By NextBestFitEnroll children and adults 55–64
Year 1, Day 1 · UHA; employers; statesDiscuss this step
Transition speed
Big bang, multi-year phase-in, or slow glide path?
The plan chooses
A four-year phase-in after an 18-month build period. Year 1: children (0–18), adults 55+, improved Medicare benefits. Year 2: 45–54. Year 3: 35–44. Year 4: everyone. Employers must keep providing coverage to workers not yet eligible.
Taiwan went from 57% to 92% coverage in under a year in 1995, but it had a much simpler starting point. A phase-in lets UHP's claims systems and staffing scale, tests rate-setting on smaller populations first, and gives displaced workers a staggered labor market. Covering by age, the Medicare for All Act's approach, moves older, more expensive groups first, which front-loads cost but also front-loads relief.
4-year age-based phase-in (chosen)
As described.
Pros
- +IT and staff ramp up gradually
- +Insurer layoffs spread over 4 years
Cons
- −Four years of running two systems, which costs more
- −Employers must manage mixed-eligibility workforces
- −Gives opponents four elections in which to stop it
Big bang (one year)
Everyone moves on one date.
Pros
- +Shortest period of dual-system cost
- +Hardest for opponents to reverse
Cons
- −Highest risk of operational failure (cf. HealthCare.gov 2013)
- −A demand surge hits all at once, so waits spike
Precedent: Taiwan NHI (March 1995).
Public option glide path (10+ years)
Start with a buy-in and let it grow.
Pros
- +Lowest disruption
Cons
- −May never reach universality; vulnerable to adverse selection
What this choice gives up
- Speed: people not yet eligible keep today's gaps for up to four more years.