Not Socialized Medicine.
Not Deregulation.
Just Healthcare Reform that Actually Works
The PATIENT Act delivers affordable, portable coverage to every working American, returns treatment decisions to doctors and patients, and creates genuine competition in the health insurance market — funded by money employers are already spending, built on infrastructure that already exists.
$5.3 Trillion
What America spent on healthcare in 2024 -- growing at 7.2% per year -- with no end in sight.
100 Million
Americans carrying some form of medical debt. In the wealthiest country in the history of the world.
1 in 3
Americans who skipped or postponed care they needed because they couldn't afford it. Not just the uninsured. All Americans.
193
Rural hospitals that have closed in the last twenty years. More than 430 additional facilities are currently identified as vulnerable to closure.
The leading cause: administrative costs they cannot absorb.
86,000
The projected physician shortage by 2036 — driven not by a lack of medical graduates, but by burnout pushing doctors out of the profession early. The single largest driver of burnout isn't too many patients. It's too much paperwork.
$496 Billion
Spent every year on billing and insurance-related administrative costs in the American healthcare system.
Research indicates roughly half of it is pure waste — money that never touches a single patient.
Affordable Coverage. Empowered Doctors.
Better Insurance.
The PATIENT Act preserves private insurance and market competition while fixing the structural failures in the insurance and payment architecture that have made care frustrating and unaffordable for decades.
It works through three interlocking reforms: making care affordable, re-empowering doctors and patients, and reinvigorating the insurance market itself.
The Eight Provisions of the PATIENT Act
The PATIENT Act works through eight interlocking provisions organized across three priorities — making care affordable, returning treatment authority to doctors and patients, and rebuilding the insurance market into one that actually serves the people paying into it. Every provision strengthens the others. Leave one out and the architecture doesn't hold.
🏷️ One Price. Everywhere.
Universal Medicare-Based Pricing
One published benchmark replaces thousands of individually negotiated rates — so the cost of a procedure is visible to both the doctor and the patient before it's performed, not as a surprise when the bill arrives.
💊 Same Drug. Same Price. For Everyone.
Prescription Drug Pricing Reform
The price Medicare negotiates with drug manufacturers becomes the price for every American — ending the system that forces patients without insurance to comparison-shop across pharmacies on a phone app just to afford their medication.
🩺 The Doctor Decides; Not the Insurer.
Provider Autonomy
Prior authorization, step therapy, and insurer-mandated referral chains are eliminated — returning treatment decisions to the physician who examined you, not the algorithm at the insurance company that didn't.
⚖️ A Referee Neither Side Can Capture.
Independent Medical Review Boards
Randomly assigned, anonymous physician panels adjudicate disputes between insurers and providers — like jury duty for medicine - preventing wrongful denials and overcharging, with neither side able to influence the outcome.
📋 Plans People Can Actually Understand.
Plan Standardization
Four clear tiers — Bronze, Silver, Gold, Platinum — replace the current marketplace of ~100 incomprehensible plan variations. With every standard plan providing comparable coverage, insurers compete on price, service and supplemental coverage.
🔄 Leave a Bad Plan Anytime.
Continuous Enrollment
The annual open enrollment window is eliminated. Americans enroll and switch carriers on their own schedule — the way they already do with auto insurance and every other product they buy — forcing insurers to earn customers every day.
🏦 Break Open the Market.
Non-Profit Insurer Tax Exemption
A new tax-exempt category invites leaner, technology-driven non-profit insurers into a market currently dominated by a few large participants, giving these new entrants a structural cost advantage to compete and win.
🧳 Coverage Goes With the Worker.
Employer Decoupling
Health insurance is permanently separated from employment — funded through an increase in the existing employer Medicare tax, portable through job changes and unemployment, and stays with the worker. COBRA is eliminated. Job lock ends.
The PATIENT Act By The Numbers
The PATIENT Act's financial foundation rests on a single structural insight: the employer healthcare tax applies to every worker on every payroll in America — a wage base of approximately $13.1 trillion, nearly twice what the current employer-sponsored system reaches. That broadened base, combined with the cost reductions produced by Medicare-based pricing, administrative simplification, and an expanded risk pool, funds a system that covers significantly more workers at dramatically lower per-capita cost — while generating a positive federal fiscal impact across every major category. The table below reflects the moderate scenario. The full financial analysis, including a comprehensive sensitivity analysis, is in the position paper.
| Current System | PATIENT Act | |
|---|---|---|
| Workers covered | ~85 million | ~149 million+ |
| Total employer healthcare spending | ~$967 billion | ~$564 billion |
| Employer cost per covered worker | ~$11,400 | ~$3,800 |
| Employer cost — $62,000 median worker | ~$11,400 | ~$2,666 |
| Employer savings — $62,000 median worker | — | ~$8,734 per employee |
| Worker out-of-pocket premium (Bronze baseline) | ~$1,440/yr (single coverage) | $0 |
| National uninsured rate | ~8% and rising | Below 3% |
| Federal fiscal impact (annual) | — | +$120 to $240 billion |
| Funding stability | Subject to congressional renewal | Permanent; adjusted annually by CMS |
| Moderate scenario\: pricing benchmark at 125% of Medicare, 75% of projected administrative savings realized. Full sensitivity analysis available in the position paper. | ||
"The worst case for the PATIENT Act is the base case for the current system."
Every Constituency. Every Interest.
One Solution.
Workers
Bronze-level coverage fully funded through the employer healthcare tax at zero out-of-pocket premium at the baseline — portable through job changes, self-employment, and unemployment. Every currently covered worker remaining at the Bronze level receives an immediate reduction in payroll deductions equal to their current premium contribution: $1,440 annually for single coverage, $6,850 for families. An estimated 22 to 32 million additional Americans gain coverage, driving the projected national uninsured rate below 3% for the first time in American history — without an individual mandate.
Employers
The employer healthcare tax replaces premium spending at a dramatically lower effective rate — reducing the average per-covered-worker cost from approximately $11,400 to approximately $2,666 on a median-salary employee, while covering nearly twice as many workers. Total employer healthcare spending drops by an estimated 42%. The entire benefits administration apparatus — plan selection, carrier negotiations, open enrollment management, COBRA processing, and ERISA compliance overhead — is eliminated entirely. The employer's role in healthcare is reduced to a single payroll tax already embedded in existing infrastructure.
Doctors & Providers
Prior authorization, step therapy protocols, and insurer-mandated referral requirements are eliminated. The treating physician determines the care plan. One universal pricing framework replaces dozens of individually negotiated insurer contracts, and independent, privately administered peer review — not the insurer's internal denial workflow — adjudicates disputed clinical decisions. The 13 hours per physician per week currently consumed by prior authorization are returned to clinical practice. Near-universal coverage eliminates the estimated $35 to $40 billion in annual uncompensated care that providers currently absorb and cost-shift onto the insured population.
Insurers
Standardized plan tiers, continuous enrollment, and universal pricing create a genuine competitive marketplace in which service quality, claims processing efficiency, and supplemental product innovation determine market share — not plan complexity, rate-negotiation leverage, or annual lock-in. A new tax-exempt category for non-profit health insurers opens the market to new competitors while existing carriers can convert or compete on their merits. Supplemental coverage products offered above the standardized base tiers represent a new and expanding revenue stream in a market where consumers have more disposable income and more freedom to act on their coverage preferences.
The Country
The Healthcare Coverage Trust Fund — legally separate from the general fund — is self-sustaining from Phase 3 of implementation forward and adjusted annually by CMS based on actual system costs. It cannot expire because a legislative deadline was missed. The federal fiscal impact is positive across every major category: recaptured revenue from the eliminated employer health insurance tax exclusion, Medicaid savings as working adults shift to employer-tax-funded coverage, elimination of ACA premium tax credit spending, and consumer spending multiplier effects — producing an estimated net federal fiscal improvement of $120 to $240 billion per year.
The Framework is Complete. Read It.
Executive Summary
The complete case for the PATIENT Act in a single concise document — the problem, the eight provisions, the three-phase implementation plan, and the financial analysis. The right starting point for legislative staff, policy professionals, executive leadership, and anyone evaluating the framework for the first time.
The Op-Ed
A 700-word version of the argument, written for general publication. Suitable for forwarding to legislative offices, sharing with board members or colleagues, or placing in front of any audience that needs the essential case before engaging with the full framework.
Full Position Paper
The complete policy framework — all five parts, including the detailed financial analysis, a comprehensive sensitivity analysis across every major scenario, the three-phase implementation timeline, and appendices providing direct comparisons of the PATIENT Act against Medicare for All and the current ACA framework.
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