What you pay
Co-pays scale with your income — not a flat fee that hits lower-income families hardest. And there's a hard annual cap. No matter how much care you need in a year, you will never pay more than 5% of your adjusted gross income.
Always $0 — no co-pay, no exceptions
Full co-pay schedule
Based on your adjusted gross income (AGI). All amounts per visit or fill unless noted.
| Income (AGI) | Primary care | Specialist | Mental health | ER | Ambulance | Hospital/day † | Imaging | Labs | Rx ‡ | Vision visit | Lenses § |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Under $75k or $150k household | $0 | $25 | $25 | $50 | $50 | $25 | $25 | $0 | $10 | $25 | $50 |
| $75k – $200k | $20 | $50 | $50 | $100 | $100 | $50 | $50 | $10 | $20 | $25 | $100 |
| $200k – $500k | $40 | $100 | $100 | $200 | $200 | $100 | $100 | $20 | $40 | $50 | $200 |
| Over $500k | $60 | $150 | $150 | $300 | $300 | $150 | $150 | $30 | $60 | $75 | $300 |
† Hospital inpatient co-pay is per day, capped at $500/year for the two lower tiers (doubled/tripled proportionally for higher tiers).
‡ Rx co-pay is the scheduled amount or the actual drug price, whichever is lower. Labs are $0 for the under-$75k tier (not listed as an exception under Section 4(d)(1)).
§ Lenses co-pay applies to basic prescription lenses, bifocals, and trifocals. Medically necessary lenses are covered at $0.
Annual out-of-pocket cap: 5% of your AGI
Once you hit this limit, all further co-pays are automatically refunded through the National Health Portal. Every dollar above the cap comes back to you — no claims to file, no appeal required. (§ 4(d)(5))
Co-pay per visit by income tier and service type. Preventive care excluded (always $0).
How it's paid for
The U.S. already spends more on healthcare per person than any country on Earth — including countries that cover everyone. Most of that money currently passes through insurance companies, billing departments, and administrative overhead. This act redirects existing spending and adds a new payroll contribution shared by workers and employers.
Year 1 HTF inflows (~$5.45 trillion total). Employer MOE phases to 7.5% by Year 4.
Progressive payroll contributions from workers and employers, no income cap. Workers below the poverty line pay nothing.
Federal and state Medicaid funds redirected to the HTF under Maintenance of Effort provisions.
Medicare Parts B and D general revenues, plus HI Trust Fund opening reserves (~$225B).
Employers contribute what they were already spending on premiums. Phases to 7.5% of payroll by Year 4.
10-year fiscal trajectory
The program launches with a lean but positive Year 1 operating surplus (~$62B), supported by the HI Trust Fund opening transfer (~$225B in reserves). As employer contributions phase to full rate, administrative savings materialize, and the growth cap steps down, annual surpluses grow to nearly $900B by 2035 — with a 10-year cumulative HTF surplus of ~$5.1 trillion.
Annual HTF operating surplus 2026–2035. Based on phased cost-control assumptions (Core CPI + 2.5pp → 0.5pp). Employee payroll rate 7%. Full methodology in the staff budget scoring document.
Built-in guardrails against waste
Administrative overhead is capped by law at 7% of HTF expenditures. If costs exceed that, automatic corrective mechanisms trigger — no Congressional action required.