By NextBestFitPhase 1: Enactment & build · Step 1.13
Launch the displaced-worker program
Month 6 onward; benefits through Year 6 · Department of Labor; state workforce boardsDiscuss this step
Pros & cons of this step
Pros
- +Turns an accepted cost (job loss) into a managed transition.
- +Many displaced workers have health-system skills that are in shortage elsewhere.
Cons
- −Wage losses for many displaced workers will be permanent despite the program Displaced-worker research finds earnings 10–20% lower for years.
- −Concentrated local economic shocks in a handful of cities.
- Generous benefits cost more but reduce political opposition and hardship.
medium confidence
Jobs and local economies
About 975k jobs are displaced in insurance, billing, brokerage, and PBMs; far more clinical jobs are demanded. Net employment rises, but the people and places differ.
Today
Health administration employs a large workforce whose jobs exist because of payer complexity.Under the plan
Administrative jobs disappear; clinical, home-care, and UHA jobs grow.Who gains
- Clinical and direct-care workers
- Workers freed from job lock
Who loses
- Insurance and billing workers
- Insurer-headquarters cities
Magnitude: See the workforce page for the full table and transition-program cost.
- PERI (2018)Estimated about 1.8M displaced jobs under Medicare for All with a transition program.
Mitigations
- Worker transition program
- Hiring preference at UHA
- Regional adjustment grants
Risk that remains: Displaced workers' earnings often stay lower for years.
Jobs affected by this step
- Health & medical insurance carriers (incl. Medicare Advantage & Medicaid plans): 384k of 452k jobs displaced. Underwriting, sales, network contracting, utilization management, and claims adjudication for UHP-covered services end. About 15% of roles (claims processing, nurse care managers, data analysts) map onto UHP and integrated-care-organization jobs.
- Third-party administrators & claims adjusting (health share): 102k of 127k jobs displaced. TPAs administer self-insured employer plans, and those plans end.
- Health insurance brokers, agents & benefits consultants: 72k of 80k jobs displaced. There is nothing left to sell except supplementary coverage.
- Pharmacy benefit manager corporate staff: 34k of 40k jobs displaced. Rebate negotiation, formulary design, and claims adjudication move to the national formulary. Pharmacists in PBM-owned retail and mail pharmacies are not counted here; dispensing continues.
- Provider billing, coding, prior-authorization & patient-collections staff: 243k of 540k jobs displaced. Coding remains for the fee schedule and quality data, but eligibility checks, prior authorization, denial appeals, patient collections, and payer-specific billing disappear. Hospitals under global budgets need far fewer per-claim staff.
- Employer HR benefits administration (health portion): 25k of 50k jobs displaced. Open enrollment, plan selection, and COBRA administration end. Retirement and other benefits remain.
- State Medicaid eligibility & managed-care oversight staff: 30k of 60k jobs displaced. Income-based eligibility determination and annual redeterminations end. Some staff move to state UHP regional offices or SNAP/TANF.
- Marketplace call centers, navigators & enrollment assisters: 14k of 15k jobs displaced. The Marketplaces close.
- Revenue-cycle management & claims clearinghouse companies: 72k of 120k jobs displaced. Outsourced billing, clearinghouses (e.g., Change Healthcare, Waystar), and denial-management vendors lose most of their business. A single claim format needs far less intermediation.
Trade-off behind each cost item
- Worker transition program+$104.4BFollows the layoffs, which track the four enrollment waves.
- More generous support costs more but reduces hardship and political opposition; displaced-worker research finds lasting earnings losses even with support.
- Accepted under the plan's ground rules; cushioned by the worker transition program and hiring preference at UHA.
- Accepted under the plan's ground rules; cushioned by the worker transition program and hiring preference at UHA.
Trade-off behind each system change
- Displaced-worker transition program (new)Costs ~$104.4B; reduces hardship and opposition.