas. Fourteen of Colorado's 64 counties have just one insurer for the individual market, and monthly premiums there can be $500 higher than in metropolitan Denver.

The so-called "public option" bill is one of several measures advocated by Polis to reduce health care costs and increase accessibility for Colorado residents. In Washington state, Democratic Gov. Jay Inslee has called for a state-based public option health insurance plan that he has called a "step toward universal health care."

Polis' campaign for office stressed a variety of strategies for achieving universal coverage.

The first-term governor already has signed a hospital price transparency bill into law.

Majority Democrats in the Legislature are expected to send him bills to create a state reinsurance program to help private insurers lower premiums; a prescription drug price transparency bill; and a bill to get the federal government's permission to import cheaper prescription drugs from Canada.

The public option legislation directs the Department of Health Care Policy and Financing and the Department of Regulatory Agencies to present a proposal in November. The plan would assess costs, funding sources, necessary federal permissions and funding, consumer eligibility and who in government would run a plan.

Supporters say enrollment could begin in 2020 and a plan could start operating in 2021. Sponsors include Sen. Kerry Donovan and Rep. Dylan Roberts, both Democrats, and Republican Rep. Marc Catlin.

Donovan noted Tuesday that too many residents in her own district, which includes Aspen, Vail and Glenwood Springs, have to choose between health insurance and paying mortgages or other family expenses.

Republican Sen. Jim Smallwood, an insurance broker, questioned the wisdom of having government step in as a competitor. He noted that high rural premiums persist and are rising under a state health insurance exchange adopted under the 2010 Affordable Care Act.

"Introducing the concept of a public cure for what is broken in Obamacare seems hypocritical," Smallwood said.

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