By NextBestFitReference
Coverage check
A checklist of every trade-off dimension, every affected group, and every part of today's system, each linked to where the plan covers it, plus automatic checks that every step, task, change, and money flow states its trade-off. The site will not build if any checklist link points at something missing.
Automatic checks
| Check | Items | Result |
|---|---|---|
| Every 2024 spending line (uses of funds) has its own calculation page | 16 | all covered |
| Every payment stream (sources of funds), old and new, has its own calculation page | 33 | all covered |
| Every cost item states its trade-off | 98 | all covered |
| Every task states its trade-off | 190 | all covered |
| Every system change states its trade-off | 141 | all covered |
| Every step has pros and cons | 38 | all covered |
| Every step has at least one risk with a mitigation | 38 | all covered |
| Every step has at least two comparisons with other countries | 38 | all covered |
| Every design decision has at least two alternatives and what it gives up | 15 | all covered |
| Every design decision is attached to a step | 15 | all covered |
| Every trade-off dimension in the register is attached to a step | 14 | all covered |
| Every major risk is attached to a step | 10 | all covered |
| Independent benchmark: Medicare for All Act: every section (H.R. 3421 (118th Congress), table of contents): every item mapped to the plan | 44 | all covered |
| Independent benchmark: Medicare for All Act: every benefit category (Sec. 201(a)) (H.R. 3421 (118th Congress), Sec. 201(a)(1)–(18)): every item mapped to the plan | 18 | all covered |
| Independent benchmark: CBO's single-payer design components (CBO, Key Design Components and Considerations for Establishing a Single-Payer Health Care System (2019)): every item mapped to the plan | 16 | all covered |
| Every coverage checklist item links to at least one place on the site | 218 | all covered |
Every automatic check passes.
Independent benchmark: Medicare for All Act: every section (44)
Checked against an outside document: H.R. 3421 (118th Congress), table of contents. Where this plan deliberately differs, the difference is stated.
| Item in the outside document | Where this plan covers it |
|---|---|
| Sec. 101 Establishment of the program | |
| Sec. 102 Universal coverage |
|
| Sec. 103 Freedom of choice (of provider) |
|
| Sec. 104 Non-discrimination |
|
| Sec. 105 Enrollment |
|
| Sec. 106 Effective date of benefits |
Differs: The bill phases in over 2 years; this plan uses 4 years plus an 18-month build. |
| Sec. 107 Prohibition against duplicating coverage |
Differs: This plan sunsets the ban for a mandatory congressional review in Year 10 and adds a wait-time guarantee. |
| Sec. 201 Comprehensive benefits |
|
| Sec. 202 No cost-sharing |
Differs: This plan keeps a standby copay schedule Congress can switch on. |
| Sec. 203 Exclusions and limitations | |
| Sec. 204 Long-term care services |
Differs: The bill covers institutional LTC fully; this plan requires an income-tested room-and-board contribution. |
| Sec. 301 Provider participation and standards; whistleblower protections | |
| Sec. 302 Qualifications for providers | |
| Sec. 303 Use of private contracts (opt-out) |
|
| Sec. 401 Administration |
|
| Sec. 402 Consultation | |
| Sec. 403 Regional administration | |
| Sec. 404 Beneficiary ombudsman |
|
| Sec. 405 Conduct of related health programs | |
| Sec. 411 Fraud and abuse sanctions |
|
| Sec. 501 Quality standards | |
| Sec. 502 Addressing health care disparities |
|
| Sec. 601 National health budget | Differs: The bill sets an annual national budget; this plan uses a growth target with congressional veto. |
| Sec. 611 Global budgets for institutional providers |
|
| Sec. 612 Fee-for-service for individual providers | |
| Sec. 613 Accurate valuation of physician fee schedule services |
|
| Sec. 614 Payment prohibitions; capital expenditures |
Differs: The bill bars payments from funding profit; this plan allows for-profit providers with disclosure and capital controls. |
| Sec. 615 Office of Health Equity |
|
| Sec. 616 Office of Primary Care |
|
| Sec. 617 Payments for drugs and devices |
|
| Sec. 701 Trust fund | Differs: The bill does not specify financing; this plan names every tax. |
| Sec. 801 ERISA: prohibition of duplicative employee benefits; workers' compensation coordination |
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| Sec. 802 COBRA and group health plan requirements |
|
| Sec. 803 Effective date of ERISA title | |
| Sec. 901 Relationship to Medicare, Medicaid, CHIP, FEHB, TRICARE, VA, IHS, school programs |
|
| Sec. 902 Sunset of the Exchanges | |
| Sec. 903 Sunset of pay-for-performance programs |
Differs: This plan keeps a single 2% quality withhold for hospitals. |
| Sec. 1001 Two-year transition |
|
| Sec. 1002 Transitional buy-in |
|
| Sec. 1011 End the 24-month disability waiting period | |
| Sec. 1012 Continuity of care |
|
| Sec. 1101 Definitions | |
| Sec. 1102 Rules of construction | |
| Sec. 1103 No use of resources for immigration enforcement |
Sources: U.S. House of Representatives (2023)
Independent benchmark: Medicare for All Act: every benefit category (Sec. 201(a)) (18)
Checked against an outside document: H.R. 3421 (118th Congress), Sec. 201(a)(1)–(18). Where this plan deliberately differs, the difference is stated.
| Item in the outside document | Where this plan covers it |
|---|---|
| Hospital services incl. emergency and inpatient drugs |
|
| Ambulatory patient services |
|
| Primary and preventive services, chronic disease management |
|
| Prescription drugs, devices, biologics, contraceptives |
|
| Mental health and substance use treatment |
|
| Laboratory and diagnostic services |
|
| Reproductive care incl. abortion, contraception, assisted reproduction |
Differs: Abortion coverage is left to an explicit congressional vote; IVF is covered with evidence-based limits. |
| Maternity and newborn care |
|
| Gender-affirming care |
Differs: Left to an explicit congressional vote. |
| Oral health, audiology, vision |
|
| Rehabilitative and habilitative services and devices |
|
| Emergency services and transportation |
|
| EPSDT for children |
|
| Non-emergency transportation |
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| Long-term services and supports | |
| Hospice care |
|
| Marriage & family therapists and mental health counselors | |
| Telehealth |
|
Sources: U.S. House of Representatives (2023)
Independent benchmark: CBO's single-payer design components (16)
Checked against an outside document: CBO, Key Design Components and Considerations for Establishing a Single-Payer Health Care System (2019). Where this plan deliberately differs, the difference is stated.
| Item in the outside document | Where this plan covers it |
|---|---|
| Administration: federal vs. state, public vs. contractors |
|
| Eligibility and enrollment (residency, immigrants, enrollment process) |
|
| Covered services, including long-term care |
|
| Cost sharing |
|
| Role of private insurance (supplementary vs. duplicative) |
|
| Provider payment rates |
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| Provider payment methods (FFS, global budgets, capitation) |
|
| Provider ownership and capital investment |
|
| Purchasing prescription drugs |
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| Cost containment (budgets, targets) | |
| Financing sources |
|
| Transition: timing, provider and insurer adjustment, displaced workers |
|
| Effects on provider supply and wait times | |
| Effects on national and government spending |
|
| Effects on the economy and labor market |
|
| Interaction with VA, TRICARE, IHS, workers' comp |
Sources: Congressional Budget Office (2019)
Trade-off dimensions (42)
Commonwealth Fund performance domains (access, care process, administrative efficiency, equity, outcomes), WHO building blocks (service delivery, workforce, information, medicines, financing, governance), and the design choices CBO lists for single-payer systems.
Affected groups (35)
Every group whose coverage, costs, income, or role changes.
Parts of today's system (141)
Every payer and program in the CMS National Health Expenditure accounts, plus the laws, agencies, and private institutions that govern them.
| Item | Where it is covered |
|---|---|
| Medicare Part A (hospital insurance) |
|
| Medicare Part B (physician & outpatient) |
|
| Medicare Part C (Medicare Advantage) |
|
| Medicare Part D (drug plans) |
|
| Medigap (federally standardized supplemental plans) | |
| Medicare Savings Programs & Part D Low-Income Subsidy | |
| Medicaid (acute care) |
|
| Medicaid long-term services (nursing homes, HCBS waivers) | |
| Medicaid non-medical supports |
|
| Children's Health Insurance Program (CHIP) |
|
| ACA Marketplaces (HealthCare.gov and state exchanges) |
|
| ACA Basic Health Program (NY Essential Plan, MN MinnesotaCare, OR Bridge) | |
| Federal Employees Health Benefits (FEHB) & Postal Service plan (PSHB) | |
| TRICARE (military dependents & retirees) | |
| Veterans Health Administration | |
| Indian Health Service & tribal programs | |
| COBRA continuation coverage |
|
| Navigator and enrollment-assistance grants |
|
| IRC §106 exclusion of employer health coverage |
|
| IRC §125 cafeteria plans & Flexible Spending Accounts | |
| Health Savings Accounts (IRC §223) and high-deductible plans | |
| HRAs, ICHRA & QSEHRA |
|
| IRC §36B premium tax credits |
|
| Employer mandate (IRC §4980H) |
|
| Medical expense deduction (IRC §213) and self-employed health insurance deduction (§162(l)) | |
| Employer health payroll tax (new) |
|
| Household income-based health premium (new) |
|
| Top-end surtax, capital-gains change, financial transactions tax (new) | |
| Nonprofit hospital tax exemption & charity care rules (IRC §501(r)) | |
| ERISA (employer benefit plans) & its preemption of state law (§514) | |
| ACA insurance market rules (guaranteed issue, community rating, essential health benefits, MLR) | |
| Ban on duplicative private insurance (new) |
|
| EMTALA (emergency treatment requirement) |
|
| No Surprises Act & independent dispute resolution | |
| HIPAA (privacy, security, transaction standards) |
|
| Medicare Secondary Payer rules & coordination of benefits | |
| Hyde Amendment |
|
| Medicare hospital payment systems (IPPS DRGs, OPPS) |
|
| Medicare Physician Fee Schedule (RBRVS) & the AMA RUC |
|
| Medicaid & Medicare DSH and supplemental payments |
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| 340B Drug Pricing Program |
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| Medicare Graduate Medical Education funding |
|
| State certificate-of-need laws |
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| Stark law & Anti-Kickback Statute |
|
| Hospital and insurer price transparency rules |
|
| Prior authorization & utilization management | |
| Medicare ACOs & CMS Innovation Center models | |
| Medical malpractice (state tort law) | |
| Pharmacy benefit managers |
|
| Medicare Drug Price Negotiation (IRA) | |
| Physician-administered drugs (Medicare Part B ASP+6%) | |
| Manufacturer rebates and Medicaid Drug Rebate Program | |
| Medical devices & durable medical equipment pricing | |
| State insurance departments & mandated benefits |
|
| State & local employee and retiree health plans | |
| State Medicaid agencies |
|
| County indigent-care programs & public hospital subsidies | |
| Scope-of-practice laws (NPs, PAs, pharmacists, dental therapists) | |
| Workers' compensation medical benefits | |
| Auto insurance personal injury protection & liability medical payments | |
| Private health insurers (commercial, MA, Medicaid MCO) | |
| Employer health benefits |
|
| Multiemployer (Taft-Hartley) union health funds | |
| Brokers, agents, benefits consultants |
|
| Revenue-cycle, clearinghouse & claims-editing vendors | |
| Medical debt collection & credit reporting |
|
| Private-equity and investor ownership of practices and facilities | |
| Provider networks |
|
| Deductibles, copays, coinsurance, out-of-pocket maximums | |
| Annual open enrollment and plan selection |
|
| Claim denials and appeals |
|
| Wait-time guarantee (new) |
|
| National Health Service Corps & Title VII/VIII training programs | |
| Licensing for internationally trained clinicians |
|
| Displaced-worker transition program (new) |
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| X12 claim transactions (837/835/270/271) across payers | |
| UHP number and card (new) |
|
| National wait-time registry (new) |
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| Critical Access Hospitals (cost-based reimbursement) |
|
| FQHC and Rural Health Clinic prospective payment (encounter rates) | |
| Medicare End-Stage Renal Disease program |
|
| Medicare hospice benefit |
|
| PACE (Programs of All-Inclusive Care for the Elderly) | |
| Dual Eligible Special Needs Plans (D-SNPs) |
|
| Ryan White HIV/AIDS Program |
|
| Title X family planning program |
|
| SAMHSA mental health & substance use block grants | |
| Certified Community Behavioral Health Clinics |
|
| ACA cost-sharing reductions & silver loading |
|
| ACA and Medicare Advantage risk adjustment | |
| Section 1332 (ACA) and Section 1115 (Medicaid) waivers |
|
| Short-term limited-duration plans, fixed indemnity plans & health care sharing ministries | |
| Direct primary care & concierge medicine |
|
| Antitrust enforcement for hospital and physician mergers |
|
| Site-of-service payment differences (hospital outpatient vs. physician office) | |
| ACA ban on new physician-owned hospitals |
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| Telehealth coverage rules |
|
| State licensure (interstate compacts for physicians, nurses, psychologists) | |
| Organ transplant financing (organ acquisition cost centers) | |
| Coverage of routine costs in clinical trials | |
| Pregnancy coverage (Medicaid covers about 41% of births) | |
| School-based health services billed to Medicaid |
|
| Health care in jails and prisons (Medicaid inmate exclusion) | |
| Employer wellness programs and on-site clinics | |
| Medical travel abroad and across borders |
|
| Disability, long-term-care, and life insurers | |
| State provider taxes and intergovernmental transfers funding Medicaid | |
| Group purchasing organizations & drug wholesalers | |
| Biosimilar and generic substitution | |
| Vaccines for Children & adult vaccine coverage | |
| 1997 Medicare cap on funded residency positions |
|
| Insurer statutory reserves and guaranty associations | |
| Provider–insurer contracts and value-based agreements | |
| Hospital uncompensated care and charity care policies |
|
| Centers for Medicare & Medicaid Services (CMS) | |
| AHRQ & PCORI (comparative-effectiveness research) | |
| Medicare Board of Trustees & trust-fund insolvency projections | |
| National Institutes of Health |
|
| CDC and state & local public health departments |
|
| FDA drug and device approval |
|
| HRSA (health centers, workforce programs, Ryan White) | |
| DOL Employee Benefits Security Administration (health plan oversight) | |
| IRS health-coverage reporting (Forms 1095-A/B/C) |
|
| Medicare hospital cost reports |
|
| Hospital and practice billing departments |
|
| Mid-transition employer plan pools |
|
| Coverage of people experiencing homelessness, migrant farmworkers, and others without records | |
| Distressed-hospital support (state bailouts, HHS Provider Relief-style funds) | |
| Fertility treatment (IVF and assisted reproduction) | |
| Ground and air ambulance services |
|
| Medicaid EPSDT standard for children |
|
| Non-emergency medical transportation |
|
| Licensed mental health counselors and marriage & family therapists | |
| Office of Health Equity (new) |
|
| Office of Primary Care (new) |
|
| Medicare pay-for-performance programs (MIPS, Hospital Value-Based Purchasing, readmission penalties) | |
| 24-month Medicare waiting period for people on disability (SSDI) | |
| Transition buy-in for people not yet eligible | |
| Continuity of ongoing treatment at switchover |
|
| Non-discrimination by participating providers | |
| Formal consultation with patients, providers, states, and tribes |