Engines
Engine 2 of 9

Distributed Healthcare

Architecture deep-dive: a universal essential floor with a Medigap-style regulated supplemental on top, under AHQB governance. The rollout phases who enrolls when — never the rate: tranches by employer size and average payroll, regions by VHA and Post Office 2.0 density plus COMPASS shortage score, over 6–8 years, each cell capacity-gated; the floor's benefit composition widens only through the AHQB one-way ratchet.

HealthcareArchitectureRolloutCapacityGovernanceTransitions
What Distributed Healthcare is — and what it covers — lives at /healthcare. That page is the canonical surface for the universal essential floor (comprehensive across categories, $0 premiums for the floor) and the Medigap-style regulated supplemental on top of it. This engine page is the architecture index for legislative staff, healthcare-policy professionals, and provider organizations: component-level detail on structure, rollout phases, capacity channels, governance, and population transitions.

Five aspects

6 components
Architecture
How the system is structured. Universal essential floor, Medigap-style regulated supplemental, payment design, long-term care, mental health and SUD.
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6 components
Rollout
How the transition happens — 4–6 years, capacity-gated. Phase 0 prepares; Phases 1–4 enroll populations sequentially.
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4 components
Capacity
Where capacity comes from to meet universal coverage demand. VHA expansion, hospital takeovers, telehealth, mobile, Kaiser-style providers.
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5 components
Governance
AHQB clinical authority, anti-cream-skimming, cost controls, quality standards, pharma pricing, safe-harbor practice guidelines.
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7 components
Transitions
What changes for each population — uninsured, federal employees, employer-insured (high-comp / middle-small), Medicare, Medicaid, current VHA users.
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Funding clarification

The payroll tax is uncapped and applies to all compensation — wages, bonuses, equity, deferred income. It provides the largest single funding stream for Distributed Healthcare, replacing fragmented current funding through FICA-Medicare, employer health premiums, and employee premium contributions.

The new payroll tax is the largest single source — not "most of the cost." Federal general-fund redirection from current Medicare, Medicaid, and VA budgets provides comparable revenue. Federal Medicaid absorption brings additional flow; states retain their share. Supplemental tiers are separately priced in the regulated market — never bundled with the payroll tax. AHQB cost controls reduce baseline expenditure compared to current US healthcare spending (18.0% of GDP, CMS 2024).

Canon and references: Blueprint Chapter 11 — Distributed Healthcare · Expert Boards (AHQB) · Five Macrogovernors (Healthcare Cost Brake)