We estimate national and state effects of implementing the Basic Health Program option in national health reform to provide near-poor adults with coverage like Medicaid and the Children’s Health Insurance Program.Implemented nationally, such a policy would reduce these adults’ annual premium and out-of-pocket costs from $1,652 to $196; lower the number of uninsured by 600,000; provide federal dollars that exceed baseline Medicaid/CHIP costs by 23 percent; reduce exchange enrollment from 9.8 to 8.2 percent of non-elderly residents; save states $1.3 billion annually in Medicaid costs; and raise risk levels in individual markets. State policy choices could change these results.