Universal access. Community-directed care.
AIP proposes universal access to community-directed healthcare, financed in the long term through Stability Accounts. Individuals and their communities determine care priorities, spending and revenue needs, with state oversight.
Proposed framework · Updated November 1, 2026
Who controls care and spending?
Individuals and their communities determine healthcare priorities, care arrangements, spending and the revenue their community needs. States oversee local systems and accountability. Universal describes who can access care; it does not mean Washington operates or directs each community’s healthcare.
What funds healthcare?
Stability Accounts and lifetime investment growth are the intended funding foundation. Communities make the spending and funding decisions. AIP is not proposing permanent reliance on GRT as the primary healthcare funding source.
The long-term funding source and the timing of payment are different questions. Care and education are needed before accounts mature. The existing illustration tracks service costs for later account reconciliation; it does not assume a newborn’s account can pay all current bills. Transitional financing, community payment arrangements, shortfall protection and obligations to existing generations must be explicitly funded and defined.
Lifetime funding and transition timing →What must be specified locally?
- Who represents residents and makes spending decisions.
- How providers are paid and how personal accounts relate to any community pooling.
- Patient choice, access, quality, privacy and independent appeals.
- Protection for high-cost patients, investment shortfalls and communities with inadequate resources.
- Portability when people move between communities or states.
These are implementation questions, not additional rules already adopted by AIP.
Evidence and cost references
The earlier $2.02 trillion federal allocation and $3.5 trillion mature-system figure describe different scopes and are not validated budgets for the clarified community model. The old lives-saved claim also required an arithmetic correction; it is not a demonstrated outcome.
Evidence and unresolved costs →The Current Crisis
Healthcare is both a personal need and part of economic participation. Illness, interrupted coverage and unaffordable care can prevent people from working, studying and building capital.
For a dated national baseline, CMS reports $5.3 trillion in US health spending in 2024, or $15,474 per person and 18.0% of GDP. These are total national expenditures—not a federal budget and not an AIP cost estimate. CMS national expenditure accounts.
The Census Bureau reports that 92.0% of people had insurance for some or all of 2024. Coverage, affordability and timely access are different measures; a person can be insured yet struggle to obtain care. 2024 coverage report.
The AIP Solution
The proposed entitlement is access to care independent of employment. Community Health Boards would organize local services, select providers and publish spending plans. Individuals retain a voice in care and local decisions; states oversee access, accountability and remedies.
| Design goal | Practical requirement |
|---|---|
| Universal access | Define covered services, provider capacity and portable eligibility. |
| Protection from medical financial ruin | Set limits on personal account obligations and fund catastrophic care. |
| Community control | Publish budgets, election rules, conflicts of interest and independent appeals. |
| Prevention and mental health | Contract for primary, mental-health and preventive care alongside acute treatment. |
| Choice and quality | Measure access, outcomes and complaints; protect patients when a local provider fails. |
Cost Breakdown
| Category | Current | AIP (Year 3) | Savings |
|---|---|---|---|
| Administrative overhead | $600B | $150B | $450B |
| Insurance profits | $100B | $0 | $100B |
| Billing/coding complexity | $200B | $50B | $150B |
| Fraud/abuse | $100B | $20B | $80B |
| Prescription drug markup | $150B | $50B | $100B |
| Total Efficiency Savings | $880B/year | ||
The five illustrative savings lines sum to $880B. They may overlap; they are not verified cash savings and cannot be pledged to new services before reconciliation. “Current” in this table refers to the earlier draft baseline, not the CMS 2024 total above.
How healthcare is paid for
Stability Accounts and lifetime investment growth are the intended funding foundation. Individuals and communities decide care priorities, spending and revenue needs, with state oversight. GRT supports initial capitalization, transition obligations and remaining public responsibilities; it is not the intended permanent primary healthcare funding source.
The earlier illustration assigned $3.5 trillion to mature healthcare and compared it with an $8.1 trillion GRT estimate. Those scopes and amounts were not reconciled; they must not be read as a validated healthcare funding plan. The retained first-year arithmetic reference instead yields $5.7684 trillion net GRT and an overall $301.6 billion gap.
Health Integration
🏥 Community-Governed Care
Healthcare decisions are made locally by elected Community Health Boards—not insurance companies or distant bureaucrats:
Local Level
Elected Community Health Boards control provider selection, priorities, and budgets
Regional Level
Coordination councils handle multi-community resources and specialist networks
State Oversight
State oversight and accountability; communities determine priorities, spending and revenue needs. Stability Accounts provide the intended lifetime funding foundation.
- Local knowledge — Communities understand their own health challenges
- Direct accountability — Board members are your neighbors, not executives
- No profit motive — Decisions based on health outcomes, not shareholder returns
- Preventive focus — Incentivized to keep people healthy, not bill for procedures
- Mental health parity — Treated equally to physical health
Lives Saved
Improved access is intended to reduce avoidable illness and deaths. The earlier draft used an annual estimate of 45,000 deaths associated with lack of insurance. Multiplying that number by 30 gives 1.35 million, not 13.5 million.
That multiplication is not a forecast of lives AIP would save. A defensible estimate needs a named study, population, baseline, implementation schedule and causal effect. The website therefore treats mortality reduction as an outcome to measure, not a promised total.
Implementation Timeline
Three stages retain the original priority: reach people without care, improve inadequate coverage, then establish universal community-directed access. The original Years 1–3 schedule is an implementation scenario, not an announced launch.
| Stage | Work to complete before expansion |
|---|---|
| 1 · Access | Fund current care; enroll residents; contract providers; establish community representation and state oversight. |
| 2 · Continuity | Protect people changing coverage; expand mental-health and specialist capacity; test claims, appeals and portability. |
| 3 · Universal access | Demonstrate access and sustainable payment across communities, including rural areas and high-cost patients. |
The earlier $2.02T transition allocation and $3.5T mature-system estimate use different scopes. They cannot be used as stage budgets until reconciled with actual community costs and payment timing.