Create the UHP Trust Fund

Months 0–12 · Treasury (managing trustee), UHADiscuss this step

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

#	Action	Owner	When	Trade-off
1.2.1	Merge the Medicare HI and SMI trust funds into the UHP Trust Fund; transfer balances.	Treasury	Month 12	Merging trust funds simplifies financing but ends the separate Medicare HI accounting that seniors view as an earned benefit.
1.2.2	Set up automatic transfers: payroll and premium receipts, state MOE payments (monthly), and federal general-revenue appropriations (permanent, indefinite).	Treasury	Month 6–12	Automatic transfers ensure stable funding but reduce Congress's ability to adjust spending each year.
1.2.3	Establish a contingency reserve equal to 2 months of benefits (about $643.4B at steady state), built over 5 years.	Treasury	Years 1–5	A 2-month reserve cushions recessions but ties up hundreds of billions of dollars that could lower taxes.
1.2.4	Create an annual trustees report with a 10-year and 75-year projection, and an automatic trigger when the reserve falls below 1 month.	Trustees	Year 1+	Long-range projections improve planning but create recurring 'insolvency' headlines that fuel political attacks.