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Prior to passage of Obamacare, the discussion among liberals was pretty exclusively centered on whether or not a public option would be included as one of the choices on the exchanges. There was also a lot of talk about allowing Medicare buy-in for those 55 and older. Meanwhile, the whole expansion of Medicaid went almost completely unnoticed.

When the Supreme Court gave states the option of whether or not to accept Medicaid expansion, we started talking about that aspect of Obamacare and watched as states who chose expansion not only had much more significant reductions in the number of people who were uninsured, they also reduced their costs.

But with Republican attempts to repeal/replace Obamacare, the program that currently covers 62 million Americans seems to have finally come to the forefront. While Speaker Paul Ryan has been dreaming of decimating Medicaid since he was going to keggers, even Republican governors who expanded the program are fighting to keep it.

So it should come as no surprise that at least one state is exploring whether or not to go full circle and actually make Medicaid their public option. Sarah Kliff has the story.

The Nevada legislature passed a bill Friday that would allow anyone to buy into Medicaid, the public program that covers low-income Americans. It would be the first state to open the government-run program to all residents, regardless of their income or health status…

Under [state Assembly member Michael Sprinkle’s] bill, people who qualify for tax credits under the Affordable Care Act would be able to use those credits to buy Medicaid coverage instead. People who don’t qualify for anything would be able to use their own money to do the same. The plan would likely sell on Nevada’s health insurance marketplace, making it a public option to compete against the private health insurance plans also selling there.

“Medicaid is the better fit [than Medicare],” Columbia University’s Michael Sparer recently wrote at the New York Times. It has a more generous benefits package, is less costly and is developing more innovative care-management strategies. Moreover, the integration of the Obamacare exchanges into Medicaid would be relatively seamless: Many health plans are already in both markets.

My reaction when I read all that was, “why didn’t someone think of this before?”

While Kliff explains that there are still some details to be worked out, this strikes me as a more natural next step towards universal care and cost containment than the kind of major overhaul proposed in California. For those who advocate a public option as the next step, why create a whole new program when Medicaid is already in place and integrated on the exchanges?

One critique of Medicaid is that there are physicians and clinics who refuse to accept it because, on average, the program pays 66 percent of what Medicare pays doctors (which is already significantly less than what private insurers pay). But as the market of those covered by Medicaid continued to grow, it would become increasingly difficult to deny providing services to so many people.

Because Medicaid is administered by individuals states with a lot of variation, this might not work in some places. But I certainly hope that Republican Governor Brian Sandoval signs this bill so that we can all watch what happens when Medicaid becomes the public option in Nevada.

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