Define the benefit package & cost sharing

Months 0–12 · Congress (statutory categories); UHA Chief Medical Officer; HTA InstituteDiscuss 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
EMTALA (emergency treatment requirement) continues— Federal insurance & health law	Hospitals must screen and stabilize anyone, which generates uncompensated care.	Continues; uncompensated care for residents disappears because everyone is covered.	Emergency departments no longer serve as the de facto safety net.
Hyde Amendment amendedYear 0 Federal insurance & health law	Annual appropriations rider barring federal funds for most abortions.	Requires an explicit congressional decision for UHP (see design decisions).	Uniform coverage vs. political breadth.
Medical debt collection & credit reporting endsYear 4 Private sector	About 100M Americans carry medical debt.	No new debt from covered care; existing medical debt purchase-and-forgive program optional (not costed).	Collection industry shrinks.
Deductibles, copays, coinsurance, out-of-pocket maximums endsBy wave Patients	Average single deductible about $1,800 in employer plans; out-of-pocket max up to $9,200 single (2025).	Abolished for covered services.	No financial barrier; more induced demand.
Ryan White HIV/AIDS Program amendedYear 4 Federal programs	Payer of last resort for HIV care, drugs (ADAP), and support services for low-income and uninsured people.	Medical care and drugs move to UHP; Ryan White funds refocus on case management, housing, and support services.	More stable coverage of HIV medications; HIV service organizations lose some of their funding role.
Title X family planning program amendedYear 4 Federal programs	Grants for family-planning services for low-income and uninsured people.	Clinical services move to UHP; Title X refocuses on outreach, education, and confidential services for minors.	Universal coverage of contraception; Title X's future scope becomes a political fight.
SAMHSA mental health & substance use block grants amendedYear 4 Federal programs	Fund services for uninsured people and services insurers do not cover.	Treatment moves to UHP; block grants refocus on crisis systems (988), prevention, and recovery support.	Treatment is covered for all; state behavioral-health agencies must redefine their role.
Telehealth coverage rules expandedYear 1 Provider payment & regulation	Medicare telehealth flexibilities repeatedly extended on short-term deadlines; private coverage varies.	Permanent UHP telehealth coverage at parity for clinically appropriate services, including audio-only for behavioral health.	Expands capacity and rural access; higher fraud risk and possible extra visits that add to rather than replace in-person care.
Organ transplant financing (organ acquisition cost centers) expandedYear 1 Provider payment & regulation	Medicare reimburses transplant hospitals for organ acquisition costs through cost reports; patients need insurance to be listed.	UHP covers transplants and lifetime immunosuppressive drugs for all; insurance status no longer affects listing.	Ends insurance-based barriers to transplant listing; more demand for a fixed supply of organs.
Coverage of routine costs in clinical trials expandedYear 1 Federal insurance & health law	Required for Medicare and ACA plans, but patients still face network and prior-authorization barriers.	UHP covers routine care costs in all approved trials nationwide.	Easier trial enrollment; small added cost.
Pregnancy coverage (Medicaid covers about 41% of births) replacedYear 1 Patients	Many pregnant people move into Medicaid during pregnancy and lose coverage after 12 months postpartum (where states extended it).	Continuous UHP coverage before, during, and after pregnancy; doulas and midwives covered.	Ends postpartum coverage cliffs; obstetric units in low-volume rural hospitals still need budget protection to stay open.
Fertility treatment (IVF and assisted reproduction) expandedYear 1 Patients	Covered by some employer plans and state mandates (about 15 states require IVF coverage); otherwise paid out of pocket at roughly $15,000–25,000 a cycle.	UHP covers infertility diagnosis and up to three IVF cycles for people with a medical infertility diagnosis, with evidence-based limits set by the HTA Institute.	Ends income-based access to fertility care; adds cost, and cycle limits will disappoint some patients. The Medicare for All Act covers assisted reproduction without stated limits.
Ground and air ambulance services expandedYear 1 Patients	Ground ambulances are excluded from the No Surprises Act, so surprise bills are common; many services are municipal.	Covered with no cost sharing at UHP rates; municipal services bill UHP; air ambulance paid at a national rate.	Ends surprise ambulance bills; private-equity-owned air ambulance firms lose high out-of-network charges.
Non-emergency medical transportation expandedYear 1 Patients	A Medicaid benefit, often poorly run by brokers; absent from Medicare and most private plans.	UHP covers rides to care for people with disabilities, older people with functional limits, and low-income people (as the Medicare for All Act does).	Reduces missed appointments; a fraud-prone benefit that needs tight program-integrity controls.