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

Every concrete action this step requires, who is responsible, and when it happens relative to enactment.

#ActionOwnerWhenTrade-off
1.4.1Build the enrollment file from SSA (Numident), IRS (filers and dependents), Medicare and Medicaid rolls, and state birth records.UHA / SSA / IRSMonth 6–12Linking SSA, IRS, and state records enrolls nearly everyone automatically but concentrates sensitive data in one file.
1.4.2Issue a UHP number to each person (extending the Medicare Beneficiary Identifier format); do not use SSNs on cards.UHAMonth 9–15Keeping SSNs off cards reduces identity theft but requires a new identifier crosswalk for every provider system.
1.4.3Mail cards in waves; offer a digital card in a mobile app; providers can verify by name and date of birth if the card is lost.UHAMonth 12–18Digital cards are convenient but disadvantage people without smartphones.
1.4.4Presumptive eligibility: anyone who shows up for care is treated and enrolled at the point of care. No one is turned away for lack of a card.UHA / providersDay 1Presumptive eligibility ensures no one is turned away but lets some non-residents receive care at public expense.
1.4.5Define residency rules: 90 days of residence, with evidence such as a lease, utility bill, school enrollment, or employer letter. Students and workers on visas are covered while resident.UHAMonth 6Flexible residency evidence reaches undocumented and unbanked residents but is easier to falsify.
1.4.6Set rules for Americans abroad: coverage pauses after 12 months abroad and resumes on return. Cross-border commuters are covered.UHAMonth 6Pausing coverage after 12 months abroad saves money but complicates coverage for long-term expatriates and military families.
1.4.7Use the IRS address file to notify every household which wave covers each member.UHA / IRSMonth 12Using IRS addresses reaches most households but misses people who don't file taxes.