Two of the most populous and legislatively influential states in the nation — California and New York — currently have single-payer healthcare systems under serious consideration. If enacted, these measures would eliminate the private health insurance industry in those states, including health insurance carriers, brokers and employer-sponsored health benefits, and replace them with state-run programs. Below are five reasons why all advisers cannot ignore the single-payer debate in these bellwether states.

1) This is the pre-cursor to a national conversation. Bernie Sanders’ “Medicare for all” message continues to be popular at the public level and has propelled a social movement based on the idea that healthcare is a human right and the healthcare delivery system should be a not-for-profit business. Progressive state legislators in California and New York are motivated by the uncertain future of the Affordable Care Act, and by fear about the loss of benefits for their state’s residents. They feel pressured to find a solution, and are putting their support behind state-based single-payer systems. Even Aetna’s CEO has acknowledged the need for a single-payer healthcare discussion at the national level.

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