By NextBestFitState pilots first
Run full universal systems in a few volunteer states, measure, then scale nationally.
Draft decision:RejectedConfidence: medium · not yet reviewed
Phased national waves chosen instead.
To review: State pilots could precede wave one if you prefer more evidence first.
Review ledgerHow this path connects
This path
State pilots first
Concrete changes if chosen
What would actually have to change in law, agencies, payment rules, or systems.
- Fund volunteer state pilots
- Evaluate before national roll-out
Effects
Each effect has its own page: the evidence, the case that it is or isn't a real cost, and whom it affects.
What it fixes
- Transition disruption: jobs, companies, and familiar coverage
Testing full universal systems in volunteer states provides real evidence before national expansion and lowers rollout risk.
What it creates or worsens
- Leaves funding vulnerable or inflexible
Volunteer-state pilots face migration and funding limits while attempting to run full universal systems.
- Takes years, or money up front, before it pays off
Testing state systems before expanding nationally makes the transition slow.
Who's affected
Who gains
- People with employer coverage
- Transition disruption: jobs, companies, and familiar coverage: People leave plans most of them rate well, and must re-learn how coverage works.
- Insurance and billing workers
- Transition disruption: jobs, companies, and familiar coverage: Jobs selling coverage and processing claims end.
- Health insurers, brokers, and their shareholders
- Transition disruption: jobs, companies, and familiar coverage: Insurers lose their core business, and shareholders lose value.
- State governments
- Transition disruption: jobs, companies, and familiar coverage: Testing full universal systems in volunteer states provides real evidence before national expansion and lowers rollout risk.
Who loses
None identified.
Where it has been tried
- Canada (Saskatchewan): Provincial program led the national system.
- Vermont: Vermont's December 2014 Green Mountain Care report estimated $2.580 billion in needed new state tax revenue for 2017 and modeled an 11.5% employer payroll tax plus income-based public premiums up to 9.5%.Sources: State of Vermont (2014)