Fiscal scoring
The Accord beside the other plans
This table sets the Accord's scenario assumptions beside the plans that occupy the same ground: single payer in the Sanders and Jayapal bills as scored by CBO, the Urban Institute and Mercatus; a Medicare public option in its transitional form (the Sanders buy-in, the Medicare for America Act) and its standing form (Medicare-X); and the seven Peterson Solutions Initiative 2024 fiscal plans with the Fiscal Commission Act.
On the health side every single-payer estimate reaches the shape the Accord's engine reaches: coverage becomes universal, national health spending moves by a few percent, and the federal line grows by roughly ten to fifteen percent of GDP because private premiums are replaced by public financing. The Accord differs in what it specifies and scores: the four payment methods, the growth rule, the specialist-pay convergence, the drug-pricing chassis, the capacity-gated rollout, and the seven-year overlap with the legacy programs.
Two facts carry the comparison. The Medicare for All bills contain no financing title and no fiscal target, and every estimator says so. The fiscal plans start from today's coverage architecture and stabilise the debt at a ratio between 59% and about 100% of GDP in 2054.
Our claim, stated as a claim: the Accord is the only plan in this table that scores universal coverage and its financing in one ledger and runs the debt to zero rather than to a stabilised ratio. The end-to-end score is the harder test, because the transition years cost more than the status quo and the score says so.
Figures for other plans are quoted from the originators named in each cell. Where a figure could not be retrieved from its source, the cell says so and the row is marked for verification; no substitute number has been supplied.
Our three scenarios, each a pair
Optimistic
Central
Conservative (the boundary)
governor live (the executed path)governor idle (the enacted rates alone)CBO current lawdebt held by the public, percent of GDP
Optimistic
Stronger nominal growth than central on the engine's optimistic path; health costs on the low band of the mechanism ledger; the central interest path.
Transition rise, by design107% of GDP in 2031
Falls under the current-law path2030
Automatic steps used0 of 8
Slack absorbednone needed
Debt at 20% of GDP2052
No external debt2055, trusts hold $3.4T
General Fund debt-free2056
Same rates, governor idledebt-free 2056
Central
The engine's central nominal path; health costs on the ruled two-phase convergence with protected lanes; interest on the central path with the executed debt-level feedback.
Transition rise, by design110% of GDP in 2038
Falls under the current-law path2032
Automatic steps used0 of 8
Slack absorbednone needed
Debt at 20% of GDP2067
No external debt2070, trusts hold $7.4T
General Fund debt-free2071
Same rates, governor idledebt-free 2071
Conservative (the boundary)
The central economy deteriorated along all three axes to the combined frontier the governor still absorbs: nominal growth 0.19pp a year below central, a 50bp interest premium, and health costs 4.5% above the ruled path, all at once and from 2030.
Transition rise, by design122% of GDP in 2043
Falls under the current-law path2032
Automatic steps used8 of 8
Slack absorbed+2pp top rate, +2pp VAT, +0.5pp payroll
Debt at 20% of GDP2077
No external debt2079, trusts hold $10.4T
General Fund debt-free2080
Same rates, governor idledoes not close by 2079
Assumption by assumption
| Dimension | The Accord | Medicare for All | Public option, transitional | Public option, standing | Other fiscal plans |
|---|---|---|---|---|---|
| Coverage universe and what is covered | Every resident, enrolled automatically, on one universal floor: Medicare plus Medigap for all ages. The floor is comprehensive across categories at launch: hospital, emergency, primary and specialty care, maternity and newborn care, mental health and substance-use treatment, formulary prescriptions, preventive care at no cost, basic dental prevention and emergency extraction, emergency vision exams, hearing screening, hospice and palliative care, and skilled post-acute care at Medicare scope. Basic hearing aids and eyeglasses are a fixed FedCard coupon of about $500 per five years. Cost sharing inside the floor is calibrated by the AHQB, the independent board that sets coverage rules. | Every US resident (S.1655 and H.R.3421, 118th Congress). Benefits include primary care, hospital care, prescription drugs, mental health and substance-use treatment, dental, vision, hearing, reproductive care and long-term services and supports, with no premiums, deductibles or copayments. CBO (2020) treats coverage under its five options as nearly universal. Urban (2019) models two variants: an enhanced single payer covering everyone including undocumented residents, and a single-payer lite covering legal residents only, which leaves 10.8 million undocumented residents uncovered and adds income-based cost sharing. | Coverage widens in steps toward the single-payer end state. The Sanders bill's four-year transition lets people buy into a transitional Medicare plan by age group before the program becomes universal (Blahous 2018, on the 2017 text). The Medicare for America Act (DeLauro and Schakowsky, H.R.2452, 2019) auto-enrolls the uninsured and the individual market, lets employers enroll their workers, and covers prescription drugs, dental, vision, hearing and long-term supports and services. | Medicare-X (Bennet and Kaine, 2025) is a plan sold on the ACA individual exchanges and the small-business exchange from 2028, open to individuals, families and small businesses. It covers the ACA essential health benefits with primary care at no cost sharing. Premium tax credits are extended above 400% of the poverty line with premiums capped at 8.5% of income, and the family-glitch fix is codified. Urban (2022) estimates the bill would reduce the uninsured by 1.1 million in 2023. | The Solutions Initiative 2024 plans leave the coverage architecture in place and change its financing. AEI converts Medicare to premium support with the eligibility age rising to 67, replaces Medicaid matching with per-capita allotments and caps the tax exclusion for employer coverage. The Manhattan Institute adopts premium support and a per-recipient federal Medicaid payment rising 4% a year. BPC repeals the income and payroll tax exclusions for employer fringe benefits. CAP raises the Medicare tax on high earners. PPI restructures Medicare as 'Medicare One'. The Fiscal Commission Act has no health design; it charters a commission. |
| Provider payment rates figures pending verification at source | One federal payer using four payment methods matched to cost structure: a reference fee schedule with site-neutral payment for professional and ambulatory services; capacity payments for standby capability such as trauma and obstetric readiness; capitation with outlier reinsurance for longitudinal primary care; and global budgets for hospitals in concentrated markets. The hospital lane is scored against delivered cost at 8 to 14% above Medicare rates (central 11%); physician services are scored at Medicare. The physician-work component of the schedule is frozen in nominal terms from 2036 until specialist pay converges to the OECD range of 2.2 to 3.4 times the average wage (the US sits near 5.4 times); primary care and rural practice stay indexed; public medical-school tuition is zero for graduates entering scheduled practice and residency slots are funded outside the Medicare cap. | The House bill pays institutions through global budgets negotiated with regional directors and pays individual practitioners on a fee-for-service basis; the 2017 Senate text sets payment consistent with current Medicare law. The estimators differ on the level. Mercatus (Blahous 2018) applies Medicare rates, about 40% below private insurance. Urban (2019) pays hospitals 115% of Medicare and other providers 100%. CBO's 2020 Option 3 pays hospitals 123% and physicians 111% of Medicare in 2030; its Options 4 and 5 pay higher rates. | Medicare for America pays providers on current Medicare and Medicaid rates. The Sanders bill's transitional plan is a buy-in to Medicare, so Medicare payment rules apply during the transition. | Medicare-X pays 100% of Medicare fee-for-service rates, with the Secretary able to pay up to 150% of Medicare for hospitals and physicians in rural areas; providers who participate in Medicare or Medicaid must accept the plan. CBO (2021) finds Medicare-based rates would reduce provider and drug-manufacturer revenues, with the effect limited by the nongroup market's small share of total enrollment. | Not a design element of the fiscal plans. Premium support (AEI, Manhattan Institute) changes what the federal government pays plans, not what plans pay providers; Medicaid per-capita caps (AEI, Manhattan Institute) limit federal payments to states. The Fiscal Commission Act prescribes no instruments. |
| Drug pricing figures pending verification at source | The AHQB formulary is priced on the VA federal supply schedule chassis, the purchasing arrangement under which the VA pays roughly half of Medicare Part D net prices on top-selling drugs (GAO-21-111). The mechanism ledger scores formulary prices at 56 to 75% of current levels across scenarios, and the AHQB holds import authority for any drug priced above the VA schedule. | The Secretary negotiates prices for the whole program (S.1655 and H.R.3421). Mercatus (2018) credits $846 billion of drug savings over 2022 to 2031 from negotiation and near-complete generic substitution and calls the assumption aggressive. CBO's 2020 Option 3 assumes a 30% reduction in drug prices. | Not stated in the Medicare for America summaries retrieved this session. The Sanders transition inherits the end-state negotiation authority. | Medicare-X gives the Secretary authority to negotiate prices for the Medicare-X plan and for all of Medicare Part D, with value-based payment arrangements permitted. | Not addressed as a design element in the plan pages retrieved this session; the Solutions Initiative plans act on Medicare's financing rather than on drug prices. |
| Long-term care | No new long-term-care program. The floor covers Medicare-equivalent post-acute care: skilled nursing, home health and hospice. Medicaid long-term services and supports, including custodial care and eligibility spend-down, continue unchanged, and the Medicaid-retained lanes stay on their current-law path inside the growth rule. An assessed-benefit expansion with no asset test is a gated future decision scored at zero. | Both bills cover long-term services and supports with no cost sharing and prioritise home- and community-based care. The cost of that choice is visible in every estimate. CBO's Option 5, the only option with comprehensive long-term services, raises federal subsidies by $3.0 trillion in 2030 against $1.5 trillion at the low end of the five options. Urban's enhanced variant includes long-term services and costs $34.0 trillion over ten years against $17.6 trillion for the lite variant without it. Mercatus assumes a state maintenance-of-effort on Medicaid long-term services and no new benefit. | Medicare for America covers long-term supports and services for seniors and people with disabilities. | Medicare-X does not cover long-term services. It directs CMS to study covering long-term services and supports, home- and community-based services, assistive technology, and adult vision, hearing and dental, and to report on premium and risk-pool effects. | Not addressed as a benefit. AEI and the Manhattan Institute cap federal Medicaid payments per capita, which governs the federal share of Medicaid long-term services without changing the benefit. |
| Private insurance above or beside the floor | A regulated supplemental sits above the floor on the Medigap model: standardized tiers, guaranteed issue, community rating, AHQB supervision. It buys financial and convenience terms on the same clinical floor (reduced cost sharing, comprehensive adult dental, premium vision and hearing devices above the coupon, private rooms, faster elective scheduling inside the same wait-time ceiling), never a different standard of care. Employer-funded supplemental is taxable compensation. Supplemental premiums are scored at about 0.67% of GDP at maturity, and the AHQB one-way ratchet moves supplemental benefits into the floor as unit costs fall. | The House bill prohibits private insurers from selling coverage that duplicates the program's benefits. Urban (2019) and Mercatus (2018) both model the elimination of private insurance for covered services; supplemental coverage survives only for benefits outside the program. | Employer coverage is preserved as an option in Medicare for America: large employers may keep offering comparable coverage or enroll their workers in the public program. Under the Sanders transition, private coverage continues until the program becomes universal. | Private plans continue to compete on the exchanges and in the employer market. CBO (2021) finds a public option priced near private plans has little effect, while a low-premium public option lowers the benchmark premium and federal subsidies and could lead private insurers to leave some markets; effects on employer coverage are small because employer contributions stay tax-excluded and workers with an affordable offer cannot take subsidies. | Private insurance remains the primary system. AEI caps the tax exclusion for employer coverage and BPC repeals the income and payroll exclusions for employer fringe benefits. Premium support (AEI, Manhattan Institute) moves Medicare beneficiaries onto competing private plans with a fixed federal contribution. |
| Transition length and what runs alongside | A seven-year capacity-gated rollout: enrollment reaches 10, 30, 42, 61, 78, 92 and 100% of the population by year, each phase gated on measured capacity, with the AHQB able to pause or roll back a phase. Employers convert in three tranches (small employers and the uninsured in Year 1, firms of 20 to 500 workers in Year 2, 500 and above in Year 3), highest plan value first; collectively bargained plans run to contract expiry, capped at three years. Medicare and Medicaid run in full alongside the new payer and fold in over Years 4 to 7, so the transition years cost more than the status quo by design: the national system share rises above today's 18.0% of GDP (CMS 2024) during the overlap and is near 19% when the full schedule takes effect in 2036. | Two years in the House bill; four years in the Senate bill, during which people buy into a transitional Medicare plan by age group. The estimators skip the transition: Mercatus scores the first ten years of full implementation (2022 to 2031) and calls take-up during the transition inherently speculative; CBO scores 2030 as a fully implemented year. | The Sanders transition has a four-year end date. Medicare for America has none, so its glide toward a single payer depends on enrollment migrating from employer coverage rather than on a statutory switch. | Medicare-X is available on every exchange from 2028 in the 2025 text. The 2021 version phased into the individual market over four years, starting in counties with few insurers, reaching every ZIP code by 2029 and entering the small-group market in the fourth year. Nothing folds; Medicare, Medicaid and employer coverage continue unchanged, and the bill states it has no effect on Medicare fee-for-service, Medicare Advantage or the Medicare trust fund. | The fiscal plans phase in over the 30-year Solutions Initiative window. BPC caps discretionary growth at 1% a year through FY2034 and 2% a year for the two decades after; AEI phases the Medicare eligibility age to 67 and holds the 2023 Fiscal Responsibility Act caps through 2025. The Fiscal Commission Act's commission reports by 2025 against a non-binding FY2039 target. |
| National health spending at maturity (share of GDP) | Converges under a growth rule: the whole floor grows at nominal GDP minus 1.0 point to 2050 and minus 0.5 point after, toward a 13.0% of GDP objective, with public health, research and structures investment, and home health protected from the bound. Dated path: about 19% of GDP at the 2036 launch, 15 to 16% by the 2050s (inside a 14.5 to 17.5% two-model bracket), the 13.0% objective by the late 2070s, against 18.0% today (CMS 2024) and 20.6% projected for 2034 under current law. | No maturity share is published; the estimates give a first-decade level. CBO (2020) puts the 2030 change in national health expenditures between a $0.7 trillion decrease and a $0.3 trillion increase across its five options, with lower provider payment rates and lower administrative cost as the largest decreases and increased use of care as the largest increase. Urban (2019): the lite variant lowers national spending by $209.5 billion (6%) in 2020; the enhanced variant raises it by about $720 billion. Mercatus (2018): national health expenditures fall about 4% over the decade because added demand from covering the uninsured and removing cost sharing nearly offsets the payment cuts. | Not estimated for the Medicare for America Act in the sources retrieved this session. CBO (2021) notes the nongroup market is a small share of total enrollment, so a public option's effect on national spending stays limited until enrollment migrates. | Small. Urban (2022) finds Medicare-X lowers employer health spending by $10.8 billion and household spending by $10.9 billion in 2023. CBO (2021) finds provider and drug-manufacturer revenues fall modestly. | Not a design target. The Solutions Initiative reports Medicare at 3.1% of GDP in 2023 rising to 5.4% by 2054 under current law; the plans act on that federal line, not on national spending. |
| Federal health spending (share of GDP) | Federal health cash in FY2036 is scored at 13.4 to 13.5% of GDP. That is a gross federal line, not an increment: it replaces Medicare, federal Medicaid, the employer-premium tax exclusion and the ACA subsidies inside the same ledger. The state Medicaid share is released to the states unconditioned at each state's absorption date and is reported as a separate line, never netted against federal cash. | CBO (2020): federal subsidies in 2030 rise by $1.5 to $3.0 trillion across the five options (Option 3 $1.77 trillion, Option 4 $2.40 trillion, Option 5 $3.0 trillion). Urban (2019): $1.5 trillion in 2020 and $17.6 trillion over ten years for the lite variant; $2.8 trillion and $34.0 trillion for the enhanced variant. Mercatus (2018): $32.6 trillion over 2022 to 2031, 10.7% of GDP in 2022 rising to 12.7% in 2031, on top of existing federal health subsidies of about 6.6% of GDP; $38.0 trillion and nearly 14.8% of GDP by 2031 if provider rates are not cut. | Not scored by CBO in the sources retrieved this session. Medicare for America finances enrolling employers through an 8% payroll contribution to the Medicare trust fund; the net federal figure is not published. | Federal savings. Urban (2022): the federal government saves $20.3 billion in 2023 and $250 billion over ten years under Medicare-X, because a lower-premium plan lowers the benchmark against which subsidies are paid. CBO (2021) reaches the same direction for a low-premium public option. | The plans lower the federal health line from a current-law base of Medicare at 3.1% of GDP in 2023 rising to 5.4% in 2054. Plan-level federal health shares in 2054 were not retrieved this session. |
| Financing instruments figures pending verification at source | A 28% flat, uncapped payroll tax (10.5% employee, 17.5% employer) replacing FICA and employer premiums; a 10% VAT with a per-person prebate, so about the bottom four spending deciles pay zero net VAT; a top income rate of 52% paired to the 10% VAT; and the wealth-transfer stack (estate-tax prepayment at 0.8 to 2.0% a year above $10 million, estate brackets of 30, 34 and 38%, a flat 5% accession tax, and a generation-skipping rate derived from the two). All of it flows to the General Fund; there is no health trust fund and no earmark. Carbon revenue above the rebate ceiling goes to the Climate Adaptation Trust and finances nothing in health. | The bills create a Universal Medicare Trust Fund that receives the appropriations now spent on Medicare, Medicaid and other federal health programs, and leave new revenue to separate legislation; the bill text does not specify premiums after the transition. Sanders has published a financing-options paper (employer and income-based premiums, higher top rates, a wealth tax); none of the estimators scores it. Mercatus notes that doubling all individual and corporate income tax collections would not cover the added federal cost. | Medicare for America: enrolling employers contribute 8% of payroll to the Medicare trust fund; enrollees pay income-scaled premiums. The Sanders transition is financed by buy-in premiums during the four years. | Premiums set by the Secretary to cover costs, plus the existing ACA premium tax credits; a $10 billion a year national reinsurance program for three years; no new tax. | AEI: broaden the income-tax base and lower rates, corporate rate to 20%, a carbon tax and a higher gasoline tax, repeal the estate and gift tax and tax unrealized gains at death. Manhattan Institute: extend most 2017 tax cuts, restore a 39.6% top bracket, cap deductions at 15%, a carbon tax with rebates for lower earners, tax gains at death. BPC: repeal the employer-benefit exclusions, SALT and step-up in basis. CAP: corporate rate to 30%, a 25% minimum income tax on households worth over $100 million, lift the Social Security earnings cap. PPI: corporate rate to 25% and new progressive income brackets. AAF: revenues two percentage points of GDP higher, raised 'in a pro-growth fashion'. EPI: address the expiring 2017 tax provisions and strengthen the Social Security trust funds. |
| Distribution: who pays more, who pays less | Employer premiums are recharacterised as wages and taxed at the same flat rate as every other dollar of compensation, households pay no premiums, the prebate zeroes net VAT for about the bottom four spending deciles, and the deferred-obligation register (estate, prepayment, accession) collects the share that today's code leaves uncollected. | Private premiums and out-of-pocket spending are replaced by federal financing, wages rise net of employer benefits and become taxable (Mercatus 2018), provider and insurer revenues fall (CBO 2020), and who pays the new taxes depends on financing legislation the bills do not contain. | Households and employers who enroll pay premiums or the 8% payroll contribution instead of private premiums; who bears the residual is not published. | CBO (2021): coverage gains fall mostly on higher-income uninsured people who are ineligible for subsidies; Urban (2022): employers save $10.8 billion and households $10.9 billion in 2023; providers serving the nongroup market receive Medicare rates instead of commercial rates. | AEI and the Manhattan Institute reduce Social Security and Medicare benefits for higher earners (a means-tested flat benefit; premium support) and add consumption taxes with rebates; CAP raises taxes on corporations and the highest-income households and lifts the Social Security cap; BPC combines benefit reductions with base-broadening. The Fiscal Commission Act assigns the question to the commission. |
| Debt path and target figures pending verification at source | Debt held by the public rises to about 110% of GDP in the late 2030s by design, because the transition years cost more than the status quo, and is on track for retirement by 2080 by statute: the Statistics Board sets the launch rates to that date, and the central case closes with no automatic governor step. The Debt Sunset Governor is a Statistics Board calculation on the projected retirement date: a projection two or more years off the most recent date moves the top income rate, the VAT and the payroll rate together in steps, up to a total of two points on the top rate, two points on the VAT and half a point on payroll before Congress must act. Retirement is published as two dates, the General Fund at zero and the general ledger at zero. | No debt target. The bills are coverage legislation; CBO's working paper scores federal subsidies rather than the deficit, and the deficit effect depends on financing the bills do not contain. | No debt target. | No debt target. Urban (2022) scores Medicare-X as reducing federal spending by $250 billion over ten years. | Against a CBO current-law baseline of 166% of GDP in 2054: BPC 59% (from 99% in FY2024); Manhattan Institute about 100% through 2040, then 68% by 2054; AEI about 85%; CAP peaks below 120% and falls modestly by the end of the window; AAF returns the debt to 'the pre-pandemic range'; PPI balances the budget within 20 years of enactment; EPI's 2054 figure was not retrieved this session. Every plan cuts debt-to-GDP by at least a third and 30-year interest costs by at least $13 trillion. The Fiscal Commission Act sets a non-binding target below 100% of GDP by FY2039 and leaves the instruments to a 16-member commission. |
| What the plan does not do | Does not create a long-term-care program, a paid-leave program, a Medicare buy-in step, premium support, a means test, a household test on the prebate, a health trust fund, or a second tier of care; does not phase in a tax rate; does not forecast an expert board's decisions; does not publish a retirement year as a forecast. | Does not specify financing, set a fiscal target, build delivery capacity or gate enrollment on it, set a rule for specialist pay, or limit total spending beyond an annual national health budget. | Does not fix an end date (Medicare for America) or a financing plan for the end state; does not address Medicare's own cost growth; does not build supply. | Does not reach universal coverage (Urban: 1.1 million fewer uninsured in 2023), does not change Medicare or Medicaid, does not cover long-term services, and does not touch employer coverage. | None of the seven plans finances universal coverage and none retires the debt; the retrieved 2054 targets range from 59% to about 100% of GDP. The Fiscal Commission Act sets no instruments and binds no one. |
Coverage universe and what is covered: accord-enginem4a-118thcbo-2020urban-2019blahous-2018medicare-for-americamedicare-x-2025urban-medicare-x-2022peterson-2024fiscal-commission-act
Provider payment rates: accord-enginem4a-118thblahous-2018urban-2019cbo-2020-via-mercatusmedicare-for-americamedicare-x-2025cbo-2021peterson-2024
Drug pricing: accord-enginegao-21-111m4a-118thblahous-2018cbo-2020-via-mercatusmedicare-x-2025peterson-2024
Long-term care: accord-enginem4a-118thcbo-2020urban-2019blahous-2018medicare-for-americamedicare-x-2025peterson-2024
Private insurance above or beside the floor: accord-enginem4a-118thurban-2019blahous-2018medicare-for-americacbo-2021peterson-2024
Transition length and what runs alongside: accord-enginem4a-118thblahous-2018cbo-2020medicare-for-americamedicare-x-2025medicare-x-2021peterson-2024fiscal-commission-act
National health spending at maturity (share of GDP): accord-enginecbo-2020urban-2019blahous-2018cbo-2021urban-medicare-x-2022peterson-2024
Federal health spending (share of GDP): accord-enginecbo-2020cbo-2020-via-mercatusurban-2019blahous-2018medicare-for-americaurban-medicare-x-2022cbo-2021peterson-2024
Financing instruments: accord-enginem4a-118thblahous-2018medicare-for-americamedicare-x-2025peterson-2024
Distribution: who pays more, who pays less: accord-engineblahous-2018cbo-2020medicare-for-americacbo-2021urban-medicare-x-2022peterson-2024fiscal-commission-act
Debt path and target: accord-enginecbo-2020urban-medicare-x-2022peterson-2024fiscal-commission-act
What the plan does not do: accord-enginem4a-118thmedicare-for-americaurban-medicare-x-2022peterson-2024fiscal-commission-act
Sources. The Accord as executed on 2026-09-10: lib/config.ts (CFG.healthcare, CFG.tcl, CFG.vat, CFG.debtSunset), data/healthcare-mechanisms.ts (ENROLLMENT, HOSPITAL_COST_OVER_MEDICARE, PHYSICIAN_FREEZE, RX, CONVERGENCE_*, PROTECTED_LANES), data/endogenous-governor.ts (DEBT_SUNSET_PARAMS, RETIREMENT_DATE_RULE), and the ruled lines in CLAUDE.md. · Medicare for All Act of 2023, S.1655 (Sanders) and H.R.3421 (Jayapal), 118th Congress; sponsor summary, Jayapal press release, 17 May 2023; transition and duplication terms as summarised at Wikipedia, 'Medicare for All Act' (retrieved 2026-09-10; bill text not retrieved). · Congressional Budget Office, 'How CBO Analyzes the Costs of Proposals for Single-Payer Health Care Systems That Are Based on Medicare's Fee-for-Service Program', Working Paper 2020-08, December 2020. · Option-level detail of CBO Working Paper 2020-08 (Option 3 hospital 123% and physician 111% of Medicare, $1.77 trillion; Option 4 $2.40 trillion; Option 5 $3.0 trillion with LTSS; 30% drug price reduction) as reported in Mercatus Center, 'Understanding CBO's Medicare for All Cost Estimates', policy brief. The CBO PDF itself was not retrievable this session. · Congressional Budget Office, 'A Public Option for Health Insurance in the Nongroup Marketplaces: Key Design Considerations and Implications', April 2021. · Linda J. Blumberg, John Holahan et al., Urban Institute, 'From Incremental to Comprehensive Health Insurance Reform: How Various Reform Options Compare on Coverage and Costs', October 2019 (Commonwealth Fund). Payment-rate assumptions (hospitals 115% of Medicare, other providers 100%) as quoted in the PMC commentary on 'Health Spending Under Single-Payer Approaches'. · Charles Blahous, 'The Costs of a National Single-Payer Healthcare System', Mercatus Working Paper, July 2018. · Medicare for America Act of 2019, H.R.2452 (DeLauro and Schakowsky); sponsor summaries and press coverage retrieved 2026-09-10. · Senators Bennet and Kaine, 'The Medicare-X Choice Act of 2025', bill summary. · Bennet and Kaine, Medicare-X Choice Act reintroduction release, February 2021 (four-year phase-in to every ZIP code by 2029; small-group market in the fourth year). · Urban Institute, 'Coverage and Cost Effects of Senators Bennet and Kaine's Medicare X Choice Act', 2022. · Government Accountability Office, GAO-21-111, prescription drug prices paid by the VA compared with Medicare Part D net prices (as cited in data/healthcare-mechanisms.ts, mechanism RX). · Peter G. Peterson Foundation, 'Solutions Initiative 2024: Charting a Brighter Future', July 2024, and the seven plan pages (American Action Forum, American Enterprise Institute, Bipartisan Policy Center, Center for American Progress, Economic Policy Institute, Manhattan Institute, Progressive Policy Institute). The CBO baseline of 166% of GDP in 2054 is the initiative's stated reference. The full-report PDF and per-plan summary PDFs were not retrievable this session. · Fiscal Commission Act (H.R.5779, 118th Congress; reintroduced by Huizenga and Peters), as summarised by the Committee for a Responsible Federal Budget, 'Fiscal Commission Act: Just the FAQs', February 2024.
The scoring itself: the fiscal scoring page, the Debt Sunset Governor, the master tables.
Architecture version: v11.0
Scoring version: v11.0, scored end to end by the executed engine (rerun 2026-09-09)
Engine source: computeProjection (governor-ON, statutory Debt Sunset Governor)