By NextBestFitPhase 0 · Before coverage starts
Preparation
Before anyone moves to the new program: fix the worst problems in today's system (automatic enrollment of the uninsured, denials, prior authorization, medical debt, surprise bills, drug middlemen), start the long-lead workforce and data work, and settle how state money keeps flowing.
Done when
- Interim fixes from the chosen paths for this phase are in force (see Changes by phase).
- Workforce expansion (residency slots, nursing faculty, scope of practice) funded and started.
- Every state's contribution computed and published.
- Payment schedules between states and the national program in place.
Changes from chosen paths in this phase: 90
42 chosen solution paths (draft picks awaiting review) land in this phase. See every change.
- Automatic enrollment with free default coverage
- Continuous eligibility (12-month or multi-year) in Medicaid and CHIP
- Buy and cancel existing medical debt
- Ban medical debt from credit reports and limit collections
- Enforce price transparency rules
- Set a default out-of-network rate instead of arbitration
- Regulate denials: reporting, penalties, and fast independent appeals
- Gold-carding and automatic approvals
- Fix Medicare Advantage payments
- Regulate PBMs: delink pay from drug prices, ban spread pricing
- Stronger antitrust: block mergers and undo some
- Limit private equity ownership and require disclosure
- Site-neutral payment
- Tie nonprofit tax exemption to community benefit
- Limit patent thickets and evergreening
- Mail-order and telepharmacy
- Convert to emergency and outpatient centers
- Expand midwives and birth centers
- Loan forgiveness and service obligations
- Permanent telehealth coverage
- Fund more residency slots
- Easier licensing for foreign-trained physicians
- Tuition-free medical and nursing school
- Expand nursing schools and faculty pay
- Fund scribes and AI documentation
- Full practice authority for NPs, PAs, pharmacists, dental therapists
- 12-month postpartum coverage and home visits
- Hospital safety bundles and review committees
- Standardize across many payers
- Stepped care and integration into primary care
- Easy access to medication treatment
- Harm reduction services
- Keep means testing, but expand home care
- Tighter hospice oversight
- Free preventive care and vaccines
- Mandatory data-sharing standards
- Mandatory security standards and backup payment systems
- Strong health privacy law
- Build capacity before demand rises
- Phased transition in waves
- Measure outcomes by clinician type and adjust scope
- Supervised transition period before independence