AmericasCare™: Community-Controlled Healthcare
AMERICA'S HEALTHCARE SYSTEM ALREADY HAS ENOUGH MONEY TO PROVIDE HEALTHCARE FOR EVERY AMERICAN.
THE PROBLEM ISN'T THE AMOUNT OF MONEY.
THE PROBLEM IS THE SYSTEM THE MONEY IS FLOWING THROUGH.
Americans spent approximately $5.3 trillion on healthcare in 2024—more than $15,000 for every person in the country.
Yet families still face medical-related bankruptcy, medical debt, deductibles, copays, rising insurance premiums, prescription drug costs, and the possibility of losing a lifetime of assets when long-term care is needed—all while the system profits from someone else's suffering.
At Americas Policy Institute, we developed AmericasCare™.
AmericasCare™ proposes a fundamentally different approach.
Instead of continuing to route America's healthcare dollars through layers of insurance plans, government programs, networks, billing systems, claims disputes, deductibles, copays, and collection processes, AmericasCare™ would redirect eligible healthcare funding into locally governed Community Healthcare Trusts connected through nationwide risk sharing.
We call it Community-Controlled Healthcare.
AmericasCare™ takes an unnecessarily complicated healthcare system and makes it simple:
You get sick or injured.
You get the healthcare you need.
The bill is verified.
The provider is paid.
That's healthcare.
It doesn't need to be more complicated than that.
MORE CARE with LESS WASTE.
REDIRECT THE MONEY. SIMPLIFY THE SYSTEM.
AmericasCare™ would redirect eligible healthcare funding currently flowing through:
• Private health insurance — approximately $1.64 trillion
• Medicare — approximately $1.12 trillion
• Medicaid — approximately $932 billion
• Out-of-pocket healthcare spending — approximately $557 billion
• Workers' compensation medical expenses — approximately $30 billion
• Automobile insurance medical expenses
• Homeowners and business insurance medical expenses
• Other existing public and private healthcare funding
Medical-payment responsibility now contained in workers' compensation, automobile, homeowners, business liability, and other overlapping insurance coverages would be consolidated into AmericasCare™.
Think about it: if you're injured at work, you don't go to a separate workers' compensation hospital or see a workers' compensation doctor.
You go to the same hospitals, doctors, pharmacies, and healthcare providers everyone else uses.
Removing medical-payment responsibility from these policies reduces the medical risk those insurers must cover, creating an opportunity for lower home, auto, workers' compensation, and business insurance premiums.
COMPREHENSIVE HEALTHCARE MEANS COMPREHENSIVE HEALTHCARE.
AmericasCare™ is designed to provide healthcare based on what you need—not what insurance plan you have, what network you're in, or whether you can afford the deductible.
Covered healthcare would include:
• Doctor and specialist care
• Hospital and surgical care
• Emergency care
• Prescription medications
• Mental and behavioral healthcare
• Dental care
• Vision and hearing care
• Preventive and wellness care
• Rehabilitation and therapy
• Ground and air ambulance transportation
• Home healthcare
• Long-term care and nursing care
• In-home caregiver support
• Medically necessary treatment while traveling
• Necessary patient and companion medical transportation
For covered healthcare:
NO DEDUCTIBLES.
NO COPAYS.
NO NETWORKS.
NO SURPRISE MEDICAL BILLS.
NO MEDICAL DEBT.
You need healthcare.
You receive healthcare.
AmericasCare™ pays the verified bill.
YOUR HEALTHCARE SHOULD NOT COST YOUR FAMILY EVERYTHING YOU WORKED A LIFETIME TO BUILD.
One of the most important protections in AmericasCare™ is comprehensive long-term care.
Today, Americans who need long-term care can face enormous costs and may be required to spend down assets to qualify for Medicaid.
Medicaid also has a five-year look-back on certain asset transfers for long-term-care eligibility, and federal law requires states to pursue estate recovery for certain Medicaid long-term-care costs, subject to specific protections and exceptions.
AmericasCare™ takes a different approach:
LONG-TERM CARE IS HEALTHCARE.
If you need nursing-home care, home healthcare, or qualified in-home caregiver support, AmericasCare™ is designed to cover that care as part of your healthcare—not force you to impoverish yourself first.
No Medicaid asset spend-down requirement for AmericasCare™ coverage.
No five-year Medicaid transfer look-back to qualify for AmericasCare™ long-term care.
No Medicaid estate recovery for long-term care paid by AmericasCare™.
You worked for your home.
You worked for your savings.
You worked to build something for your family.
Needing healthcare should not take it away from them.
HOW AMERICASCARE™ FUNDS WORK
AmericasCare™ would establish 435 Community Healthcare Trusts based around America's congressional districts.
Healthcare dollars generated within and allocated to these communities would flow into locally governed Community Healthcare Trusts rather than through today's maze of insurance companies and government healthcare payment systems.
But the 435 trusts would NOT operate as 435 isolated pools of money.
They would be connected through nationwide risk sharing.
Think of the basic concept behind organizations such as Medi-Share: many participants share healthcare costs so that one person does not have to carry the financial burden of a major illness alone.
AmericasCare™ applies that basic sharing principle across entire communities.
If one Community Healthcare Trust experiences unusually high medical costs because of cancer, catastrophic injuries, an aging population, or other major healthcare needs, that community would not be left to carry those costs alone.
All 435 Community Healthcare Trusts would share healthcare risk nationwide.
THE MONEY IS CONTROLLED LOCALLY.
THE RISK IS SHARED NATIONALLY.
WHO CONTROLS THE MONEY?
The community does.
AmericasCare™ is NOT a single-payer, government-run healthcare plan that replaces today's insurance bureaucracy with another massive government bureaucracy.
It is Community-Controlled Healthcare.
Healthcare dollars are controlled locally by the communities they serve, while healthcare risk is shared nationally.
Government does not control your healthcare.
Insurance companies do not control your healthcare.
THE COMMUNITY CONTROLS THE MONEY.
YOU AND YOUR HEALTHCARE PROFESSIONALS CONTROL YOUR HEALTHCARE.
Each Community Healthcare Trust would be governed locally by a board made up of people who live and work in the community, including:
• Local business owners and employers
• Local residents
• Healthcare professionals
• Financial and fiduciary professionals
• Community representatives
Local business owners and employers would have a significant voice because they contribute substantial healthcare dollars and have a vested interest in controlling costs, maintaining a healthy workforce, and making sure the money is managed responsibly.
But no single group, industry, or special interest would control the trust.
Insurance companies, pharmaceutical companies, hospital systems, politicians, or any other special interest could not buy or control the board.
Trustees would be subject to term limits, financial disclosure, strict conflict-of-interest rules, independent audits, and public financial transparency.
And there would be one very important limitation:
TRUSTEES DO NOT DECIDE WHO GETS HEALTHCARE.
Medical decisions would remain between patients and qualified healthcare professionals, subject to established medical standards, verification, and an independent appeals process.
The board manages the money.
Healthcare professionals manage the healthcare.
The community holds them accountable.
WHERE DOES AMERICASCARE™ REDUCE COSTS?
AmericasCare™ is designed to reduce the cost of healthcare by simplifying how healthcare is financed, administered, purchased, billed, and paid for—NOT BY DENYING PEOPLE CARE.
Potential cost reductions include:
• Administrative Simplification — Replace layers of insurance plans, networks, claims rules, approvals, and separate payment systems with a simpler healthcare payment structure.
• Simplified Billing — Give providers a standardized way to submit verified medical bills instead of maintaining staff and systems to navigate the different rules and requirements of numerous payers.
• Prompt Provider Payment — Pay verified bills promptly, reducing the time and money providers spend on billing, collections, claim follow-up, payment disputes, and bad debt.
• Prescription Drug Negotiation — Combine the purchasing power of all 435 Community Healthcare Trusts to negotiate lower pharmaceutical prices for the American people.
• Waste, Fraud, and Abuse — Use verification, auditing, transparency, and payment-integrity controls to protect healthcare dollars from improper spending.
• Eliminate Duplicative Medical-Payment Systems — Consolidate medical payment responsibilities now spread across health insurance, workers' compensation, auto insurance, and other overlapping systems where appropriate.
• Reduce Employer and Provider Administration — Simplifying healthcare financing could reduce the time and money businesses and healthcare providers spend administering today's complicated system.
Research has estimated that hundreds of billions of dollars are spent each year administering America's healthcare system.
Our financial modeling indicates that AmericasCare™ could potentially create approximately $372 billion to more than $1 trillion in gross annual efficiencies, depending on how successfully these reforms reduce administrative costs, pharmaceutical costs, billing expenses, waste, and other inefficiencies.
Those are potential gross efficiencies—not guaranteed savings.
POTENTIAL COST REDUCTIONS WE HAVE NOT COUNTED
We believe AmericasCare™ could create additional cost reductions and economic benefits. However, rather than assign dollar values we cannot yet confidently support, our financial model currently gives these potential benefits ZERO financial credit:
• Earlier Diagnosis and Treatment — Today, some Americans delay or avoid healthcare because they cannot afford the deductible, copay, prescription, or other out-of-pocket expense. Removing those financial barriers could allow health problems to be treated sooner instead of after they become more serious and potentially more expensive.
• Healthier Communities and Preventive Care — Because Community Healthcare Trusts have a direct financial interest in the health of the people they serve, communities would have an incentive to support voluntary wellness, prevention, fitness, nutrition, and other programs that could help reduce future healthcare needs and costs.
• Reduced Complications from Chronic Disease — Removing financial barriers to regular care could help people better manage conditions such as diabetes, heart disease, and high blood pressure before they lead to expensive complications, emergency care, or hospitalization.
• Reduced Medical Debt — When covered healthcare bills are paid by AmericasCare™, fewer unpaid patient balances could mean fewer collections, less bad debt, and fewer costs associated with trying to collect money patients may not have.
• Reduced Medical-Related Bankruptcy — Serious illness can financially devastate a family through medical expenses and lost income. Removing covered medical expenses from that burden could reduce the number of Americans pushed toward bankruptcy and the economic costs that follow.
A widely cited study of bankruptcy filers found that medical problems—including medical expenses and income loss caused by illness—contributed to approximately two-thirds of the bankruptcies reported by those surveyed.
• Reduced Uncompensated Care — When verified healthcare bills are paid promptly, hospitals and providers could experience less uncompensated care, bad debt, collection expense, and cost shifting to other patients and payers.
• Lower Other Insurance Premiums — Removing medical-payment responsibility from workers' compensation, auto, homeowners, and business insurance reduces the medical risk those policies must cover, creating an opportunity for lower premiums.
• Investment Earnings — Appropriate healthcare reserves could be invested under strict fiduciary and risk-management rules. Investment earnings could help strengthen the Community Healthcare Trusts and further reduce future healthcare funding requirements.
We currently assign $0 in savings to ALL of these potential benefits.
If savings are ultimately realized in any of these areas, they would be additional to the financial efficiencies already included in our model.
AmericasCare™ does not have to save $1 trillion to succeed.
It has to reduce unnecessary costs and use the healthcare dollars Americans are already spending more efficiently.
MORE CARE with LESS WASTE.
WHY SHOULD AMERICANS PAY MORE FOR THE SAME MEDICINE?
Americans pay some of the highest prescription drug prices in the world.
In 2024, Americans spent approximately $467 billion on retail prescription drugs.
For years, one of the most powerful purchasers of healthcare in America—Medicare—was actually prohibited by federal law from directly negotiating prescription drug prices with pharmaceutical manufacturers under Medicare Part D.
Think about that.
The American people were spending hundreds of billions of dollars on prescription drugs, yet the government had created a system that prevented Medicare from using its enormous purchasing power to directly negotiate those prices.
That never made economic sense.
Federal law has finally changed—but even now the negotiation process is being phased in only a limited number of drugs at a time.
The first negotiated prices covered just 10 drugs and did not take effect until 2026.
Another 15 drugs receive negotiated prices in 2027.
Another 15 are scheduled for 2028.
Beginning in 2029, the law generally allows another 20 drugs per year to be added to the negotiation program.
There is no date when Medicare simply begins negotiating the price of every prescription drug.
WHY ARE WE STRINGING THIS OUT FOR YEARS?
If negotiation can reduce prescription drug costs, why should Americans have to wait year after year while only a limited number of drugs are added to the process?
And we already know negotiation can make a difference.
For the first 10 prescription drugs selected for Medicare price negotiation, the federal government estimated that the negotiated prices would have reduced 2023 net spending on those drugs by approximately $6 billion—or about 22 percent—if those prices had been in effect that year.
This is a perfect example of why we believe America needs Community-Controlled Healthcare.
AmericasCare™ would give all 435 Community Healthcare Trusts the ability to combine their purchasing power when negotiating prescription drug prices.
Instead of waiting for Washington to decide which limited number of drugs can be negotiated each year, AmericasCare™ would be designed to use the purchasing power of the entire system to negotiate prescription drug costs on behalf of the American people.
If millions of Americans are purchasing the same medications, why shouldn't Americans use that enormous purchasing power to negotiate the best possible price?
That's not complicated healthcare policy.
THAT'S COMMON-SENSE BUSINESS.
AMERICANS SHOULD NOT HAVE TO PAY MORE FOR MEDICINE JUST BECAUSE THEY ARE AMERICANS.
WHAT HAPPENS TO ANY POTENTIAL SAVINGS GENERATED?
If AmericasCare™ generates savings beyond what is needed to provide healthcare and maintain appropriate reserves, those savings should continue working for us.
Each of the 435 Community Healthcare Trusts could independently—or collectively with other trusts—decide how those savings could best benefit the people they serve.
We could:
• Strengthen our healthcare reserves.
• Reduce future healthcare costs.
• Invest some of the money in the stock market.
• Loan some of the money back to ourselves through qualified home or auto loans.
• Invest in programs that improve the health of our communities.
• Return some of the savings directly to the people.
Insurance companies already invest portions of the premiums and reserves they hold and use the earnings to strengthen their companies and generate profits.
Why can't we use the same basic principle for ourselves?
There would be one absolute priority:
HEALTHCARE COMES FIRST.
Healthcare obligations and appropriate reserves would always be protected before savings could be invested, loaned, returned to the people, or used for other purposes.
AmericasCare™ does not depend on investment earnings or loan interest to provide healthcare. Those are simply potential additional benefits created by using the healthcare dollars Americans are already spending more efficiently.
WE CAN DO BETTER.
America does not need another layer of healthcare bureaucracy.
We do not need another system that puts insurance companies, government agencies, or corporate interests between Americans and their healthcare.
We already spend approximately $5.3 trillion every year on healthcare.
The question is not whether America can afford to provide comprehensive healthcare.
The question is whether we have the courage to change a system that costs this much and still leaves millions of Americans worried about whether they can afford to get sick.
AmericasCare™ offers a different path.
Take the healthcare dollars Americans are already spending.
Put those dollars under community control.
Share healthcare risk nationwide.
Insurance companies and government healthcare programs already spread healthcare risk across millions of people. AmericasCare™ keeps that proven principle—WE SIMPLY CHANGE WHO CONTROLS THE MONEY AND THE PROCESS.
Instead of insurance companies or government bureaucracies controlling the system, the communities whose money funds the system control it.
Reduce unnecessary costs and waste.
Protect families from medical debt and medical-related bankruptcy.
Protect the homes and assets Americans worked a lifetime to build.
Give doctors and healthcare professionals the ability to focus on providing healthcare.
And give Americans a voice in what happens to the savings we create.
This will not happen because politicians suddenly decide to change the system.
It will happen when enough Americans stand together and demand something better.
That is what Americas Policy Institute is about.
SUPPORT POLICY NOT POLITICIANS.
It's time for We the People to take control of our healthcare dollars and demand a healthcare system that works for us.
MORE CARE with LESS WASTE.
If you believe America can do better, we invite you to stand with us.
REVIEW THE AMERICASCARE™ PETITION
IT'S OUR MONEY.
IT'S OUR COMMUNITY.
IT'S OUR DECISION.