Phase 1: Enactment & build · Step 1.11

Rewrite insurance & benefits law

Effective in stages with each enrollment wave · Congress; DOL EBSA; Treasury; state insurance commissionersDiscuss this step

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

#	Action	Owner	When	Trade-off
1.11.1	Prohibit sale of insurance covering UHP benefits to UHP-eligible people (wave by wave). Penalty: a 100% excise tax on premiums for prohibited coverage.	Congress / Treasury	Each wave	A 100% excise tax effectively bans duplicative insurance, but it restricts voluntary contracts and will be litigated.
1.11.2	Define 'supplementary coverage' (non-covered services only) and regulate it under state insurance law; require a minimum 85% medical loss ratio.	Congress / NAIC	Month 12	An 85% minimum loss ratio protects buyers of supplementary coverage but may drive small insurers out of the market.
1.11.3	Repeal the employer mandate penalty (IRC §4980H) and the individual-market subsidies (IRC §36B) at Year 4.	Congress	Year 4	Repealing the employer mandate ends hiring distortions but removes a requirement employers have planned around.
1.11.4	End the tax exclusion for employer health coverage (IRC §106) for UHP-covered services; keep it for supplementary dental, vision, and LTC coverage up to a cap.	Congress	Each wave	Ending the tax exclusion raises revenue and fairness but takes away a tax benefit workers didn't see as income.
1.11.5	Amend ERISA preemption so states can regulate supplementary coverage and enforce UHP coordination of benefits.	Congress	Month 0	Amending ERISA preemption lets states regulate supplements but creates 50 sets of rules for multistate employers.
1.11.6	Repeal health COBRA continuation once everyone is eligible.	Congress	Year 4	Repealing COBRA removes an unaffordable option but eliminates a fallback if UHP is ever underfunded.