Create the Health Technology Assessment Institute

Months 0–18; continuous · HTA Institute (independent, within HHS)Discuss this step

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

#	Action	Owner	When	Trade-off
1.10.1	Merge PCORI and AHRQ's evidence centers into the Institute; staff about 600 analysts and clinicians.	HHS	Month 0–12	Merging PCORI and AHRQ builds a capable institute quickly but may shift their missions from research to coverage decisions.
1.10.2	Publish methods: comparative effectiveness and budget impact. If cost-per-QALY is used, also report results without it, to address disability-discrimination concerns.	HTA Institute	Month 6	Reporting results with and without QALYs addresses disability-rights concerns but complicates decisions.
1.10.3	Build a 'low-value care' list (e.g., imaging for uncomplicated low-back pain, vitamin D screening) for non-coverage or clinical guidance.	HTA Institute	Year 1–2	A low-value care list reduces waste but restricts some services patients and physicians want.
1.10.4	Set a 180-day maximum for assessment of new drugs and devices, with provisional coverage during review.	HTA Institute	Month 12	Provisional coverage during review speeds access but makes later removal politically hard.