Healthcare coverage,
in detail.

01 / Coverage

Keep work coverage. Have a public option.

Medicare is the working model. We propose expanding and improving it for lifelong coverage, with the core benefits below and no patient charges for covered public-plan care. Existing public medical coverage would join the improved plan in protected stages, as described below. Detailed service and transition rules remain open.

• You can keep work insurance without a second public-plan premium. Switching to the public plan is voluntary.
• We would verify actual coverage for each person, including dependents, and align dates to avoid gaps.
• Eligible uninsured people whose premium is zero would enroll automatically, with an easy opt-out.
• A nonzero premium requires explicit agreement to coverage and its cost before household debt begins.

Silence does not create a bill or end coverage. Eligible people who remain uninsured keep full publicly funded coverage indefinitely even if they never respond, including above the zero-premium threshold. The opt-out remains. That coverage must be funded without assuming premiums from people who have not agreed to pay.

Citizens and lawful residents are eligible for income-based help. Other residents may buy the plan at full price, without a subsidy. The family premium rules below do not change eligibility; mixed eligibility and coordination with other coverage still need detail.

An offer of work insurance does not remove income-based help. If you otherwise qualify and choose the public plan, your premium follows the same household income schedule. This applies even when a plan through your job or a family member's job meets our coverage and affordability standards. Employers still meet their contribution duties; public payments stay pooled without a separate personal premium discount.

Move existing public coverage in protected stages.

Medicare, Medicaid and the Children's Health Insurance Program (CHIP) core medical coverage would move to the improved public plan. Its common all-ages package includes dental, vision and hearing, with no patient charges for covered care. For people eligible under the public-plan rules, separate program categories would no longer determine access to that core package.

• Keep coverage until its replacement is ready. Enrollment, covered services, prescriptions, provider payments and continuity arrangements must work before existing coverage ends. Protect ongoing treatment and access to needed care.
• Protect additional services and eligibility. Long-term daily-living support, disability-related services and children's broader medically necessary care keep coverage and funding until suitable replacements are ready. Preserve existing program coverage for people who do not qualify for the new plan. The separate long-term-care commitment still needs its own design.
• Preserve choice and premium consent. People can keep qualifying work coverage without a second public-plan premium. Moving from a public program does not create a new nonzero premium through silence or transfer consent automatically to a different charge. The adopted public premium rules apply; a lower household bill is not guaranteed for everyone.

Match each person, service and source of funding.

Existing program coverage remains protected for people who do not qualify for the new plan. A survey coverage category does not establish eligibility, and a whole program budget is not available to transfer.

A publicly accountable payer, with contracted administration permitted. The national plan owns the benefits, payment rules and coverage/appeal duty and carries the insurance obligation. Contractors may process claims, enrollment and pharmacy payments under public rules; they cannot impose a narrower benefit or formulary. Permanent risk-bearing insurer plans are not the delivery channel for the transferred core.

Continue Medicare Advantage, Part D and Medicaid managed-care arrangements until equivalent funded benefits, providers, medicines and payments are ready. Then lawfully end or convert the transferred core's insurer role, keeping needed coordination and support funded. Settle old claims, capitation, rebates and refunds; a contract ending does not erase its bills or create savings. No forced early cancellation, assumed layoffs or guaranteed incumbent returns.

Program order, readiness, benefit matching, existing premium deductions and exact contract transfers still need implementation. Veterans, military and Indian Health Service arrangements are not merged or defunded. No completion date is selected; conditional first coverage remains no earlier than late 2029.

02 / Core benefits

Medical, dental, vision and hearing care.

The standard public package would cover these core types of care for all ages:

• Primary, preventive and ongoing care: doctor and specialist visits, screenings, vaccinations and chronic-condition care.
• Hospital and emergency care: urgent care, surgery, inpatient treatment, lab work and imaging.
• Prescription medicines.
• Mental-health and addiction treatment: outpatient and inpatient care, alongside the platform's parity and access commitments.
• Pregnancy and children's care: contraception, pregnancy, childbirth, postpartum, newborn and age-appropriate pediatric services.
• Rehabilitation and needed equipment: physical, occupational and speech therapies to develop, restore or maintain function.
• Skilled nursing and skilled home healthcare, palliative care and hospice. Eligibility, settings and duration need rules; no blanket short-term-only limit is selected.
• Dental, vision and hearing: preventive and restorative dental care, eye exams and needed glasses, hearing assessments and needed hearing aids.

These categories also set the minimum types of care for employer plans seeking contribution credit. Detailed service and device rules, drug lists, clinical standards, exceptions and appeals remain open. Including a category does not promise every treatment. Covered public-plan care has no patient charges; employer plans have separate affordability requirements.

Specific treatment questions, including abortion, fertility treatment and gender-affirming services, still need explicit decisions. This category list selects neither inclusion nor exclusion of those services.

Coordinate long-term support.

Ongoing help with bathing, dressing or daily supervision remains part of the long-term-care proposal. Its benefits, eligibility and funding need coordinated design; including skilled home healthcare does not settle or withdraw that commitment. The staged public-program transition preserves needed additional services and their funding until suitable replacements are ready.

Fund the complete treatment bundle. A device price alone is not a treatment budget. Include the clinically needed assessment, fitting, accessories, training, follow-up, upkeep and delivery support. Public hearing-device purchasing uses multiple qualified suppliers, with clinical exceptions and appeal protections; it does not limit care to a bare device or shift covered costs to patients.

The full package has not been priced. The working-cost comparisons do not establish adequate care or a complete bill. Coordinate drug, mental-health and long-term-care funding without counting the same spending or savings twice.

03 / Household costs

Premiums rise with income.

Premiums are zero through 200% of the applicable federal poverty guideline. The contribution rate then rises linearly to 6% of household income at 500%, and stays at 6% above that point. The premium cannot exceed the plan's full price.

The 6% limit caps public-plan premiums. It does not cap all medical spending or taxes. Covered public-plan care has no deductible, copays or coinsurance. The premium limit is not a tax on everyone or an automatic cap for employer insurance.

Your premium follows this income schedule and the consent rules. It does not include a personal discount tied to your employer's public payment. Losing that payment does not itself raise your bill, and a lower bill for every worker is not guaranteed.

Count family support. Charge for public coverage.

• Count the support family: responsible adults and spouses or committed partners sharing family duties, children in their care, and adults dependent on ongoing basic support or care. Roommates, occasional gifts or insurance enrollment alone do not establish membership. Supported members still count when insured elsewhere or temporarily away.
• Pool relevant adult income: include responsible adults' income across insurance choices. A parent keeping job coverage can affect the family's public premium without owing a public premium for themselves. Use the public income rules below, including the dependent earnings allowance; employer job-pay rules do not define this income.
• Protect safe, fair treatment: start with a support declaration, check conflicts and allow correction and appeal. Ended relationships, abuse or abandonment need safe separate treatment without another adult's signature or contact. Income and family details stay private; disputes must not interrupt eligible coverage. Care across separate homes does not merge the adults' incomes or duplicate the child's allowance or bill.

Use equal shares for partial-family coverage. Divide the household's income-schedule amount equally among its members, without age or health weighting. Assess only public-covered shares with valid consent, capped by each member's applicable full public price. Use the whole-month calculation below. Partial months, actual full prices and complex-family rules still need detail before operational billing.

Illustration, not a price quote: if a three-person family's annual income-schedule amount were $2,400, two public-covered members would have $800 shares totaling $1,600. This assumes a stable, fully eligible household, full-year coverage, valid consent and a full-price ceiling that does not lower the bill.

One adult's consent cannot create another adult's debt. A guardian must have authority to accept a child's charge; the accepted bill belongs to the responsible adult. Unaccepted shares stay zero and are not shifted to consenting members. Full eligible uninsured nonresponse coverage remains; later silence does not cancel previously accepted debt.

Shared-support allocations, mixed eligibility, full-price attribution and detailed consent rules remain open. Recognizing a family member does not itself grant coverage or subsidy eligibility.

Count income broadly. Protect basic support.

Start with adjusted gross income: income after allowed tax adjustments, before standard or itemized deductions. Add excluded foreign earnings and housing amounts, tax-exempt interest and nontaxable Social Security, including equivalent railroad benefits. Count each amount once, across the support family.

• Count earnings and returns: taxable pay from all jobs, bonuses, severance and stock compensation; net business and rental income; interest, dividends and recognized net gains. Count profit or gain, not gross sales or returned principal. Unsold asset growth is not a new income item.
• Count retirement and replacement income: taxable pensions, retirement withdrawals and Roth conversions, unemployment, and Social Security including disability insurance (SSDI). Preserve after-tax basis, qualified Roth exclusions, qualifying home-sale exclusions and other lawful AGI adjustments.
• Protect aid and principal: exclude Supplemental Security Income (SSI), qualifying tax-excluded public aid, veterans' disability and statutory workers' compensation, child support, ordinary gifts, loan principal and inherited principal. Income from inherited assets can count. Other disability payments follow their tax treatment.

Health and retirement deductions that lower adjusted gross income can lower this measure. It differs from gross job pay used for employer affordability and from the financing surtax. Use records without double-counting joint income; non-filers can supply other evidence.

Protect dependents' first work earnings.

A genuine support dependent, including a dependent adult, gets an annual work-income allowance equal to the basic federal single-filer standard deduction: $16,100 for 2026. It follows future changes to that deduction, without age or filing-status additions. Apply it to wages and net earnings from their own gig or other self-employment after allowed adjustments, without deducting costs twice. Count only earnings above the allowance. It cannot shelter investment, retirement or other nonwork income. Responsible adults, spouses and committed partners do not get this allowance; tax filing does not determine it. Do not duplicate it across homes or coverage changes.

Income illustration, not a premium quote: a dependent with $18,000 in counted work earnings and $500 in interest adds $2,400 to family income after the 2026 allowance: $1,900 in excess earnings plus the $500 interest.

04 / Patient costs

Covered care has no additional patient bill.

The public plan would have no deductible, copays or coinsurance for covered care, at every income level. This applies across the core package, including covered medicines, dental, vision and hearing services and devices. Annual patient cost sharing for that care would be zero.

Qualified providers offering covered services must accept the public plan for its enrollees, without extra patient bills, cash-only opt-outs or compulsory membership fees for that care. Provider rates, payment arrangements and enforcement still need detailed rules.

Premiums remain separate. If you have agreed to a public premium, you still owe it under the income schedule. A covered appointment, prescription or hospital stay creates no additional patient charge under the plan.

Clinical rules, drug lists, exceptions and appeals remain open. Truly noncovered services remain separate, with clear consent and no double billing. Emergency assessment and stabilization need no prior approval; the access rules below protect covered care when the usual provider is unavailable.

Employer plans must meet the core-benefit benchmark and separate limits on premiums and combined annual costs, including their own low-income protections. The public-plan rule does not automatically make employer coverage charge-free at every income.

The funding estimate must include zero patient charges. The plan must fund covered care and enough providers to deliver it. Lower billing costs or better health cannot be assumed to pay for that commitment.

05 / Providers and access

Choose qualified providers. Get care in time.

All qualified providers offering covered services must accept the public plan for its enrollees. The public plan has no selective insurance network. Practices and hospitals may stay privately owned; they must follow the program's payment rules and cannot add a patient bill or require a cash-only contract or membership fee for covered care.

Licensing, clinical scope, safety and quality standards still apply, including exclusions for unsafe practice or fraud. Providers may have genuine capacity limits, but cannot refuse patients simply because they use the public plan or close only their public-plan panel. This does not promise an immediate visit with any named clinician.

Employer coverage remains an option, with its own patient-cost rules. Requiring acceptance of the public plan does not remove employer-plan networks or move their members' bills to the public plan. Access to eligibility-specific public systems still needs transition rules.

Maximum waits, with faster care when needed.

These working appointment limits apply to children and adults in the public plan and employer coverage qualifying for credit. Clinical urgency always requires faster care when needed.

Count from the request for the needed appointment. A usable appointment must be available within the window; a directory entry or unanswered referral is insufficient. Administrative handoffs cannot restart the clock. Patients may choose later visits, and clinicians may document appropriate later planned care. Shortages alone do not excuse a missed standard.

These are appointment limits, not deadlines to finish every treatment. Medicines, tests, procedures, home services and continuing treatment must follow clinical need; an initial visit does not end the plan's duty to arrange the care.

The plan must help find care.

If the usual provider cannot meet the need in time, the public plan must arrange another qualified provider. Qualifying employer plans must arrange outside-network care when needed. Emergency care and that fallback carry no higher patient charge than equivalent in-network care and no extra provider bill; patient payments count toward existing limits. Public covered care remains free of patient charges.

Plans must arrange care and payment before the deadline, without requiring patients to call an entire directory, advance the full bill or settle payment disputes. Emergency care proceeds while plans and providers resolve payment. Urgent escalation and independent review must act before harmful delay; slow authorization cannot defeat the protection.

• Make appointments usable: provide disability and language support. Telehealth must be clinically suitable and usable, without replacing needed in-person care. When a local access failure requires travel, the plan must arrange and fund necessary transport and lodging when needed.
• Protect ongoing care: provider or network changes need safe handoffs for active treatment and medicines, with temporary continuation when clinically needed. Enforcement must not automatically cancel coverage or force a public-plan switch.
• Check actual access: independently check appointments and directories, report waits and unresolved failures by service and area, and require corrective action. Good averages do not erase an individual's right to help. If no suitable clinician is available, record the unmet standard and require an urgent clinical plan and a funded capacity remedy.

06 / Billing

Bills must follow coverage and changing income.

Agreed premiums apply only to covered months, with collection at tax time. Monthly amounts below are accounting equivalents. Use expected income for the coverage calendar year: income already received plus a reasonable forecast. Prior returns are evidence, not an income floor. Reflect known seasonal work and count foreseeable bonuses or gains once.

Calculate by month. Settle within an annual ceiling.

For a stable, eligible support family and whole covered months:

1. Allocate the monthly share. Divide the annual household income-schedule amount by 12, then equally among all family members. Assess only public-covered shares with valid consent, limited by each person's applicable full price for that month. Coverage from July through December means six months of charges.
2. Reduce assessments promptly after a real income loss. Compare the charge based on expected annual income with the charge based on 12 times the new recurring monthly family income; use the lower amount for affected months. Include remaining adult earnings and replacement benefits. Correct excess charges back to the verified change. Earlier high pay must not undo that relief.
3. Count liquid taxable severance in its receipt month. For that month's hardship test, add the one-time payment to recurring family income before multiplying by 12; still use the lower charge compared with the annual forecast. In later months, use recurring income alone. Count severance once in annual income, including foreseeable payments in forecasts; do not assume it repeats or spread it across later months. Keep notice, valid consent and protection for earlier honest bills. This does not set rules for illiquid gains or other one-time income.
4. Apply each person's final annual ceiling. Recompute monthly shares using final annual income and each month's full-price cap. Add only that person's public-covered, consented shares to set their ceiling. The final charge is the lower of this ceiling and their total protected assessments. Refund paid excess or cancel excess still due; never raise a protected assessment or transfer another person's unused ceiling.

Illustration, not a price quote: if protected assessments total $2,250 and the person's final ceiling is $1,200, remove the $1,050 excess. If $1,800 was already paid, refund $600 and cancel $450 of unpaid charges. These are invented accounting amounts; they do not select a payment arrangement.

• Do not add a year-end charge solely because an honest, reasonable forecast differed from actual income when the household kept it reasonably updated. Unexpected later income may change future agreed assessments with notice and valid consent; it does not reopen protected earlier periods.
• Correctly assessed, accepted charges remain due. Deliberate material concealment needs separate review and appeal under lawful, consented terms; forecast errors or disputed updates are not automatically fraud. Preserve eligible coverage.
• Billing disputes get a simple process. Disputed collections pause, and mistakes are corrected or refunded.
• An employer's missed payment must not end eligible public coverage or become the worker's debt.

Partial months, changing families, mixed eligibility, hardship with other one-time resources, verification, notice/effective-date standards, liquidity support, rounding and review procedures remain open. Annual income before enrollment can affect the rate, subject to income-drop relief. The public household rules keep each unaccepted share at zero. A complete operational billing system still needs these details.

07 / Shared funding

All employers share the cost.

The employer obligation is a percentage of covered payroll, with no earnings ceiling. The same basic rate would apply across employers; the numerical rate has not been chosen.

An employer's own spending on qualifying work coverage can meet its obligation in full. Any unmet amount goes to the public plan. Employee deductions earn no credit. A mere offer of insurance is not funded coverage.

The obligation continues when a worker voluntarily switches to public coverage. Required public payments enter a common pool that funds care, including for people without an employer. The payment need not equal the employer's old insurance premium.

Smaller employers that need it would get temporary transition assistance. Eligibility, duration, form and funding remain open; no permanent size exemption has been selected.

08 / Payroll definitions

Count compensation once.

These definitions calculate the employer healthcare obligation. They do not create a new employee deduction, change employee income taxes or define household income for public premiums.

Included pay

Wages, salaries, overtime, bonuses, commissions, stock-based pay, employer-paid leave, cash severance and reported cash or electronic tips. Count gross pay before employee health and retirement deductions. Leave already included in salary counts once.

Employer-funded benefits

Separately employer-funded health and retirement benefits stay outside the payroll base. Only qualifying employer health spending can earn the separate coverage credit; retirement contributions and worker deductions cannot.

Work expenses

Exclude documented reimbursements for genuine work expenses. Return excess advances. Relabeling salary as expenses does not exclude it.

Shares and options

Stock awards count when vested and delivered, at market value less any purchase payment. Options count at exercise, at share value less the exercise price. Count the compensation once; later investment gains stay outside this employer contribution.

Private-company valuation, unusual or early-exercise awards, corrections, anti-deferral and payment rules remain open, as do other pay categories. The source notes explain the research behind these choices.

09 / Coverage credits

Credit follows the covered worker.

Qualifying insurance spending meets the corresponding covered-worker obligation. Extra spending on a covered worker cannot cancel the obligation for an uncovered coworker.

To earn credit, employer plans must cover at least the same core types of care as the public plan, including dental, vision and hearing. The core package defines those categories. Plans must also meet the affordability requirements below and provide usable access. Spending more on an inadequate plan does not make it qualify.

Different insurers, networks and cost-sharing designs remain possible within these requirements. Detailed services and access implementation still need decisions, as does how separate dental or vision contracts could qualify together. The benchmark does not require equal provider payment rates.

Qualifying employer-funded family coverage earns credit through documented funding shares for each worker. The shares must add up to the employer's actual net funding for that family's coverage, excluding employee contributions and other employers' money. Records must support the shares; subscriber names, extra payroll roles or assigning amounts just to maximize credits cannot change them. Count each dollar once and cap credit at the employer's obligation for that worker; unused credit cannot move to another worker.

Missing or unexplained shares remain unknown in cost estimates, with no automatic equal split.

Annual worker credits. Refund actual overpayments.

Use one calendar-year cap per worker and liable employer, combining that worker's payroll roles at the same employer. Do not annualize partial-year pay or invent full-year coverage. Qualifying dependent-only coverage can still earn credit through documented employer funding after the worker switches. Annual credit may offset obligations in later public-covered months, so a switch does not necessarily finance itself.

Actual net costs: insured plans use employer-funded premiums after refunds and rebates. Self-funded plans use paid covered claims, necessary plan administration and stop-loss premiums, less matching recoveries and other funders' money used for those same expenses. Do not count deposits, unspent reserves, general overhead, lobbying or a separate retained-risk allowance as final costs. Use documented pool and worker shares, not each worker's personal medical claims. Missing allocations stay unknown.

Quarterly provisional payments are reconciled annually to actual costs in both directions. For planning, remittance falls within 30 days of quarter-end and initial reconciliation by the following June 30; these are not enacted deadlines or assumed compliance. Late claims and recoveries correct the original calendar coverage year's cap; cash belongs to the year paid or refunded.

Refund public overpayments, not private spending above a cap. Unused credit cannot move between workers, employers or coverage years. Reconcile small-employer help against the same net burden once. Employer corrections never become worker debts or interrupt care. Household consent and downward-only settlement remain separate. National credit, collection and refund amounts are still unknown.

10 / Work-plan costs

Limit premiums and the bills that follow.

Work coverage must meet separate affordability limits to earn employer contribution credit:

• A worker-premium limit: cap what workers pay to keep the relevant coverage.
• A combined annual ceiling: count worker premiums plus the maximum patient charges for covered care across medical, prescription, dental, vision and hearing benefits. Separate benefit contracts must not bypass this protection.
• Low-income and family protections: limits must reflect ability to pay, with stronger protection at lower incomes. Use the actual family premium and patient-charge exposure when assessing family coverage. A cheap employee-only plan cannot establish affordability for dependents.

The actual coverage receiving credit must qualify. Merely offering a cheaper plan is insufficient. Voluntary upgrades and family-credit calculations still need rules, including when employee-only coverage passes but a dependent tier fails. A failed credit test does not automatically switch a worker to public coverage.

Whose income counts?

Both limits use the worker's gross pay from the job providing coverage, before taxes and employee health or retirement deductions. A spouse's earnings, pay from other jobs, investments and other household income are excluded from that job's income base. When two workers use separate employer plans, unused family allowance can transfer between them, so the other worker's pay can affect the allowance received and the resulting charges. Public-plan premiums still follow their separate household-income rules.

For example, a worker earning $40,000 at the job providing coverage would use that $40,000 even if their spouse earns $60,000. The applicable allowance and coverage unit determine the dollar limits. This ties protection to the job, but families with equal total income can receive different protection depending on which job provides coverage.

Protect basic income, then limit the worker's share.

The working employer affordability benchmark has four parts:

• Protect 200% of the applicable poverty guideline, adjusted for family size. Allocate this living allowance between coverage workers as described below. Only job pay above the worker's allocated allowance enters the percentage calculation. At or below that allowance, qualifying coverage has zero worker premiums and zero patient charges for covered care.
• Limit worker premiums to 4% of pay above the allowance. This percentage does not apply to the entire paycheck.
• Limit premiums plus maximum covered-care patient charges to 8% of pay above the allowance. The 8% includes premiums; it is not added on top of the 4%.
• Apply a combined annual backstop of $6,000 for self-only coverage or $12,000 for family coverage. For two distinct workers each using one separate employer plan, divide the outer family ceiling into $6,000 per worker. Use whichever is lower: the applicable dollar ceiling or the 8% calculation. Any one family member's covered-care charges also stop at $6,000 within the family total.

The dollar backstops are stated in 2026 reference dollars; future indexing remains open. They are not nominal 2029 promises. One family plan gets one aggregate limit. Premiums cannot exceed the combined ceiling; covered-care charges must fit within what remains after actual premiums. A deductible already included in a patient-charge maximum is not added again. These are maximum permitted charges, not prices to raise a lower bill to.

To illustrate the financing shift, hold a plan's price fixed and use the 2025 survey average of $6,850 in worker family premiums. The $100,000 example would shift $5,490 of that premium to the employer, before pricing lower patient charges. This is a benchmark calculation, not a wage-specific observation, a national estimate or added total health spending. Sources and limits are below.

Recognize the family the worker helps support.

The employer affordability allowance reflects ongoing family support responsibilities, including members with other insurance:

• The worker and a spouse or committed domestic partner sharing family responsibilities. Separate bank accounts alone do not exclude a partner.
• Children in their ongoing care, including biological, adopted, step and foster children, and children cared for by a guardian or relative. Tax claims are evidence, not the sole gate.
• Dependent adults, including adult children, parents and other relatives who rely on ongoing help with basic living needs or care. Age or disability alone does not establish dependency, and turning 26 does not automatically end support recognition.

Temporary absence for school, work or treatment does not by itself end support. Roommates, occasional gifts and insurance enrollment alone do not establish dependency. Regular housing, food and daily care count, including unpaid care; no cash-majority test is required.

Allowance membership and insurance eligibility are separate. Recognizing a supported parent does not by itself require the employer to enroll them. An independent adult child can remain eligible for parental coverage without adding to the living allowance. Actual qualifying plan bills must still count.

Coordinate protection across employer plans.

• Recognize one protected family allowance. Allocate it across coverage-providing jobs without duplicating it. Each job uses its own worker's approved gross pay as the income base; the other worker's pay can affect unused allowance transfers.
• Apply one $12,000 outer family ceiling across qualifying employer coverage, with a $6,000 per-person covered-care backstop within it. Keep tighter income-based and coverage limits. Self-only employer coverage retains its $6,000 combined backstop even when the worker supports people insured elsewhere. All these dollar backstops use 2026 reference dollars.
• Count each bill once and retain accumulated spending. Separate medical, drug, dental, vision or hearing plans, overlapping coverage and midyear switches must not create fresh limits. Families should be able to keep separate insurance choices.
• Recognize shared custody and support. Share the child's additional allowance between supporting homes. An ended relationship, abandonment or abuse needs safe review without requiring the other adult's signature or contact; disputed records should not interrupt care.
• Limit information shared with employers. An administrator would coordinate allowance shares, limits and necessary spending totals. Employers should not receive a spouse's pay, tax return or diagnoses.

Confirm support without routine paperwork barriers.

• Start with a signed support statement. Reuse reliable records where lawful. Check conflicting or duplicate claims and use proportionate audits, with notice and a chance to explain or correct mistakes. Ask for an explanation before documents; help families with missing records. No single tax, custody or other document is required in every case.
• Use 50/50 shares when care and support across two homes are roughly equal. Each home keeps its base allowance; divide the child's additional allowance once. Allow supported adjustments for unequal arrangements. If only one home provides qualifying support, it gets the whole child increment. Shares total 100%; a disputed claim alone does not establish equal support.
• Consider regular care and basic living support together. Earnings, tax claims or overnight counts alone do not set the share. An administrator reviews disagreements, with an appeal route and no unsafe contact or required second signature. Keep care continuous and protect honest estimates from retroactive bills; employers receive necessary shares and limits, not another home's income or sensitive records.

This reduces routine paperwork but requires judgment in disputed cases. Evidence lists, unequal-share review standards, cross-region rules, shared adult dependency, more than two supporting homes and interim/refund procedures still need detail. These rules concern employer living allowances; public premium households and insurance eligibility stay separate.

Share the allowance and set each worker's ceiling.

These formulas cover one support family with one or two distinct workers, each using one coverage-providing job, for aligned full benefit years:

1. With two coverage workers, start with half the living allowance each. If one worker's eligible pay is below their half, transfer the unused part up to the other worker's pay above their share. Leave any remainder unused; it is not cash. The shares still total one family allowance.
2. Apply the 4% premium and 8% combined rates to each worker's pay above their final share. Premiums must also fit inside the combined ceiling; covered-care charges fit within what remains after actual premiums.
3. Give each coverage worker a fixed $6,000 combined annual ceiling, retaining any lower income-based limit. This covers the worker-paid premiums and covered-care charges for the worker and dependents on that plan. Unused spending capacity does not transfer to let the other employer charge more. These backstops remain in 2026 reference dollars.
4. With one coverage worker, use the full family living allowance and the existing $6,000 self-only or $12,000 family backstop. A spouse on public coverage and separate medical, dental or vision contracts do not create another worker share.

This choice uses living allowance that would otherwise go unused. The fixed ceiling shares can give stronger protection when one worker covers dependents, but can also favor splitting coverage between jobs and require more employer financing. An administrator needs verified unused-allowance and eligible-pay information; employers should receive allocated shares and limits rather than the other worker's pay.

Detailed support procedures and other coverage arrangements remain open. More than two coverage workers, one worker with multiple employers, joint plans, partial years, different benefit years, transfer timing, the administrator and refund responsibility need rules. The two-worker formula covers one support family; it does not combine separated homes. Income updates must preserve refunds, accumulated spending and protection from retroactive bills for honest estimates.

Public-plan premiums keep their separate household-income rules. Mixed public/private cost coordination and family coverage-credit formulas remain open. This employer framework creates no new public subsidy or universal limit on all household health bills.

Which pay counts, and when?

Affordability uses cash pay and stock compensation the worker can readily turn into cash. These rules are separate from the employer contribution base.

• Count cash earnings: salary, hourly wages, overtime, commissions, bonuses and reported cash or electronic tips. Employer-paid leave counts once within pay; unpaid leave supplies no assumed wages.
• Count severance and unused-leave cash once if received during qualifying coverage associated with that employer, including qualifying continued coverage. Do not treat the payment as a continuing salary. Continuation eligibility and pricing still need rules.
• Count stock compensation once it is usable: shares must be vested, delivered and readily saleable, or options exercised into such shares. Cash-settled awards count as cash. Keeping saleable shares by choice does not delay counting; inaccessible awards wait.
• Exclude employer-funded health and retirement benefits and genuine work-expense reimbursements. Document expenses, return excess advances and do not relabel salary. Employee benefit deductions remain part of gross pay.

Stock compensation is valued at vesting and delivery or exercise, less actual purchase or exercise payments, before taxes. If access comes later, count the lower of that compensation value and the then-accessible net value. Exclude later investment gains and do not count the award again when sold. No borrowing against stock is required; private-company valuation, trading restrictions, unusual awards and anti-deferral rules need detail.

When earnings change, update the limits.

1. Use current expected pay for monthly premiums. Start with current wages and expected hours. Use the latest three completed months as a reference for recurring variable pay, adjusted for known changes. Documented seasonal work can use up to twelve months of history to estimate the relevant season. New hires use available history and their current schedule; assume no speculative overtime.
2. Review monthly and respond promptly to income drops. Reduced hours, unpaid leave, lost commissions or job loss override old averages. Apply lower permitted charges by the next practicable payroll or billing cycle and correct excess charges back to the effective change. Workers can report changes between reviews.
3. Count exceptional payments once. Include a one-time bonus, usable stock award or severance payment in annual income when available. Spread it across remaining covered months for the premium estimate; it creates no charges for earlier months.
4. Keep one combined ceiling for the plan's benefit year. Use eligible pay already received during covered months plus expected pay for the remaining covered months. Keep earlier premiums and covered-care charges counted across medical, drug, dental, vision and hearing benefits. An income update does not reset spending or erase earlier earnings.
5. Refund excess charges. Stop charges above a lower applicable ceiling and refund amounts already paid above it. Higher earnings may affect future charges with notice, but honest estimates create no retroactive premium debt or reopened settled medical bills. Check actual eligible pay at year-end or the end of covered employment and refund any remaining excess.

Match income and charges to covered months. Changing plans must not create a fresh full-year spending allowance. Exact partial-year formulas, income-band annualization, cross-plan credits and multiple-employer coordination remain open. An annual ceiling alone may not make an early deductible or a bill before a commission arrives manageable.

This approach requires income updates and puts more forecasting risk on employers and plans. Counting saleable stock may require selling shares; tips and severance can also raise the income base. Detailed family verification, unequal-share review and other coverage arrangements, indexing, partial-year and hardship rules remain open, along with other pay categories, detailed stock rules, processing deadlines, refund responsibility, fraud due process, access implementation, enforcement and transitions. The numerical benchmark does not complete deductible or payment-plan protections. Actual family coverage must qualify; a failed affordability test does not automatically cancel coverage or force a switch.

These independently chosen employer limits keep the public plan's household-income premium schedule and zero patient charges separate. Above the employer allowance, different deductibles and copays remain possible within the limits and remaining safeguards. Qualifying for work coverage does not block income-based public help if you choose the public plan and otherwise qualify.

11 / Delivery and cost

Federal funding must meet the remaining cost.

Federal law would provide ongoing funding sufficient for covered benefits and the operations needed to deliver them. General revenues, from the broader federal budget, would cover the cost left after counting public employer payments, consented household premiums and any existing public funds explicitly coordinated by later law.

Coverage would not depend on a fixed annual pot. Revenue shortfalls would trigger public financial review and legislative action, without automatic coverage loss, new patient charges or retroactive premium debt. Payment rules, audits and cost controls still apply; this does not promise any price a provider asks.

Our goal is to lower Americans' total healthcare costs through simpler administration, better drug prices and efficient care, while protecting benefits and access. Gains must exceed the costs of added care, replacement operations, staffing, startup and temporary overlap. Test ongoing costs and the full transition separately. Show what households, employers and taxpayers each pay. Moving a bill between them is not a saving. Net savings remain unestimated. The legacy figures do not price this goal.

Federal responsibility for medical costs that move.

As core medical coverage moves from Medicare, Medicaid and CHIP into the national plan, federal funding would meet the cost left after approved employer payments and consented premiums. The separate state program share for that transferred care would end as the responsibility moves, with no continuing or temporary state contribution to the new core.

• Protect services that stay behind. Retained long-term support, disability services, broader children's care and coverage for people ineligible for the new plan keep their relevant federal and state funding until suitable funded replacements are ready. States do not lose the federal share for those retained services.
• Keep obligations until care moves. States remain responsible for care not yet transferred and bills already incurred. Ending a program share does not exempt state or local governments from the ordinary employer contribution and coverage-credit rules for their workers.
• Let states decide how to use actual budget relief. After meeting retained obligations, states could fund services, build reserves or change taxes. They would not have to send freed funds to Washington or reinvest every dollar in healthcare. A state tax cut is not guaranteed. Separately funded state enhancements may add to the national benefit, without narrowing it.

Focus additional taxes on those most able to pay.

Build on the platform's taxes on corporate profits, investment income, gains at death and financial transactions, along with improved tax enforcement. Preserve the large-fortune minimum-tax commitment and its legal and scoring conditions. The starting approach protects low- and middle-income households from a new broad household healthcare tax. Employer contributions and agreed premiums keep their existing rules.

Evaluate a surtax on very high incomes as an additional source. A surtax is an extra income tax above a chosen threshold. The working thresholds and broad annual income benchmark below guide that evaluation. Detailed implementation, rates and the joint revenue estimate remain open.

A general income tax would apply under its own rules, including to people keeping employer coverage. It would not require consent to a public premium. The premium cap does not cap all taxes, and coverage credits apply to the employer healthcare obligation, not ordinary income taxes.

This approach may not raise enough. Capital income fluctuates, and corporate or employer taxes can also affect wages and investment returns. Compare taxes, premiums, patient bills and compensation effects together; do not promise that everyone else bears no cost. A remaining gap requires an explicit financing decision, with the federal coverage guarantee preserved. No new broad employee payroll tax, sales tax or second universal employer levy is part of this starting package.

A high income floor, adjusted for regional prices.

Use these annual national thresholds as the working benchmark for costing. Amounts are in 2026 reference dollars and would be adjusted each year for national inflation.

Raise the threshold where overall regional prices are above the national average. Use BEA's all-items Regional Price Parities, which compare regional prices with a national reference of 100. Prices 10% above average would raise the threshold by 10%. Cheaper regions keep the national floor. This regional adjustment is separate from annual inflation indexing; it does not depend on a person's rent, mortgage or spending choices.

Only income above the applicable threshold would face the surtax. For example, before any national inflation update, a single filer in a region with prices 10% above average would have a $550,000 threshold. At $600,000 in counted annual income, $50,000 would be subject to the added tax. This illustrates the tax base, not a tax bill; no rate is chosen.

These filing categories are separate from the healthcare support-family and job-pay rules. The head-of-household floor recognizes qualifying dependent responsibilities. The joint floor can benefit a couple with one high earner compared with a single person on the same income. There is no additional per-dependent amount in this benchmark, and unmarried partners do not automatically combine incomes for this tax.

Count broad annual income, including one-time gains.

Start with federal adjusted gross income (AGI): income after allowed adjustments, before standard or itemized deductions. Add the specified excluded income below. This is a separate surtax measure; the employer payroll, job-pay and public-premium definitions keep their own rules. Joint filers count both spouses' relevant income from all jobs and investments.

• Work: wages, bonuses, commissions, tips, severance and stock compensation recognized under income-tax rules.
• Business and property: net business and rental income after allowable costs, including taxable profits passed through to an owner. Gross business sales are not personal income; an owner's taxable share can count before cash is distributed.
• Investments: interest, dividends and recognized net gains, with valid cost basis and loss offsets. Short- and long-term gains face the same surtax treatment, without a special lower surtax rate for capital gains.
• Retirement and other income: amounts included in AGI, including taxable pensions, retirement withdrawals, Roth conversions and the taxable portion of Social Security.
• Add back specified exclusions: otherwise excluded state/local bond interest, foreign earned income and related housing exclusions/deductions, and excluded qualified-small-business-stock gains under section 1202. Count each amount once. These additions affect this proposed surtax, without repealing their regular-tax treatment.

Keep qualifying home and retirement protections. Preserve the qualifying main-home gain exclusion, qualified retirement-account deferral, return of after-tax basis and qualified Roth distributions. Other AGI adjustments and exclusions remain the working baseline unless explicitly changed. Deductions taken after AGI, including the standard, itemized and qualified-business-income deductions, do not further reduce this surtax base.

Ordinary loan principal, transfers between one's own accounts and returned investment principal are not new income. Ordinary gifts and inherited principal keep their income-tax treatment; income they generate and taxable inherited retirement distributions can still count. Debt forgiveness and disguised compensation follow their actual tax character. This adds no annual revaluation tax on unsold assets; amounts already recognized under tax rules still count. The separate large-fortune and gains-at-death commitments remain.

Count one-time income in the year it is recognized. There is no new exemption or multi-year averaging election simply because a gain, bonus or conversion is unusual. Lawful installment-sale recognition remains where applicable; this is not a new right to spread every sale. Payment arrangements for tax already owed are separate and still need design.

For example, at national prices in 2026 reference dollars, a single filer with $150,000 of other counted income and a $900,000 fully recognized gain has $1,050,000 of counted income. The $500,000 floor leaves $550,000 exposed to the eventual surtax. This assumes no other adjustments and shows the tax base, not a bill; no rate is chosen.

Count each source once.

• Employer and household money: count public employer payments after qualifying-coverage credits and household premiums that people agreed to pay. Credited private spending is not public cash. An employer payment cannot count again as a separate federal saving.
• Existing public programs: the staged move to common medical coverage preserves obligations and services left behind. Under the federal/state funding choice, ended state payments cannot count as continuing public-plan revenue. Exact transfers and reconciliation still need rules. Existing Medicare payroll taxes are not automatically abolished or redirected. Moving money between federal accounts does not itself create net savings.
• The wider platform: taxes already counted for ATTRACTOR cannot fund healthcare and another promise with the same dollar. The remaining gap must stay visible.

The surtax benchmarks do not establish an operational tax. Its rate, employer rates, program transfers and any deficit target remain open; no premium increase is selected. The funding guarantee does not change who qualifies or what care is covered. Detailed account, reserve, transfer and budget rules remain open.

Read the working costs; keep the gaps visible.

The working-cost report and evidence download show selected conditional comparisons, with missing costs beside them. The full cost and matched funding remain unknown. Publishing partial work does not adopt its assumptions as policy or weaken patient protections.

Targeted help through the transition.

Workers actually displaced by the reform can receive placement and retraining services for 12 months, extendable to finish approved training up to 24 months total. Affected public-sector and outsourced workers are included. This is not an assumed layoff count, wage-replacement benefit or personal cash cap.

Enterprises with fewer than 50 employees, combined under common ownership, can receive grants for 50% of verified eligible direct cost increases in their first transition year and 25% in the second, then none. Cap the eligible increase at public contribution liability after worker-specific credits. Adjust documented pre-reform spending for workforce/payroll changes; genuinely new firms without a predecessor baseline receive no transition grant. Reconcile actual overpayments and assistance once.

Help applies to initial conversion cohorts within a time-limited statutory window, which must be fixed before borrowing. Admitted workers keep their training-completion rights. Borrow only for actual net temporary implementation/support costs and include interest in ongoing financing. No borrowing amount is adopted; later recurring help needs recurring funding.

The legacy health range on The Math predates this design. It does not price the core benefits, zero patient charges for covered care, premium and consent rules, full coverage for eligible uninsured nonresponders, billing protections, payroll basis, coverage credits, benefit and affordability standards or transition help together. Unaccepted premiums cannot be assumed as revenue.

Employer affordability rates, the protected allowance and dollar backstops, support-based family membership, unused-allowance transfers and fixed two-worker ceiling shares, job-pay measurement and income-update/refund protections can change private plan costs, credits, public employer receipts and enrollment in the public plan. Those effects and their administration need a joint estimate; neither more credits nor more public enrollment can be treated as a guaranteed budget saving.

Required public-plan provider participation, appointment limits, care coordination, continuity and necessary travel also need a joint cost and capacity estimate.

A new estimate needs enrollment, claims, benefits, employer and household receipts, payment behavior, program offsets and collection timing. Staff, outreach, startup systems and income help also need funding. The existing relative-year ramp and historical phase-in range do not enforce a budget cap or establish a 2029 forecast.

What must be compared before choosing tax rates?

1. Total healthcare spending: compare all affected public and private care, operations, capacity and transition costs with the current system in the same years. Count each cost once and include added necessary care.
2. The public plan's full bill: covered care, delivery capacity, administration and transition costs.
3. The money reaching the plan: actual employer payments after coverage credits, consented premiums and any explicitly authorized program transfers.
4. The change to the federal budget: added spending and receipts across all affected programs and taxes. Show state/local budget relief separately from combined public spending and household bills. Count shared platform revenue once. Moving money between federal accounts does not create savings.

Test costs and financing together.

Each enrollment scenario must pair care costs with actual collections for the same case and period. Our first estimate starts with transferred public coverage and eligible uninsured people, with voluntary private switching compared separately. See the estimate's scope and timing. These are conditional comparisons, not enrollment forecasts.

Compare three cost cases: no extra efficiency gains, improvements supported by evidence, and the savings needed to cover added care and transition. The first assumes no savings from price cuts, less paperwork or changes in how existing care is delivered. It still counts added care and work needed for coverage and access. Each case also tests no incoming household premiums, with refunds preserved. National costs and savings remain unknown.

Price each kind of care and test access.

The public plan sets national payment rules by service, using Medicare as a reference where it fits. Rates account for efficient, good-quality care, patient needs, local costs and the staff and facilities needed to meet access standards. Each provider's past revenue or profit is not guaranteed.

Small rural hospitals retain the direction of cost-based payment; other justified capacity support needs explicit funding. Publish payment rules and reasons, check access and quality, and phase needed changes to protect ongoing care. Covered public-plan care keeps zero patient charges and no extra provider bill.

The earlier 120–140% of Medicare range remains a costing comparison, with no required minimum, maximum or overall average. Actual rates remain open. Services without suitable Medicare prices need their own costing. Treatment bundles, outcome-based payments and drug negotiation remain separate proposals.

Historical tests now cover skilled nursing, home health, hospital services and clinician care. They vary payments and the amount of care separately, counting existing patient payments only once. Hospital service payments are tested separately from other inputs and support; extra capacity still needs costing. Different reporting periods, payment systems and patient groups remain separate. These tests do not price the whole plan or adopt Medicare's benefit limits.

The research now maps all eight benefit categories to existing spending records and compares costs in the same calendar years. It compares overall spending growth with price growth; enrollment and added care still need estimates. The 2030 comparison is a reference, not a launch promise. Current-law spending is neither this plan's bill nor money available to fund it.

Private-plan exits and a concentration of sicker patients in the public plan are risks to assess. Risk adjustment would move money toward plans with sicker patients; how that pool would cover this plan remains unresolved. Keeping work coverage is voluntary. Premium consent and the opt-out protect choice, while full coverage after nonresponse creates costs and payment incentives that must be modeled.

Earliest first coverage: late 2029.

That start depends on legislation, funding and ready systems. It is not a promise of full coverage by then. The proposed three-to-four-year rollout still needs a starting milestone and stages. Platform-wide implementation begins no earlier than January 20, 2029.

13 / Evidence

Sources and their limits

These sources informed the design work. They do not endorse the proposal, set its 2029 rules or provide a score of this package. The choices above are platform commitments, not a description of current law.

• CBO: A Public Option for Health Insurance (2021)

  Design tradeoffs, provider payments, employer coverage and budget effects. A qualitative design report, not a cost estimate for this plan.

• Medicaid: Children's treatment protections · Long-term services and supports · Medicare: Coverage options

  Reviewed September 27, 2026. Explain services and coverage arrangements that need explicit protection or transition rules. Medicaid children's protections do not describe every CHIP program. The sources do not endorse this transition or estimate its costs; dated spending examples are not used as current savings.

• Medicaid: Federal and state financing · CHIP: Financing

  Reviewed September 27, 2026. State contributions are distinct from federal funds. No historical rate or allotment on these pages sets the new plan's funding terms, and no state share is automatically transferred.

• MACPAC: Non-federal financing · CMS: 2026 Part D state contributions

  Reviewed September 27, 2026. State funding can include local and provider-related money; existing payments to federal programs also need reconciliation. MACPAC's breakdown is historical, and no Part D rate is used. These sources establish neither future state budget relief nor a cost estimate for this proposal.

• IRS: Income by filing status, 2023 Table 1.2 · CMS: National health spending, 2024

  Reviewed September 24, 2026. Historical checks on scale, using different years and populations. Grouped AGI data do not score the proposed surtax, and national spending cannot establish this plan's costs or federal funding gap.

• CMS: 2024 spending tables, Table 19 · AHRQ: 2024 MEPS household data

  Analyzed September 28, 2026. The first scenario model uses federal/state spending categories and weighted coverage months, with annual spending approximated across those months. The household survey excludes institutional residents and does not establish eligibility or behavior under this plan. The sources have different scopes and are not added together or scaled into a national plan estimate.

• AHRQ: 2024 medical-event methods · Home-care methods

  Analyzed September 29, 2026. The transfer-mapping pass links dental, hospital, emergency, outpatient, office and home events to observed coverage. Bundled payments and uncertain timing remain separate. A home-care month can mix medical services and personal support; worker labels cannot divide the bill. Recorded spending and better timing still do not price the proposed benefits or establish a funding gap.

• MedPAC: Skilled nursing · Home health · Hospice

  Analyzed September 29, 2026. The March 2026 reports supply 2024 payment evidence. Provider costs, payer mix and access differ across services. The initial payment tests hold the mix of care fixed; they do not establish a national price or justify a uniform rate increase or cut.

• MedPAC: Payment adequacy · Hospitals · Clinicians

  Analyzed September 30, 2026. Hospital Table 3-1 and clinician page 105 supply separate 2024 payment bases, including patient payments or liability. Hospital inputs and support need distinct treatment; fiscal and calendar years are not combined. These tests do not set the plan's rates or price its broader benefits and changed payer mix.

• CMS: June 2026 spending projections · Spending definitions

  Analyzed September 30–October 1, 2026. The common-year reference uses 2024 spending and 2029/2030 projections, with separate price indexes. Benefit categories and CMS coverage counts overlap; existing spending does not establish new-plan enrollment, costs or funding.

• Medicaid: Long-term care and home-support tables, methods and quality notes

  Analyzed September 29, 2026. The 2023 service categories mix medical and support benefits, with reporting gaps. Managed-care provider payments generally differ from state payments to health plans. These records cannot establish which whole budgets transfer, or be added to the separate 2024 spending evidence.

• HealthCare.gov: Job-based and Marketplace coverage · CBO: Public-option design, Box 3-1

  Reviewed October 1, 2026. Work offers can limit current Marketplace aid. This proposal permits income-based help despite those offers for otherwise eligible public enrollees. CBO describes possible coverage and funding shifts; its 2021 rules and estimates do not price this plan.

• HealthCare.gov: Counted income · Changing-income estimates · IRS: 2026 deduction reference

  Reviewed October 7, 2026 with IRS Publication 525. These inform income categories and the $16,100 reference. Our support-family rules, dependent allowance, current-income relief and honest-forecast protection are platform choices, not current Marketplace rules or a cost estimate.

• IRS Publication 15 · Publication 15-B · Publication 525

  Research context for wages, tips, leave, benefits, expenses and stock compensation, reviewed September 15, 2026. Our employer healthcare definitions are proposed choices, not changes to existing employee tax treatment.

• HealthCare.gov: Minimum value

  An existing-law alternative considered in the design work. The platform selected the public-plan core-benefit comparison; detailed service and affordability rules remain open.

• HealthCare.gov: Marketplace benefit categories · Medicare: Original Medicare coverage gaps

  Background for the benefit categories and the choice to include dental, vision and hearing. Reviewed September 16, 2026; current program limits are not automatically adopted.

• Medicare: Home health · Medicare: Long-term care

  Background on skilled medical care and daily-living support, reviewed September 16, 2026. Our long-term-care commitment still needs coordinated benefit and funding decisions.

• HealthCare.gov: Total health-plan costs · Out-of-pocket limits

  Background on premiums and charges when care is used, reviewed September 17, 2026. Current Marketplace amounts and exclusions are not automatically imported.

• HealthCare.gov: Affordable coverage · IRS: Minimum value and affordability

  Background on employee/family premiums and income measures, reviewed September 17, 2026. Current thresholds, employer exemptions and subsidy rules are not automatically adopted; the proposed combined-cost limit goes beyond a premium-only test.

• IRS: Employer affordability questions 39–41

  Reviewed September 17, 2026. Existing wage-based employer tests show an administrative precedent, not proof that our limits are adequate. Their pay definitions and rules differ from this proposal and are not automatically adopted.

• HealthCare.gov: Estimating changing income

  Reviewed September 18, 2026, alongside the IRS stock and pay guidance above. Expected-income estimates can reflect schedule changes and recent trends. Our averaging windows, stock-access and refund protections are platform choices; the source does not validate them or supply our income definition.

• HHS: 2026 poverty guidelines

  Reviewed September 18 and rechecked September 20, 2026. The examples use the contiguous-state/DC guidelines; Alaska and Hawaii have separate values. The notice does not define this proposal's family unit. The protected allowance, rates, unused-share transfers and ceiling allocation are platform choices, not HHS recommendations.

• HealthCare.gov: Household membership · Department of Labor: Young-adult coverage

  Reviewed September 19, 2026. Marketplace membership generally follows tax households with exceptions and includes people insured elsewhere. Eligibility for parental coverage until age 26 is separate from financial dependency. These distinctions inform our design; the support-family framework and coordinated limits are platform choices with remaining verification and allocation procedures to specify.

• CMS: Eligibility verification

  Reviewed September 21, 2026. Declarations, existing records and checks of conflicting information provide an administrative precedent. The state-count table is a 2013 snapshot. Our support definition and qualified 50/50 sharing rule are platform choices; this source supplies neither those rules nor their cost.

• KFF: 2025 Employer Health Benefits Survey

  Reviewed September 18, 2026. The average family worker premium supplies an illustrative financing benchmark, not actual costs for our example family or a 2029 forecast. The survey covers nonfederal public/private employers with at least ten workers. The proposed limits and dollar backstops are not validated affordability thresholds.

• California DMHC: Timely access · CMS: 2024 managed-care access standards

  Reviewed September 21, 2026. These provide wait-time and oversight precedents. Our uniform urgent limit and broader provider categories are policy choices; the standards are not an exact copy of either program or proof of nationwide capacity.

• 42 CFR 438.206: Access, October 2025 edition · CMS: Surprise-billing protections

  Reviewed September 21, 2026. Dated outside-network access rules and emergency billing protections inform the safeguards. They do not establish every proposed protection; employer fallback and required public-plan participation need their own enforceable rules.

• Medicare: Provider participation and opt-out · H.R. 3069: Introduced 2025 text, sections 301–303

  Reviewed September 21, 2026. These distinguish coverage from provider participation. ATTRACTOR chooses required public-plan acceptance without a cash-only opt-out for covered care. Current Medicare opt-outs and the bill's separate private-contract and insurance rules are not adopted; neither source costs our design.

• RAND: Health Insurance Experiment (2006 summary)

  The historical experiment found that patient charges reduced use of both effective and less-effective care. It informs caution about payment barriers; it does not estimate this plan's costs or prove zero charges pay for themselves.

• CBO: Common budgetary terms, December 2021

  Reviewed September 22, 2026. Explains funding authority, transfers and deficits. Funding written into law does not create revenue; an internal federal transfer is not a net saving. The guide does not cost this design, and its dated statements about budget caps are not used as current law.

• 2026 Medicare Trustees Report, sections II.A and II.F

  Reviewed September 22, 2026. Parts B and D adjust premiums and federal contributions to expected costs, while financing demands still grow. This is a precedent for funding that responds to costs. We do not import Medicare's premium adjustments, redirect its trust funds or treat the report as a score of this plan.

• CBO: Household income in 2021, Appendix A · Household income in 2022

  Reviewed September 22, 2026. CBO's methods explain how employer and corporate taxes can reach workers. The newer report shows concentrated and fluctuating capital income. These inform the financing tradeoffs; neither estimates this plan's household costs or revenue.

• CBO/JCT: Income surtax options, December 2024

  Reviewed September 22, 2026. Illustrates a tax on income above a threshold. Its thresholds, rates, start date and historical estimates are not adopted here. A new design needs fresh joint costing.

• BEA: Regional Price Parities · Methodology

  Reviewed September 22, 2026. Regional averages compare prices, with sampling and geographic limits. They do not set these proposed thresholds or measure each household's budget. Published data must be refreshed for implementation.

• BLS: Consumer Price Index questions · IRS: Filing status

  Reviewed September 22, 2026. Local CPI levels measure price changes over time, not price differences between cities. IRS filing categories supply terminology; neither source endorses the surtax amounts or selects its inflation update rules.

• United States v. Ptasynski (1983), pages 84–86

  Reviewed September 22, 2026. This oil-tax case allowed a particular geographic exemption based on neutral circumstances while requiring scrutiny for discrimination. It does not establish the legality of a regional income-surtax adjustment.

• IRS: Adjusted gross income · Modified AGI · Form 1040 instructions

  Reviewed September 23, 2026. Explain income categories, adjustments and deductions after AGI. Modified AGI differs by purpose; our surtax additions are platform choices, not a copied IRS formula.

• IRS: Capital gains and losses · Main-home sales · Schedule D instructions

  Reviewed September 23, 2026. Distinguish net gain, basis, losses and conditional home/business-stock exclusions. The proposed business-stock addition changes this surtax's base; these sources neither endorse that choice nor estimate its yield.

• IRS: Partnership income · Roth IRAs · Retirement distributions · Taxable and nontaxable income

  Reviewed September 23, 2026. Explain income without cash distributions, retirement basis/conversions, qualified Roth treatment and gifts/inheritances. Keeping these distinctions does not exempt all retirement income or guarantee ready cash to pay a tax.

• IRS: Installment sales · Farming/fishing income averaging

  Reviewed September 23, 2026. Explain existing recognition rules and a limited averaging election. They do not create general relief for one-time gains or supply a new surtax payment schedule.