Medicaid for All is opt-in, not opt-out. Keep your employer or union plan if you want it. Enroll instead, and pay a transparent premium with no deductibles and no surprise bills.

Who's Covered

American citizens and legal residents. Federal law separately requires hospitals to stabilize anyone in a medical emergency regardless of status. That law is unchanged by this plan.

What's Covered

All medically necessary care. Not a list of approved conditions, a standard. That includes everything currently covered under Medicaid and Medicare, dental care and restoration, vision, hearing, long-term care, and mental health and addiction treatment, plus anything else a doctor determines you need. If it's medically necessary, it's covered, whether or not it made a list somebody wrote down in advance.

This includes procedures already covered for some patients under standard medical necessity rules, like breast reduction for gynecomastia, hair restoration, hormone therapy, and facial reconstruction. No diagnosis of gender dysphoria or any gender-identity-related classification is required to access these treatments. The same medical necessity standard applies to everyone, the same way it already does for any other treatment a doctor prescribes.

Nearly 40% of Michiganders with a diagnosable mental illness receive no treatment. In the Upper Peninsula, half the counties have no psychiatrist, and 70% of primary care doctors report having nowhere to refer a patient in crisis. Medicaid for All covers inpatient and outpatient psychiatric care, medication-assisted treatment for addiction, and counseling at rates high enough to bring providers to counties that don't have any today.

Enrollment

No open enrollment window. If you're transitioning from other coverage, your new coverage starts the day the old coverage ends. If you're enrolling without prior coverage, coverage begins the day you enroll.

Outreach and Enrollment Assistance

An opt-in plan only works if people know it exists. Medicaid for All funds outreach and enrollment assistance the way the ACA Navigator program once did at full strength, real people in real communities helping other people sign up, not insurance brokers working on commission. That program was gutted by 90% in 2025, and enrollment dropped as a result. This plan restores it, focused on rural counties and underserved communities first.

Premiums

Your premium is capped as a percentage of income, not set by the health of the people who enroll. Medicaid for All pays providers using the same government-negotiated rate structure Medicare already built. That keeps the plan affordable even if healthier people choose to stay on employer coverage.

Subsidies

Below a set income level, your premium is zero, the same as Medicaid works today, and if you're already eligible for Medicaid, nothing changes: no new premium, no new paperwork. Above that threshold, your premium is capped as a rising percentage of income, calculated off your tax return the same way ACA subsidies already work, so it adjusts automatically without a new application every year. The gap between what you owe and the real cost of your coverage is covered by the funding sources below, not by charging other enrollees more.

State Contribution

States keep contributing their share, the same obligation that exists under Medicaid today. Each state decides how to raise its share.

Timeline

Full enrollment within three years of enactment. Congress's own Medicare for All proposals have used a four-year transition; this plan moves faster because no one is required to leave existing coverage.

Funding Sources

Tax provisions require legislation that starts in the House of Representatives, under the Constitution's Origination Clause. Lydia will work with House allies to introduce and advance this funding, the same path the Affordable Care Act took to become law.

• Negotiating drug prices, the way every other wealthy country already does: an estimated $113 billion a year in savings
• Ending the billions spent annually fighting insurance denials that are overturned and paid anyway 70% of the time
• Cutting bureaucratic waste by consolidating duplicate federal health agencies and running the program at public-plan administrative cost, roughly 2%, instead of private-insurer overhead
• Repealing Certificate of Need laws that block new healthcare providers from competing
• Closing the S-corp loophole that lets business owners reclassify wages as profit to avoid payroll tax
• Supporting House legislation taxing offshore corporate profits and capital gains at the same rate as wages
• Supporting House wealth tax legislation on the wealthiest fraction of a percent of the country, including closing the trust loopholes currently used to avoid it

Funding Protections

Medicaid for All is mandatory spending, the same legal status Medicaid has today. Coverage isn't subject to an annual vote once someone is enrolled. This matters because Congress just proved what happens when it isn't: enhanced ACA subsidies expired on December 31, 2025, not because Congress voted to cut them, but because Congress simply failed to act. Premiums for millions of Americans more than doubled overnight. Medicaid for All can't fail that way. Provider reimbursement is tied to the Medicare Economic Index, the existing federal measure of medical practice cost inflation, so reimbursement isn't cut through budget inaction either. This applies to coverage decisions too: no administrator can reclassify a medically necessary treatment as cosmetic or experimental to avoid covering it.