NY state already increased their Medicaid buy-in threshold to $50,000 for a family of four. It’s not called Medicaid, but “essential plan”, but it comes to the same thing. I suspect that states will gradually raise this threshold and allow people to buy into Medicaid until they end up with a de-facto public option. It will be done slowly so as not to piss on the insurers’ parades, but it will happen.