By NextBestFitFederal budget view (one year, 2024 dollars)
Under single payer nearly all health spending flows through the Treasury, so federal outlays roughly double even though national spending barely changes.
Result
$2.10T
Per resident, per year
$6,169
÷ 341.1M people
Per household
$15,918
÷ 132.2M households
How it's calculated
| # | Step | Arithmetic | Value |
|---|---|---|---|
| 1 | Outlay: Medicare benefits & administration Absorbed into UHP. | $1,118.0B → $0.0B | −$1.12T |
| 2 | Outlay: Federal share of Medicaid & buy-ins Absorbed into UHP. Before the plan, buy-ins are paid by Medicaid to Medicare and appear in both outlays and premium receipts. | $612.8B → $0.0B | −$612.8B |
| 3 | Outlay: Marketplace tax credits & subsidies Absorbed into UHP. | $116.6B → $0.0B | −$116.6B |
| 4 | Outlay: FEHB employer premiums Replaced by federal employer payroll tax (a transfer within government, shown as outlay below). | $46.7B → $0.0B | −$46.7B |
| 5 | Outlay: Federal employer payroll tax (to UHP) Intragovernmental; counted for completeness. | $0.0B → $30.0B | $30.0B |
| 6 | Outlay: UHP benefits Every covered service for every resident. | $0.0B → $3,860.4B | $3.86T |
| 7 | Outlay: UHP administration | $0.0B → $96.5B | $96.5B |
| 8 | Outlay: Workforce investment | $0.0B → $12.0B | $12.0B |
| 9 | Outlay: VA, DoD, IHS, CHIP & other federal programs Continue. | $360.6B → $360.1B | −$0.5B |
| 10 | Federal health outlays, before | $2.25T | |
| 11 | Federal health outlays, after | $4.36T | |
| 12 | Receipt: Medicare payroll taxes (HI) Continue to the UHP Trust Fund. | $431.3B → $445.5B | $14.2B |
| 13 | Receipt: Medicare premiums Part B/D premiums and Medicaid buy-ins end. The federal buy-in appropriation is redirected to UHP (an intragovernmental transfer, netted out after); the state buy-in becomes part of MOE. | $159.1B → $0.0B | −$159.1B |
| 14 | Receipt: Employer health payroll tax Includes federal and state & local employers. | $0.0B → $873.4B | $873.4B |
| 15 | Receipt: Household income-based premium | $0.0B → $512.2B | $512.2B |
| 16 | Receipt: Income tax on former premium dollars | $0.0B → $95.3B | $95.3B |
| 17 | Receipt: Top-end taxes | $0.0B → $330.1B | $330.1B |
| 18 | Receipt: State maintenance of effort States paid this to their own Medicaid programs before. | $0.0B → $345.7B | $345.7B |
| 19 | Dedicated receipts, before | $590.4B | |
| 20 | Dedicated receipts, after | $2.60T | |
| 21 | General fund needed, before | $2,254.7B − $590.4B | $1.66T |
| 22 | General fund needed, after | $4,359.1B − $2,602.2B | $1.76T |
| 23 | Change in general-fund health spending Differs slightly from the ledger's general-revenue line because the federal government also stops paying FEHB premiums and starts paying the employer tax as an employer. | $92.6B |
Trade-off: Headline 'federal cost' numbers look enormous because private premiums become public taxes; the fair comparison is national spending and who pays.