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Healthcare

No American should
go broke getting well.

The United States spends more per person on healthcare than any other developed country. We get worse results. 27 million people have no insurance at all. This is not a tragedy. It is a choice. And we can make a different one.

The Crisis in Numbers

The richest country on Earth.

With the most expensive, hardest-to-get healthcare in the developed world.

27M

Americans with no health insurance. That is more than the whole population of Australia.

$13,493

Average yearly healthcare spending per American. Twice the average of peer nations.

500K

Personal bankruptcies each year tied to medical debt. Nearly unheard of anywhere else.

1 in 4

Americans who rationed or skipped prescription drugs because of cost in the past year

Why This Happened

The healthcare industry owns Congress.

The United States is the only wealthy democracy without universal healthcare. It is not because we lack the money. It is because drug companies, insurers, and hospital systems spend over $600 million a year lobbying Congress to block real reform.

The Affordable Care Act was a big step. It covered 20 million more Americans. But it left the core problem in place: a for-profit system with no duty to provide care when care cuts into profit. Drug prices in the U.S. are 2-3 times higher than in Canada, Germany, or the UK. Same drugs. Same makers.

Project 2025 proposed gutting Medicaid expansion and ending the extra ACA subsidies. It would turn Medicare into a "premium support" (voucher) model that shifts costs onto seniors. These were not budget plans. They were transfers of wealth from sick people to insurers.

What Project 2025 Did to Healthcare

  • Proposed turning Medicaid into a block grant. That would cut benefits for 90 million Americans.
  • Ended the Inflation Reduction Act's Medicare drug price negotiation. That handed price control back to pharma.
  • Rolled back the extra ACA subsidies. More than 5 million people lost coverage.
  • Weakened FDA control over drug approvals in favor of "accelerated approvals" with no evidence required.
  • Ended rules requiring reproductive health coverage. Brought back gag rules on providers.

The Plan

What Project 2029 proposes.

Based on Chapter 14 (HHS) of Project 2029. Specific bills. Real legal authority. A plan that can actually pass.

1

Medicare Public Option

Universal coverage within reach, without waiting for a revolution

Create a strong Medicare public option open to every American, whether or not they have a job. Price it at actuarial cost, with income-based subsidies so no American pays more than 8.5% of income on premiums. Open it to individuals, small businesses, and large employers. This creates real competition. Private insurers must lower prices and improve coverage, or lose customers.

Legal Authority: Social Security Act (42 U.S.C. § 1395); Article I spending power; Commerce Clause
2

Medicare Drug Price Negotiation - Expanded

End drug company extortion

Build on the Inflation Reduction Act's drug pricing rules and make them stronger. Let Medicare negotiate prices for all drugs, with no patent exclusivity limits. Cap insulin at $35/month for all Americans, not just people on Medicare. Let Medicare use international reference pricing, tying U.S. prices to what other wealthy countries pay. Hit drug companies that refuse to negotiate in good faith with an 80% excise tax.

Legal Authority: Inflation Reduction Act (P.L. 117-169); Social Security Act § 1847A; Commerce Clause
3

Medicaid Protection and Expansion

Guarantee coverage for the most vulnerable. No block grants. No cuts.

Lock in Medicaid expansion in all 50 states through federal incentives and penalties. Ban block grants by law, so it takes a Congressional supermajority to change. Expand Medicaid to cover dental, vision, and hearing for everyone enrolled (extend the ACA's senior dental expansion to all ages). End the five-year wait for Medicaid for legal immigrants. Set a federal floor for Medicaid payment rates at 90% of Medicare rates.

Legal Authority: Social Security Act Title XIX (42 U.S.C. § 1396); NFIB v. Sebelius (2012); Spending Clause
4

Mental Health Parity Enforcement Act

Treat mental illness like any other illness

Toughen enforcement of the Mental Health Parity and Addiction Equity Act (MHPAEA), with civil penalties up to $1M per violation per day. Require insurers to cover every DSM-5 diagnosed mental health condition, with no prior authorization for the first 10 sessions. End prior authorization for substance use treatment and residential mental health care. Add 10,000 community mental health workers to the National Health Service Corps. Provide $20B over 5 years to build up community mental health centers.

Legal Authority: MHPAEA (29 U.S.C. § 1185a); ACA § 2726; Employee Retirement Income Security Act
5

Reproductive Healthcare Protection Act

Abortion is healthcare. Treat it like it.

Write Roe v. Wade protections into federal law. Restore and expand Title X family planning funding to $1.5B a year. Require every hospital that takes federal funds (nearly all of them) to provide emergency reproductive care. Repeal the Hyde Amendment. Denying abortion coverage to people on Medicaid is a class-based limit that violates equal protection principles. Protect reproductive healthcare providers from FACE Act violations and targeted harassment.

Legal Authority: Spending Clause; Civil Rights Act; 14th Amendment Equal Protection; Whole Woman's Health v. Hellerstedt (2016)
6

Rural Healthcare Access Act

Where you live should not decide if you live

Rural hospitals have closed at a rate of one per month for the last decade. 30 million rural Americans lack good access to emergency care. Project 2029 proposes a $15B Rural Hospital Stabilization Fund. Full telehealth expansion, with permanent coverage under Medicare/Medicaid. 5,000 new Primary Care loans under NHSC for rural placements. And required Medicaid payment rate floors so rural hospitals are not shortchanged.

Legal Authority: Hill-Burton Act; Social Security Act; Rural Health Care Act; Appropriations power

Take Action

What you can do right now.

Vote for Coverage

Every federal election is a vote on healthcare. Register and vote in every election, including primaries.

Register to Vote →

Demand Medicare Expansion

Call your senators and representative. Ask them directly: will you support a Medicare public option?

Find Your Rep →

Share the Facts

Download the healthcare one-pager. Share it. Every person who understands the issue is an asset.

Get One-Pager →

Read the Full Chapter

Chapter 14 of Project 2029: the complete HHS reform blueprint with full legal citations.

Read Chapter 14 →

Share This

Help others understand what's at stake.

FAQ

Frequently Asked Questions

What is Project 2029's plan for healthcare reform?
Project 2029 proposes six major healthcare reforms: a Medicare Public Option available to all Americans with income-based subsidies capped at 8.5% of income; expanded Medicare drug price negotiation with a $35 monthly insulin cap for all Americans; Medicaid protection from block grant conversion; a Mental Health Parity Enforcement Act with $1M daily penalties for violations; a Reproductive Healthcare Protection Act codifying abortion access in statute; and a $15 billion Rural Healthcare Access Act to prevent rural hospital closures.
Why does the United States have the most expensive healthcare in the world?
The US spends $13,493 per person on healthcare annually - twice the average of peer nations - but gets worse outcomes. The reason: pharmaceutical companies, insurance companies, and hospital systems spend over $600 million per year lobbying Congress to prevent meaningful reform. Drug prices in the US are 2-3 times higher than in Canada, Germany, or the UK for identical drugs from identical manufacturers.
Would Project 2029 create single-payer universal healthcare?
Project 2029 proposes a robust Medicare Public Option rather than immediately eliminating private insurance. The public option would be available to every American regardless of employment status, priced at actuarial cost with income-based subsidies ensuring no American pays more than 8.5% of income on premiums. This creates genuine competition that forces private insurers to lower prices and improve coverage - or lose customers to the public option.
What did Project 2025 do to Medicare and Medicaid?
Project 2025 proposed converting Medicaid to a block grant - effectively cutting benefits for 90 million Americans - and converting Medicare to a premium support voucher model that would shift costs onto seniors. It eliminated the Inflation Reduction Act's Medicare drug price negotiation, handing price control back to pharmaceutical companies, and rolled back ACA subsidy enhancements, causing 5+ million people to lose coverage.
How does Project 2029 address prescription drug prices?
Project 2029 proposes expanding the Inflation Reduction Act's drug pricing provisions with no patent exclusivity limits on Medicare negotiation, capping insulin at $35 per month for all Americans (not just Medicare beneficiaries), using international reference pricing to anchor US prices to what other wealthy nations pay, and imposing an 80% excise tax on pharmaceutical companies that refuse to negotiate in good faith.