In the ensuing years, various public option proposals have been put forth by states and by federal lawmakers. Varying approaches to a public option were supported by several of the candidates who ran for the 2020 Democratic presidential nomination. The platform of then-candidate Joe Biden, who won the 2020 election, incorporated a proposal for a widely available public option that would be similar to Medicare but available for purchase by any American. (Congress has a slim Democratic majority as of 2021, and the idea of a federally-run public option has been considered. But the Biden administration and Congressional Democrats have tended to focus more on the American Rescue Plan's subsidy enhancements, which are driving record-high enrollment in the health insurance marketplace, and record-low after-subsidy premiums.) Public option concepts run the gamut from a strictly government-run and administered program, to Medicaid buy-in (which would generally incorporate private insurers that have Medicaid managed care contracts), to a quasi public-private program in which the government sets some or all of the parameters and reimbursement rates, and contracts with private insurers to offer the coverage. Thus far, that third option has been the one that a few states have opted to pursue: Washington state rolled out the nation's first public option in the fall of 2020. The plans are offered by private health insurers, with provider reimbursements capped at 160% of what Medicare pays. Colorado regulators and lawmakers spent much of 2019 working on a public option proposal that they hoped to make available by the fall of 2021. But the legislation to create the program was abandoned in May 2020 as a result of the COVID-19 pandemic. Lawmakers in Colorado revived the bill in 2021, and it was ultimately signed into law in June 2021, with plans set to become available in the fall of 2022 (for 2023 coverage). But due to amendments made during the legislative process, the program will essentially just be standardized plans, offered by private health insurance companies, with premium reduction targets. Nevada also enacted legislation in 2021 that will create a public option program, although the plans won't be available for purchase until the fall of 2025, for coverage effective in 2026.