One federal payer buys an essential floor through four payment methods matched to cost structure rather than to who owns the building: a reference fee schedule, capacity payment for standby capability, capitation with reinsurance, and hospital global budgets. Delivery stays plural and regional — private practices, nonprofit systems, public hospitals, tribal systems, and a standing public arm of federally chartered Regional Health Authorities, aggregated from entities that already run multi-site operations. Every county is assigned to exactly one Authority, so deserts are attached rather than built. Inside the floor there is no prior authorization, no network denial and no balance billing. A regulated supplemental sits above it, separately priced.
Anchor
The essential floor
One national entitlement, the same in every state, that no state may reduce and no insurer may adjudicate. Read component →
Anchor
Four payment methods
Payment matched to cost structure rather than to who owns the building. Read component →
Anchor
The public arm
Federally chartered Regional Health Authorities, aggregated from entities that already have multi-site management capacity — standing rather than triggered. Read component →
Primary
Geography and the access bundle
Access in a low-density catchment is bought as a four-part bundle, scored per region covered rather than per facility subsidized. Read component →
Primary
Patient mobility and inter-authority settlement
Care follows the patient across catchment lines and the money settles behind the counter — which turns out to be the quality metric as well. Read component →
Primary
The regulated supplemental
A financial and convenience layer on the same clinical floor — standardized, guaranteed-issue, community-rated, and separately priced. Read component →
Primary
Long-term and memory care
Insurance against care costs no income floor could absorb — clinical layer inside the Authority, residential layer outside it. Read component →