What it replaces:
The Compact replaces the ACA’s insurer-first subsidy model with direct payments to providers, automatic fraud audits, and a public option that costs less and covers more.
| Category | Estimated Cost | Offset Mechanism |
|---|---|---|
| Direct Provider Payments | $280B | Reallocation of ACA subsidies + clawbacks from fraud enforcement |
| Public Option Administration | $60B | Premium contributions + insurer exit penalties |
| Mental Health, Dental, Vision, Substance Abuse | $90B | ACA essential benefit reallocation + provider efficiency bonuses |
| Long-Term Care & Reproductive Health | $70B | Medicaid integration + facility audits |
| Fraud Enforcement & Audit Infrastructure | $15B | Recovered funds from clawbacks + whistleblower incentives |
| Total Annual Cost | $515B | Fully offset by $530B in savings |
| Source | Estimated Savings | Mechanism |
|---|---|---|
| ACA Subsidy Elimination | $300B | Premium tax credits and insurer subsidies repealed |
| Administrative Waste Reduction | $50B | Overhead cap + direct-pay model |
| Fraud Clawbacks & Audit Recovery | $40B | AI-driven audits + whistleblower incentives |
| Insurer Exit Penalties | $20B | Public option absorbs market, insurers pay clawback fees |
| Efficiency Bonuses & Risk Pool Optimization | $20B | Outcome-based provider incentives |
| Total Annual Savings | $530B | Net savings: $15B/year |
The Compact delivers more care, more coverage, and more accountability—while saving taxpayers $15 billion a year. It’s not just affordable. It’s offensive-proof.