By NextBestFitEnroll children and adults 55–64
Year 1, Day 1 · UHA; employers; statesDiscuss this step
Pros & cons of this step
Pros
- +Covers every child, ending a gap where about 4 million children are uninsured.
- +Adults 55–64 are the most expensive group in the individual market; moving them first lowers premiums for everyone still in it.
Cons
- −Mixed-coverage households: parents in employer plans, kids in UHP. This is confusing for a few years.
- −Front-loads cost: this is the most expensive age group to cover.
- Relief for the oldest and youngest first vs. the fiscal ease of covering cheaper, younger adults first.
medium confidence
Equity across income, race, and geography
One tier for everyone removes payer-based segregation of care, which falls along income and racial lines today.
Today
Who you see and how fast depends on your insurance, which tracks income and race.Under the plan
Same card, same rates. A cash tier for opted-out providers remains for the wealthy.Who gains
- Low-income and minority communities
- Rural residents
Who loses
- People who benefit from today's priority access
Magnitude: Large.
- Canada/UKIncome-related gradients in access are smaller than in the U.S., though they persist for specialist care.
Risk that remains: Geographic shortages persist without capacity investment.
Trade-off behind each system change
- Children's Health Insurance Program (CHIP)Ends coverage gaps when children age out or family income changes.
- School-based health services billed to MedicaidMore funding for school health services; schools must meet UHP billing standards.
- Medicaid EPSDT standard for childrenChildren keep the strongest coverage standard in U.S. law; broad medical-necessity rules raise costs.
- 24-month Medicare waiting period for people on disability (SSDI)Covers some of the sickest people right away; adds cost in Year 1 before the matching revenue arrives.