Phase 2: Wave 1: seniors, near-seniors, and children · Step 2.1

Upgrade Medicare enrollees into UHP

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 Part A (hospital insurance) absorbedYear 1 Federal programs	Covers inpatient, SNF, hospice, and some home health for 65+ and disabled; funded by the 2.9% HI payroll tax; deductible $1,676 per benefit period (2025).	Folded into UHP. The HI payroll tax continues and flows to the UHP Trust Fund; deductibles and coinsurance end. Employer Medicare payroll tax (1.45%) $159.2B → $165.7B Worker & self-employed Medicare payroll tax $246.4B → $254.1B	Seniors gain; the separate Medicare 'earned benefit' identity, which is politically protective, is diluted into a program for everyone.
Medicare Part B (physician & outpatient) absorbedYear 1 Federal programs	Voluntary; $185/month premium (2025) plus income-related surcharges (IRMAA); 20% coinsurance with no cap.	Folded into UHP. Premiums, IRMAA, and coinsurance end; Social Security checks rise by the premium amount. Medicare Part B & D premiums $132.3B → $0.0B	Higher-income seniors who paid IRMAA gain the most per person among seniors, though they pay the household premium.
Medicare Part C (Medicare Advantage) endsEnd of Year 1 Federal programs	About 54% of Medicare enrollees in private plans paid by capitation, with networks, prior authorization, and supplemental benefits.	Ends after a final contract year (Year 1). Provider-run integrated care organizations may take capitated budgets without an insurance layer. Insurer & plan overhead eliminated $306.0B → $26.4B	Ends coding-intensity overpayments (MedPAC: ~20% above FFS), but about 33 million people lose plans that score high on satisfaction.
Medigap (federally standardized supplemental plans) endsYear 1 Federal programs	About 12.6M people pay roughly $2,000–4,000/yr to cover Medicare cost sharing.	Ends; no cost sharing remains to insure. Unearned premiums refunded. Individually purchased insurance (net of subsidies) $86.3B → $0.0B	Seniors save premiums; Medigap insurers and agents lose that business.
Medicare Savings Programs & Part D Low-Income Subsidy endsYear 1 Federal programs	Means-tested help paying Medicare premiums and cost sharing; complex enrollment, low take-up.	End: nothing left to subsidize. Federal Medicare buy-in premiums for dual eligibles $16.1B → $16.1B State Medicaid share → UHP maintenance-of-effort payment $345.7B → $345.7B	Removes a means test that many eligible people never navigated.
Medicare End-Stage Renal Disease program absorbedYear 1 Federal programs	Since 1972, Medicare covers dialysis and transplants for nearly everyone with kidney failure; private insurers pay first for 30 months and pay dialysis firms several times Medicare rates.	Folded into UHP; the 30-month private coordination period ends; dialysis paid at the UHP bundled rate.	Ends the commercial-rate premium that dialysis chains (DaVita, Fresenius) depend on for profit; their margins fall sharply.
Dual Eligible Special Needs Plans (D-SNPs) endsEnd of Year 1 Federal programs	Medicare Advantage plans for people with both Medicare and Medicaid.	End with Medicare Advantage; duals get all care through UHP, ending Medicare–Medicaid coordination problems.	Ends a long-standing coordination failure; care-coordination staff of D-SNPs must move to providers.
Continuity of ongoing treatment at switchover newEach wave Patients	—	Hospital stays, courses of treatment, and prescriptions under way on switchover day continue under prior terms for up to 90 days (inpatient stays until discharge); existing prior authorizations are honored.	Prevents disrupted treatment; complicates payment during the first months.