Phase 3: Waves 2 & 3: working-age adults · Step 3.1

Enroll adults 45–54 (Year 2) and 35–44 (Year 3)

Start of Years 2 and 3 · UHA; employersDiscuss 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
Mid-transition employer plan pools amendedYears 1–3 Private sector	Employer plans cover workers of all ages.	Pools shrink each wave as older workers leave; premiums are re-rated for the younger remaining workers.	Remaining premiums fall; small employers' pools become volatile.
Transition buy-in for people not yet eligible newYears 1–3 Patients	—	People in later waves may buy into UHP early at a community-rated premium, with Marketplace-style subsidies (as the Medicare for All Act's transition buy-in does).	Fills gaps during the phase-in; sicker people will buy in first (adverse selection), raising the buy-in's cost.