The basics
The AMERICA Act guarantees essential healthcare for every U.S. citizen and legal resident. One national program pays for essential care. Your doctor gets paid. You get care. No insurance company in the middle deciding what's covered.
This is not a government takeover of hospitals or doctors. Providers stay private. You choose who you see. The only thing that changes is who pays the bill — and how much you owe.
What's covered
Essential care includes everything you'd expect — and some things you might not have today:
- Primary care, specialist visits, hospital care
- Mental health and substance use treatment — same access as any other care
- Prescription drugs — no coverage gaps, no donut holes
- Dental — preventive cleanings, fillings, medically necessary work
- Vision and hearing — eye exams, glasses, hearing aids
- Prenatal, maternity, and reproductive care
- Long-term care and home health services
- Preventive screenings and vaccines — always free
What you pay
Co-pays are based on your income — not a flat fee that hits lower-income families harder. And there's a hard annual cap: you will never pay more than 5% of your income in a year, no matter how sick you get or how many times you need care.
| Your household income | Primary care | Specialist | Prescription | Emergency room |
|---|---|---|---|---|
| Under $75,000 | $0 | $25 | $10 | $50 |
| $75,000 – $200,000 | $20 | $50 | $20 | $100 |
| $200,000 – $500,000 | $40 | $100 | $40 | $200 |
| Over $500,000 | $60 | $150 | $60 | $300 |
Preventive care, vaccinations, and children's wellness visits: always $0.
If you hit your annual cap, any additional co-pays are automatically refunded. You track it through a free online health portal.
What stays the same
- Your doctors. Any licensed provider in the United States participates. No networks, no referrals needed for essential care.
- Your HSA. Health Savings Accounts are preserved for extras, co-pays, and non-essential services.
- Supplemental insurance. Private insurers can still offer plans for things like luxury hospital rooms, elective cosmetic procedures, or additional dental and vision upgrades.
- VA, TRICARE, and Indian Health Service. These programs continue. Eligible beneficiaries can choose to use the national program instead, but nobody is forced to switch.
Your rights under this law
- No prior authorization for essential care — your doctor decides what you need, not an insurance company.
- No balance billing — what the program pays plus your co-pay is the full bill. Providers cannot charge you more.
- Free choice of provider — nationwide, no networks, no gatekeepers.
- No denials of covered care — violations carry penalties up to $100,000 per incident.
- Coverage that follows you — job loss, career change, early retirement, starting a business. Your coverage never lapses.
How it's paid for
The United States already spends more on healthcare per person than any other country — including countries that cover everyone. Most of that money passes through insurance companies, billing departments, and administrative overhead before it reaches a doctor.
This act redirects existing Medicare and Medicaid spending into one fund, requires employers to contribute what they were already spending on premiums, and adds a new payroll contribution. Workers below the poverty line pay nothing. Middle-income workers pay less than most pay in premiums today.
Independent projections show the program is financially stable from day one, with surpluses that grow over time as administrative costs fall and preventive care reduces expensive emergency treatment.
Phased rollout — no overnight disruption
The act phases in over five years. Private insurance for essential care winds down gradually. Your current coverage continues during the transition. If you're in active treatment — cancer, pregnancy, dialysis, behavioral care — you keep your current providers for at least 12 months, no interruption.
Full bill text, financial modeling, and supporting documentation available at [repository link] Questions or feedback? Open an issue or submit a pull request.