Primary care coverage for the uninsured is the first necessary step to reform and can be more cost effective and tolerable than a major system reform. By providing foundational care to the uninsured, more care resources are targeted to those that most need the services, while providing benefits such as increased productivity and reduced inappropriate emergency department utilization. The authors aimed to design a primary care coverage system in the United States for the uninsured using established reimbursement, budgeting, and compliance methods. Providing four primary care visits for acute care, four associated ancillary and four fulfilled pharmaceutical–treatment prescriptions, and one preventive primary care visit per year for nearly 48,000,000 uninsured would cost $36 per month for every working American and legal alien resident. Theoretical and empirical literature was reviewed and the authors applied practical knowledge based on their experience in healthcare systems to develop the Access America Program.