By NextBestFitPhase 1: Enactment & build · Step 1.2
Create the UHP Trust Fund
Months 0–12 · Treasury (managing trustee), UHADiscuss this step
Accounting structure only. Building the reserve is cash timing and is not in the steady-state ledger.
| Cost item | Type | 2024 / before | Amount |
|---|---|---|---|
| Government public health 3 calculation steps | Spending | $157.6B | $157.6B |
| Non-commercial research 3 calculation steps | Spending | $70.4B | $70.4B |
| Employer Medicare payroll tax (1.45%) 4 calculation steps | Funding source | $159.2B | $165.7B |
| Worker & self-employed Medicare payroll tax 4 calculation steps | Funding source | $246.4B | $254.1B |
| Philanthropy, provider investment income, private research 3 calculation steps | Funding source | $340.5B | $340.5B |
| Federal employer Medicare payroll tax 3 calculation steps | Funding source | $5.8B | $5.8B |
| Medicare general revenue & net trust fund draw 3 calculation steps | Funding source | $509.6B | $509.6B |
| Federal Medicare buy-in premiums for dual eligibles 3 calculation steps | Funding source | $16.1B | $16.1B |
| Federal public health 3 calculation steps | Funding source | $35.4B | $35.4B |
| Other federal programs 3 calculation steps | Funding source | $17.9B | $17.9B |
| State & local employer Medicare payroll tax 3 calculation steps | Funding source | $19.9B | $19.9B |
| State & local health programs (CHIP share, hospitals, etc.) 3 calculation steps | Funding source | $84.2B | $84.2B |
| State & local public health 3 calculation steps | Funding source | $122.1B | $122.1B |
| Other state & local programs 3 calculation steps | Funding source | $40.9B | $40.9B |
| Federal budget view (one year, 2024 dollars) 23 calculation steps | Budget view | — | $2.10T |
| Ten-year federal window (2027–2036) 20 calculation steps | Budget view | — | $32.06T |