By NextBestFitPhase 3: Waves 2 & 3: working-age adults · Step 3.3
Wind down the private health insurers
Years 1–5 · State insurance commissioners; NAIC; UHADiscuss 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 |
|---|---|---|---|
| Pharmacy benefit managers endsBy wave Drugs & devices | Three PBMs process about 80% of prescriptions; rebates, spread pricing, formulary placement. | Role ends for UHP; pharmacies are paid acquisition cost plus a dispensing fee by UHA. | Transparent prices; loses PBMs' (contested) role in squeezing manufacturer prices. |
| Private health insurers (commercial, MA, Medicaid MCO) endsYears 1–5 Private sector | $1.64T in private premiums; ~$279.6B in non-medical spending across private, MA/Part D, and Medicaid plans. | Core business ends; run-off rules; Blues assets to charitable foundations; may sell supplementary coverage or contract with UHA. | Largest administrative saving; ~384,047 jobs and $420.0B–$714.0B of shareholder value at risk. |
| Brokers, agents, benefits consultants endsYear 4 Private sector | Sell and service group and individual health coverage. | Health line of business ends except supplementary. | ~72k jobs displaced. |
| Insurer statutory reserves and guaranty associations amendedYears 1–5 Private sector | States require insurers to hold reserves; guaranty funds protect policyholders if insurers fail. | Reserves are released only after run-off claims are certified paid; guaranty associations backstop any failure during wind-down. | Protects pending claims; delays shareholders' access to released capital. |