The transition is accelerated to 4–6 years (down from earlier 7–10 year framings) but remains strictly capacity-gated. Phase 0 (Months 0–9) builds infrastructure before any patient transitions. Phases 1–4 enroll populations on a schedule that prioritizes the largest coverage gap (uninsured) first and back-loads the most politically sensitive groups (Medicare) for safety. No phase proceeds if it degrades access, wait times, or quality.
Anchor
Rollout overview — 4–6 year capacity-gated transition
Phase 0 (Months 0–9) sets up; Phase 1 (Year 1) enrolls uninsured + federal employees; Phase 2 (Years 1–2) expands capacity + pilots high-comp; Phase 3 (Years 2–4) full high-comp + large employer; Phase 4 (Years 4–6) middle/small + Medicare + federal Medicaid. Read component →
Primary
Phase 0 — Months 0–9: Preparation
Capacity mapping, provider contracting (RFI/RFQ), telehealth launch, mobile-health deployment begins, VHA capacity assessment, hospital-distress monitoring activated, payment-system + claims-rail tested. Read component →
Primary
Phase 1 — Year 1: Uninsured + federal employees
~27M currently uninsured enroll. Federal employees and their families transition. VHA begins admitting non-veteran civilians where capacity exists. Telehealth scaled nationally; mobile health in underserved regions. Read component →
Primary
Phase 2 — Years 1–2: Capacity expansion + high-comp pilot
Aggressive capacity expansion (hospital stabilization / takeover, Kaiser-style provider contracts, primary care, behavioral health). Begin high-salary employer cutover in pilot regions. Read component →
Primary
Phase 3 — Years 2–4: Full high-comp + large employer
Full high-compensation employer cutover. Large employer transition. Payment system fully dominant. Majority of population covered by end of Phase 3. Read component →
Primary
Phase 4 — Years 4–6: Middle/small + Medicare + federal Medicaid
Middle and small employer cutover. Medicare integration (late, controlled). Federal Medicaid portion integrated; states retain their share. System reaches near-universal coverage. Read component →