Goal: Show how AMERICA Act pays for itself and bends the cost curve vs. the current for‑profit insurance model, while investing in wellness and primary care (akin to France’s SHI approach).
2026 Snapshot (billions)
| AMERICA Act (Reformed) | Notes | |
|---|---|---|
| HTF Outlays (essential services) | $5,389 | Year 1 reflects partial reform savings (~$130B of $430B eventual); full savings by Year 5 |
| Inflows (central case, MOE at 5%) | $5,451 | AMERICA Act payroll + Medicare HI + Employer MOE at Year 2 rate (5%) + Medicare B/D + Medicaid MOE + co‑pays |
| Operating Balance | +$62 | Lean but positive; HI Trust Fund transfer (+~$225B) brings total Year 1 reserves to ~$287B |
| HI Trust Fund opening reserves | ~$225B | One-time balance-sheet transfer per §7(f); not an annual flow |
| Indexation | Phased Core CPI cap | CPI+2.5pp Years 1–2; CPI+1.5pp Years 3–5; CPI+1.0pp Years 6–10; CPI+0.5pp Year 11+ |
See funding waterfall: 
How AMERICA Act Saves vs. For‑Profit Status Quo (Illustrative Annual Impacts)
| Lever | Mechanism | Conservative Impact |
|---|---|---|
| Administrative simplification | Single payer for essentials reduces duplicative claims, network + prior‑auth overhead | ~$150B |
| Eliminate insurer net income on essentials | Remove profit margin on essential services | ~$30B |
| Drug pricing (expanded negotiation) | Cost‑plus / class‑based + reference pricing beyond IRA scope | ~$40B |
| Site‑neutral payments & facility‑fee limits | Pay same rate in hospital/outpatient settings for like services; curb facility add‑ons | ~$60B |
| All‑payer global hospital budgets | Hard cap on aggregate hospital revenue growth (Core CPI + 0.5pp) | ~$90B |
| TOTAL, order‑of‑magnitude | ~$370B |
These savings come on top of better purchasing power, simpler billing, and reduced churn—areas that keep U.S. costs high under the current insurer‑centric model. Forward growth at Core CPI + 0.5pp on hospital budgets bends the curve relative to status‑quo trend growth.
Wellness & Primary Care Focus (Why Total Costs Fall Over Time)
- Universal, first‑dollar preventive care and mental‑health parity reduce avoidable ER and inpatient utilization over time.
- Care coordination and telehealth improve adherence and early intervention (mirrors features of France’s SHI + complementary coverage).
- Chronic care frameworks and drug affordability increase medication adherence → fewer complications and readmissions.
France’s model succeeds on low admin load, national fee schedules, and broad, predictable coverage; AMERICA Act parallels these design choices via global budgets, site‑neutral pricing, and negotiated medicines.
Financing (Four Pillars) — 100% Aligned to Bill Text
- AMERICA Act Payroll: employer doubled share; employee 5%–9.5% band (≤105% FPL → 0%).
- Medicare Realignment: HI payroll + Parts B/D general revenues → HTF.
- Medicaid MOE: federal + state effort redirected to HTF (indexed to core CPI, enrollment‑adjusted).
- Employer MOE: ≥7.5% of payroll or prior‑year employer health spend (inflation‑adjusted).
Result: 2026 inflows exceed outlays by ~$693B, with multi‑year surpluses projected under core‑CPI caps.
What Changed vs. the Prior Financials Note
- The earlier note focused on a progressive payroll schedule alone; AMERICA Act now uses a four‑pillar financing framework and core‑CPI indexation across payments and caps to ensure sustainability.