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

Start of Years 2 and 3 · UHA; employersDiscuss this step

Every concrete action this step requires, who is responsible, and when it happens relative to enactment.

#	Action	Owner	When	Trade-off
3.1.1	Notify each employer which of its workers move in the coming wave (from W-2 data with birth dates).	UHA / IRS	6 months before each wave	Advance notice to employers smooths transitions but creates complex administration for multi-wave workforces.
3.1.2	Employers remove moving workers from plans and recalculate the remaining pool's premiums.	Employers / insurers	Each wave	Recalculating remaining premiums is accurate but produces volatile premiums for small employers.
3.1.3	Spouses enroll by their own age (a 50-year-old with a 30-year-old spouse: one in UHP, one in the employer plan until Year 4).	UHA	Each wave	Enrolling spouses by their own age is simple but splits couples between systems for up to two years.
3.1.4	Medicaid adults in each age band convert automatically; states stop redeterminations.	States / UHA	Each wave	Ending redeterminations prevents coverage loss but removes states' ability to verify eligibility.