Phase 1: Enactment & build · Step 1.1

Create the Universal Health Administration

Months 0–18 · HHS Secretary; UHA Administrator (Senate-confirmed, 6-year term, removable only for cause)Discuss this step

Every existing law, program, institution, or practice this step changes: what it is today, what happens to it, when, and what that costs or trades off.

What	Today	Change	Trade-off
Claim denials and appeals replacedYear 1 Patients	Different processes per insurer; external review varies.	One national appeals process with 30-day decisions; ombudsman.	Simpler; a single payer's denial has no alternative insurer.
Centers for Medicare & Medicaid Services (CMS) replacedYear 0 Federal programs	Runs Medicare, oversees state Medicaid and CHIP programs and the federal Marketplace.	The Center for Medicare and its contractors become the core of the Universal Health Administration; Medicaid and Marketplace oversight shrinks to the residual Medicaid program. Public program administration $66.1B → $107.5B Agency start-up before steady-state funding	Builds on proven operations; carries over CMS's institutional culture and legacy systems.
Office of Health Equity (new) newYear 1 Federal programs	Disparities monitoring is scattered across agencies.	A UHA office that publishes access, wait-time, and outcome data by race, ethnicity, language, disability, geography, and income, and directs capital funds to underserved areas.	Makes inequities visible and fundable; adds data-collection burden and can become politically contested.
Formal consultation with patients, providers, states, and tribes newYear 0 Federal programs	Rulemaking comment periods and advisory committees.	Standing advisory councils for patients, clinicians, states, labor, and tribal nations, with published responses to their recommendations.	More legitimacy and earlier warning of problems; slower decisions.