Phase 1: Enactment & build · Step 1.5

Define the benefit package & cost sharing

Months 0–12 · Congress (statutory categories); UHA Chief Medical Officer; HTA InstituteDiscuss this step

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Task 1.5.3 of 7

Set $0 cost sharing for all covered services; write the standby prescription copay schedule ($0/$5/$15, $200 annual cap, waived below 200% FPL) that Congress can switch on.

Who does it

Congress

When

Drafting

Trade-off

Zero cost sharing removes financial barriers but removes the price signal against low-value care.

Part of: Define the benefit package & cost sharing

Write down exactly what UHP covers, what it excludes, and what patients pay at the point of care: nothing for covered services. Out-of-pocket spending falls from $556.6B to $197.3B; what remains is for excluded items.

This step changes 14 existing laws, programs, or institutions. See the list.