Method & assumptions

Private insurers paid roughly 254% of Medicare for hospital services in 2022 (RAND round 5); we use 220% to blend in lower-paying Marketplace and Medicare Advantage-adjacent contracts. Medicaid pays below Medicare on base rates but closer to it once supplemental and directed payments are counted, so 90%. UHP pays 120% of Medicare because MedPAC finds Medicare fee-for-service margins negative for the average hospital (about -13% in 2023); 120% approximately covers the average efficient hospital's costs once billing overhead falls. Inpatient care is not very price-sensitive, so utilization rises only 4%.

Commercial physician prices average about 140% of Medicare (higher for specialists, near 120% for primary care). Medicaid's fee index is about 0.72× of Medicare. UHP pays an average of 112% of Medicare, weighted toward primary care (125%) and away from procedures (105%). Removing deductibles and copays and covering 28 million uninsured people raises visits by roughly 12%, consistent with RAND Health Insurance Experiment elasticities and Oregon Medicaid experiment results.

Physical therapy, mental-health counseling, optometry. A quarter of today's out-of-pocket spending in this category (elective chiropractic, massage, and therapy beyond clinical-necessity limits) stays out of pocket. Mental-health and therapy demand is highly price-sensitive, so utilization rises 15%.

Adult dental is the largest new benefit. Medicaid dental fees average about 60% of private fees. Cosmetic work and adult orthodontics (about 20% of today's out-of-pocket dental spending) stay out of pocket. About 40% of adults skip dental care today because of cost, so utilization rises 35%.

Home- and community-based services (HCBS) become an entitlement instead of a capped Medicaid waiver with waiting lists (about 700,000 people were on HCBS waiting lists in 2023). Rates rise 5% to raise direct-care worker pay. Non-medical help (housekeeping) stays out of pocket.

Medicare's home-health payment becomes the national rate. Utilization rises 20% because long-term home care is covered without the Medicaid asset test.

UHP pays for the clinical and personal-care component of nursing-home stays. Residents still contribute toward room and board on an income-tested scale, as in Canadian provinces; we estimate that keeps 45% of today's out-of-pocket nursing spending out of pocket. Medicare's short-stay rates are about 30% above the blended reference rate; Medicaid's are about 15% below it.

A single national formulary negotiating every brand drug cuts brand net prices about 35% (still above the 2-3x lower prices in other wealthy countries, RAND 2024). Generics, about 20% of spending, stay at today's price. 0.8 x 0.65 + 0.2 x 1.0 = 0.72. Medicaid already gets mandatory rebates, so it pays about 70% of the reference price. Removing copays raises fills 8%, mostly adherence to chronic medications. Drugs not on the formulary stay out of pocket (5%).

Basic eyeglasses and hearing aids become covered. Designer frames, premium hearing aids, and convenience items (40% of today's out-of-pocket spending) remain out of pocket. Utilization rises 25%, mostly for hearing aids: only about 30% of adults over 70 who would benefit from one have one.

Over-the-counter products stay out of pocket, as they do in nearly every universal system. The small Medicare amount (supplies tied to covered conditions) continues under UHP.