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Voice to Congress | |
Last Updated: 2026-07-25 15:42 UTC
Healthcare is one of the largest and most consequential issues this project tracks. This page holds 20 specific, quantified requirements – concrete steps that would deliver better quality healthcare at a lower overall cost for the American people – each paired with a real metric, a verified current value, and a numeric target with a deadline, not just a description of the problem.
These gaps are connected, not separate: coverage that reaches more people, care that costs less, access that arrives sooner, hospitalizations that are prevented rather than treated, and mothers who survive childbirth all point toward the same outcome – a better quality of life, achieved at a lower cost, on a faster timeline than addressing any one of them alone would allow.
Coverage: The uninsured rate is 8.2% (2024), +0.3 pp vs 2023 (Worsening). The target is 1.0% by 2036.
Cost: Health spending is 18.0% (2024) of GDP, +0.3 pp vs 2023 (Worsening). This single number touches nearly everything this project tracks – healthcare spending growth is one of the largest identifiable drivers of both the cost of living and the federal debt and deficit.
Access: Primary care shortage areas have 47.74% (latest published: Mar. 31, 2026) of need met, -0.44 pp vs Dec. 2025 baseline (Worsening), targeting 70.0% by 2036.
Quality: Preventable hospitalizations for the general adult population are 1,328.4 per 100,000 adults 18+ (2017, current PQI-90 definition) – the most recent confirmed figure; no national data point has been found for any year since. Medicare fee-for-service beneficiaries are tracked as a separate metric, since their rate moves in the opposite direction, and currently stand at 2,768 per 100,000 Medicare FFS beneficiaries 18+ (2023, most recent confirmed).
Maternal health: The maternal mortality rate is 17.9 per 100,000 (2024, final), -0.7 vs 2023 (not statistically significant) (Improving), against a target of 10.00 by 2036.
Every figure below is sourced, dated, and independently verified, with the full reasoning behind each target documented alongside it.
Color Rule: Red text = bad current value, bad trend, missing critical data, or unfavorable gap. Green text = favorable value or improving trend. Amber text = context-dependent, incomplete, pending, or source-method review needed. Neutral/gray text = descriptive value that is not inherently good or bad.
HC-COV-INS-001: Congress shall enact, fund, and oversee national health coverage policies that increase the percentage of the U.S. population with health insurance from 91.8% in 2024 to at least 99.0% by 2036, with progress measured annually using the U.S. Census Bureau's American Community Survey.
Current Metric: HC-MET-COV-001: Insured rate
Current Value: 91.8% (2024)
Trend: -0.3 pp vs 2023 (Worsening)
Value to the People: Reaching 99.0% coverage would mean roughly 24 million more people covered relative to the 2024 baseline (91.8% of a total population of about 333 million), matching the typical OECD member's coverage level instead of remaining one of the four lowest-coverage countries in the OECD.
HC-COV-UNI-001: Congress shall enact, fund, and oversee national health coverage policies that reduce the percentage of the U.S. population without health insurance from 8.2% in 2024 to no more than 1.0% by 2036, with progress measured annually using the U.S. Census Bureau's American Community Survey.
Current Metric: HC-MET-COV-002: Uninsured rate
Current Value: 8.2% (2024)
Trend: +0.3 pp vs 2023 (Worsening)
Value to the People: A decline to 1.0% would mean roughly 24 million fewer uninsured people at the 2024 population size (8.2% of a total population of about 333 million); the actual 2036 count will depend on population growth alongside the rate change, and would reverse CMS's own baseline trajectory of a rising uninsured rate through 2034 rather than merely slowing it.
HC-FIN-PCP-001: Congress shall enact, fund, and oversee national health spending policies that hold U.S. health spending per capita at or below $18,863 by 2034, growing no faster than the Federal Reserve's 2.0% long-run PCE inflation target from the 2024 baseline of $15,474, with progress measured annually using CMS National Health Expenditure data.
Current Metric: HC-MET-FIN-001: Health spending per capita
Current Value: $15,474 (2024)
Trend: +6.1% vs 2023 (Worsening)
Value to the People: Staying at or below the inflation-only ceiling every year would mean healthcare stops consuming a growing share of real household and government budgets relative to the broader economy, directly easing the pressure captured in the Affordability metrics (HC-MET-AFF-001, HC-MET-AFF-002); it would also mean U.S. per-capita spending grows slower than CMS's own projected GDP-per-capita pace (3.8% average, 2025-34), a genuine reversal of the current pattern.
HC-FIN-GDP-001: Congress shall enact, fund, and oversee national health spending policies that hold total U.S. health spending at or below 18.0% of GDP in every year through 2034, with progress measured annually using CMS National Health Expenditure data.
Current Metric: HC-MET-FIN-002: Health spending as % of GDP
Current Value: 18.0% (2024)
Trend: +0.3 pp vs 2023 (Worsening)
Value to the People: Holding the line at 18.0% every year instead of climbing to 20.6% by 2034 would preserve roughly 2.6 percentage points of GDP for other public and private priorities, hundreds of billions of dollars annually at 2034's projected economic size.
HC-QLT-LEX-001: Congress shall enact, fund, and oversee public health and health care policies that raise U.S. life expectancy at birth to at least 81.95 years by 2036, following this project's International Benchmark Convergence Policy (closing 50% of the gap to Japan's OECD-reported benchmark by year 10, 75% by year 20, 100% by year 30), with progress measured annually using CDC/NCHS final mortality data against the SSA's own actuarial baseline.
Current Metric: HC-MET-QLT-001: Life expectancy at birth
Current Value: 79.0 years (2024, final, record high)
Trend: +0.6 yr vs 2023 (Improving)
Value to the People: Reaching 81.95 by 2036 would close half the gap to Japan's OECD-reported 2023 benchmark, a real, achieved figure, not a hypothetical one, while still falling short of matching it outright until 2056 under this policy's 30-year full-convergence horizon.
HC-QLT-AVM-001: Congress shall enact, fund, and oversee public health and health care policies that reduce U.S. preventable mortality from 217 per 100,000 (2022 OECD-verified baseline) to no more than 145 by 2036, and treatable mortality from 95 to no more than 77 by 2036 – both matching the current OECD average – with progress measured annually using OECD Health Statistics under the OECD/Eurostat avoidable-mortality definitions.
Current Metric: HC-MET-QLT-002: Avoidable mortality (preventable & treatable)
Current Value: 217 / 95 per 100,000 (2022)
Trend: -21 / -3 vs 2021 (Improved vs. pandemic-era 2021, still worse than 2013)
Value to the People: Reaching 145/77 by 2036 would mean the U.S. reaches the current OECD average on both preventable and treatable mortality – substantially narrowing, but not eliminating, the gap with the highest-performing countries, which post considerably lower rates on both measures.
HC-AFF-MDR-001: Congress shall enact, fund, and oversee medical debt protection policies that reduce the national medical debt incidence rate from the KFF/SIPP baseline of 6.0% of adults owing over $1,000 (2021, the latest published threshold-matched estimate) to 2% by 2036, with the data vintage of the SIPP wave in use disclosed in every public report.
Current Metric: HC-MET-AFF-001: Medical debt incidence
Current Value: 6.0% of adults, $1,000+ threshold (2021)
Trend: Not yet established (Only one data point exists at this threshold)
Value to the People: A decline to 2% would mean roughly a third as many adults carrying significant ($1,000+) medical debt as today – at the 2021 adult population size, a reduction from about 14 million to roughly 4.7 million, or about 9.3 million fewer affected adults.
HC-AFF-FPR-001: Congress shall enact, fund, and oversee health care affordability policies that reduce the percent of adults reporting delayed or skipped medical care due to cost from the Federal Reserve SHED 2025 baseline of 26% to 20% by 2036, with progress measured annually using the Federal Reserve's Survey of Household Economics and Decisionmaking.
Current Metric: HC-MET-AFF-002: Delayed or skipped care due to cost
Current Value: 26% (2025)
Trend: -2 pp vs 2024 (Improving, but still above the 2021 low)
Value to the People: Reaching 20% by 2036 would represent the lowest cost-related care avoidance recorded since the Federal Reserve began this survey series in 2013 – real progress, though still meaning roughly 1 in 5 adults delay or skip care because of cost.
HC-ACC-PCP-001: Congress shall enact, fund, and oversee primary care workforce policies that raise the national primary care Percent of Need Met to 70% by 2036, from the December 2025 baseline of 48.2%, including directing HRSA to incorporate nurse practitioner and physician assistant capacity into the underlying HPSA shortage-designation formula, with progress measured using HRSA's quarterly HPSA designation data.
Current Metric: HC-MET-ACC-001: Primary care shortage (Percent of Need Met)
Current Value: 47.74% (latest published: Mar. 31, 2026)
Trend: -0.44 pp vs Dec. 2025 baseline (Worsening)
Value to the People: Reaching 70% need met by 2036 would mean most of the current gap is closed, provided Congress also acts on the NP/PA formula change this target assumes; HRSA's own broader workforce model still projects a 70,610 FTE shortfall by 2038 on a different, larger measure, so this would not fully close that broader gap, and full designation resolution would remain unfinished business beyond 2036.
HC-MNT-MHR-001: Congress shall enact, fund, and oversee behavioral health workforce policies that raise the national mental-health HPSA Percent of Need Met to 47% by 2036, growing by at least 2 percentage points annually from a 2026 baseline of 27%, with progress measured using HRSA's quarterly HPSA designation data.
Current Metric: HC-MET-ACC-002: Mental-health HPSA provider capacity – Percent of Need Met
Current Value: 27.29% baseline (Dec. 31, 2025). Latest published: 26.78% (Mar. 31, 2026)
Trend: -0.51 pp vs Dec. 2025 baseline (Worsening in the latest snapshot, after improving through 2024-2025)
Value to the People: Reaching 47% by 2036 would mean the mental-health HPSA gap has been meaningfully narrowed, not just held from getting worse – roughly a quarter of the current practitioner shortfall closed, concentrated in the areas of highest need, though full designation resolution would remain a longer-term goal beyond 2036.
HC-QLT-PHO-001: Congress shall enact, fund, and oversee preventive and chronic-disease-management policies that reduce U.S. preventable hospital admissions for ambulatory care-sensitive conditions (AHRQ PQI-90) among the general adult population from the 2017 baseline of 1,328.4 per 100,000 to 1,062.7 (a 20% reduction) by 2036, with progress measured annually using AHRQ's Healthcare Cost and Utilization Project (HCUP). See Row 20 (HC-QLT-PHM-001) for the companion Medicare fee-for-service beneficiary requirement.
Current Metric: HC-MET-QLT-003: Preventable hospitalizations, general adult population (AHRQ PQI-90)
Current Value: 1,328.4 per 100,000 adults 18+ (2017, current PQI-90 definition) – the most recent confirmed figure; no national data point has been found for any year since
Trend: Historically improving under earlier composite versions (1,941 in 2005 to 1,582 in 2012, an 18.5% decline), but no confirmed data exists to establish the current-definition trajectory past 2017
Value to the People: Reaching 1,062.7 per 100,000 by 2036 would represent a real, historically-grounded continuation of two decades of progress and meaningful savings in avoidable hospital costs.
HC-MAT-MMR-001: Congress shall enact, fund, and oversee maternal health policies that reduce the U.S. maternal mortality rate from the 2024 final baseline of 17.9 deaths per 100,000 live births to 10.0 by 2036, matching a common peer-country benchmark, and shall reduce the racial disparity ratio between Black non-Hispanic and White non-Hispanic maternal mortality rates from the 2024 baseline of 3.2 to 2.0 by 2036.
Current Metric: HC-MET-MAT-001: Maternal mortality rate
Current Value: 17.9 per 100,000 (2024, final)
Trend: -0.7 vs 2023 (not statistically significant) (Improving)
Value to the People: Reaching 10.0 by 2036 would represent hundreds of prevented maternal deaths annually; closing the disparity ratio to 2.0 would mean a meaningfully larger share of that improvement reaches Black mothers specifically, not just the national average.
HC-FWA-IPR-001: Congress shall enact, fund, and oversee program-integrity policies that hold improper payment rates across Medicare Fee-for-Service, Medicare Part C, Medicare Part D, Medicaid, CHIP, and ACA Advance Premium Tax Credits at or below their FY2024 levels in every fiscal year beginning FY2026, with progress measured annually using CMS's Comprehensive Error Rate Testing program and the HHS Agency Financial Report. All public reporting of this metric shall explicitly state that improper payment measurement is not a fraud measure.
Current Metric: HC-MET-ADM-002: Improper payment rate (by program)
Current Value: Mixed across 6 programs (FY2025)
Trend: Mixed by program (4 of 6 worsening)
Value to the People: All six programs holding at or below their FY2024 level every year from FY2026 onward would reverse the FY2025 backslide seen in four of the six programs and demonstrate the volatility can be managed continuously, not just checked once at a distant deadline.
HC-AFF-PMB-001: Congress shall enact, fund, and oversee health care affordability policies that reduce the share of adults reporting problems paying family medical bills in the past 12 months from the 2025 baseline of 17% to 8% by 2036, with progress measured using the Urban Institute's Health Reform Monitoring Survey / Well-Being and Basic Needs Survey.
Current Metric: HC-MET-AFF-003: Problems paying family medical bills
Current Value: ~17% (2025)
Trend: Reversed pandemic-era improvement (Worsening since 2021)
Value to the People: Reaching 8% by 2036 would mean returning below the pandemic-era low of 12.2% and sustaining it, rather than the current pattern of falling only when extraordinary federal relief is in place.
HC-ADM-OVH-001: Congress shall enact, fund, and oversee administrative simplification and insurance oversight policies that hold the combined share of national health expenditures devoted to government program administration and the net cost of private health insurance at or below its 2024 level of 7.0% through 2036.
Current Metric: HC-MET-ADM-004: Administration and insurance overhead (percent of National Health Expenditures)
Current Value: 7.0% (2024)
Trend: -0.5 pp vs 2023 (Improving)
Value to the People: Administrative and insurance overhead would be held at the 2024 level even as CMS's own projections point toward a substantially higher share by the early-to-mid 2030s, preserving that difference for direct patient care spending instead.
HC-AFF-RXN-001: Congress shall enact, fund, and oversee prescription drug affordability policies that hold the share of adults aged 18-64 who do not take prescription medication as prescribed due to cost at or below its 2021 level of 8.2% through 2036, with progress measured using NCHS/NHIS survey data.
Current Metric: HC-MET-AFF-004: Cost-related prescription medication nonadherence
Current Value: 8.2% (2021)
Trend: -3.2 pp vs 2017 (Improving)
Value to the People: Roughly 9.2 million adults reported skipping doses, taking less medication, or delaying a prescription fill due to cost in 2021 (the 8.2% base year, per NCHS's own estimate); holding at or below that level would prevent this from creeping back toward the 11-15% range seen in 2013-2017.
HC-AFF-OOP-001: Congress shall enact, fund, and oversee health care affordability policies that hold out-of-pocket health spending per person to no more than the Federal Reserve's 2.0% long-run inflation target from the 2024 baseline of $1,632, reaching no more than $1,989 by 2034.
Current Metric: HC-MET-FIN-004: Out-of-pocket health spending per person
Current Value: $1,632 (2024)
Trend: +$118 vs 2023 (Worsening)
Value to the People: Real (inflation-adjusted) out-of-pocket burden per person would stop rising, holding steady from the 2024 level rather than continuing to outpace general prices.
HC-COV-UND-001: Congress shall enact, fund, and oversee health insurance design policies that hold the share of working-age adults who are insured all year but underinsured – meaning their out-of-pocket costs or deductible are high relative to their income – at or below its 2024 level of 23% through 2036.
Current Metric: HC-MET-COV-003: Underinsured rate (working-age adults, insured all year)
Current Value: 23% (2024)
Trend: Not assessable vs 2022 (sampling-method change)
Value to the People: Underinsurance would be held at roughly 1 in 4 working-age adults with continuous coverage rather than climbing back toward the 2016 peak (28%, roughly 1 in 3.5), a level the Fund's own reporting links to sharply higher rates of medical debt and forgone care.
HC-ACC-TAR-001: Congress shall enact, fund, and oversee primary care access policies that hold the share of adults who, among those who made a routine-care appointment in the past 12 months, sometimes or never got that appointment as soon as they needed it at or below its most recently confirmed level of 14% through 2036.
Current Metric: HC-MET-ACC-003: Adults not getting routine-care appointments as soon as needed
Current Value: 14% (2016 – stale, see Feasibility)
Trend: Not assessable (insufficient comparable data)
Value to the People: Confirms patients are not waiting longer than they themselves consider acceptable for routine, non-urgent care at a rate any worse than the last confirmed national baseline – though "met" against decade-old data is a weak claim until this pass's data gap is closed.
HC-QLT-PHM-001: Congress shall enact, fund, and oversee preventive and chronic-disease-management policies, with particular attention to care coordination for Medicare beneficiaries, that hold U.S. preventable hospitalizations among Medicare fee-for-service beneficiaries (AHRQ PQI-90) at or below the 2023 level of 2,768 per 100,000 in every year from 2026 through 2036, with progress measured annually using CMS's Mapping Medicare Disparities Tool. See Row 11 (HC-QLT-PHO-001) for the companion general-adult-population requirement.
Current Metric: HC-MET-QLT-004: Preventable hospitalizations, Medicare fee-for-service beneficiaries (AHRQ PQI-90)
Current Value: 2,768 per 100,000 Medicare FFS beneficiaries 18+ (2023, most recent confirmed)
Trend: Worsening (+1.6%/yr, 2021 (2,681) to 2023 (2,768))
Value to the People: Holding at or below 2,768 every year from 2026 would reverse the recent uptick for a population already bearing a disproportionate share of preventable hospitalizations, and preserve the Medicare program savings that come with fewer avoidable admissions.