Universal HealthcareBy NextBestFit
Phase 1: Enactment & build · Step 1.4

Enroll everyone automatically

Months 6–18 for Wave 1, then before each wave · UHA, SSA, IRSDiscuss this step

Who is eligible

Who counts as a resident?

The plan chooses
Every person who lives in the U.S., regardless of immigration status, after 90 days of residence. Visitors and people within 90 days of arrival receive emergency care billed to travel insurance or paid by UHP if uncollectable. Undocumented immigrants are covered. This is the most contested choice in the plan, and the alternatives are set out below.

Leaving out roughly 11 million undocumented residents would keep EMTALA-driven uncompensated emergency care, public-health gaps (infectious disease goes untreated), and the eligibility-verification bureaucracy that single payer is meant to remove. Their care is already in the 2024 baseline (uncompensated care, Emergency Medicaid, out-of-pocket). Covering them adds an estimated $25–40B in utilization, which is included in the utilization effect.

All residents after 90 days (chosen)

As described.

Pros
  • +No verification bureaucracy at the point of care
  • +Public-health benefits from treating contagious disease early
Cons
  • −Politically very costly; the most common objection
  • −A possible 'magnet' effect Evidence from Spain and others is weak, but voters believe it.

Precedent: Spain (restored 2018), Italy (STP card), Thailand (migrant health insurance).

Citizens and lawful residents only

Undocumented people get emergency care only.

Pros
  • +Politically easier; saves about $25–40B a year
Cons
  • −Requires status verification in every clinic, plus a billing system for the uncovered
  • −Hospitals keep uncompensated care

Precedent: UK charges some overseas visitors; Canada covers permanent residents only.

What this choice gives up
  • Political support from voters who oppose coverage for undocumented immigrants.

VA, TRICARE, and the Indian Health Service

Do the existing federal direct-care systems fold into UHP?

The plan chooses
No. The VA, military health system, and IHS continue as delivery systems, and their beneficiaries are also UHP-eligible. UHP pays the IHS and tribal programs for care they deliver to UHP-eligible patients, which adds money to chronically underfunded programs. TRICARE for dependents and retirees moves to UHP; active-duty care stays with the Defense Health Agency.

These are treaty, service, and readiness obligations with their own politics and legal basis. Merging them would add risk without adding savings.

Keep as delivery systems (chosen)

As described.

Pros
  • +No disruption to veterans' care; honors tribal sovereignty
Cons
  • −Keeps $306.8B of separate federal programs and some duplication

Fold into UHP

Single system for everyone.

Pros
  • +Maximum simplicity
Cons
  • −Veterans' organizations and tribes would strongly oppose
What this choice gives up
  • Some administrative simplification.