Phase 2: Wave 1: seniors, near-seniors, and children · Step 2.6

Expand capacity before demand peaks

Year 0 onward; continuous · HRSA; UHA; states (scope of practice)Discuss this step

Every existing law, program, institution, or practice this step changes: what it is today, what happens to it, when, and what that costs or trades off.

What	Today	Change	Trade-off
Medicare Graduate Medical Education funding expandedYears 0–5 Provider payment & regulation	Medicare funds most residency positions, capped since 1997 apart from recent small additions.	Moves to UHP with 14,000 new slots focused on shortage specialties.	More physicians long-run; training takes 3–7 years after medical school.
Scope-of-practice laws (NPs, PAs, pharmacists, dental therapists) amendedYears 1–3 States & localities	Vary widely; many states restrict independent practice.	Federal grants encourage full practice authority to expand capacity.	More capacity vs. physician-group concerns about quality and supervision.
National Health Service Corps & Title VII/VIII training programs expandedYear 1+ Workforce & training	Scholarships and loan repayment for service in shortage areas; small scale.	Expanded to tuition-free training tied to 4 years of service.	More clinicians where needed; service obligations limit graduates' choices.
Licensing for internationally trained clinicians amendedYears 1–3 Workforce & training	Most must repeat residency in the U.S.	Supervised-practice pathways to licensure.	Faster capacity; contributes to 'brain drain' from other countries.
State licensure (interstate compacts for physicians, nurses, psychologists) amendedYears 1–3 Workforce & training	Clinicians need a license in each state where the patient is located; compacts cover some states.	Federal grants encourage all states to join compacts so clinicians can serve UHP patients across state lines.	More capacity, especially for telehealth; states cede some control over discipline and standards.
1997 Medicare cap on funded residency positions expandedYears 0–5 Workforce & training	Hospitals' Medicare-funded residency slots largely frozen at 1996 levels.	Lifted for shortage specialties; 14,000 new positions funded.	More physicians long term; teaching hospitals gain influence over workforce composition.
HRSA (health centers, workforce programs, Ryan White) expandedYear 1+ Workforce & training	Funds health centers, the National Health Service Corps, nursing programs, and Ryan White.	Expanded as the agency for workforce and capacity investment; health center grants shift from uncompensated care to capacity. Workforce capacity investment $0.0B → $12.0B Capacity expansion in shortage areas	A central workforce agency can target shortages; it competes for funds with direct care in every budget cycle.