In committee
State-Based Universal Health Care Act of 2025
Starting in 2026, this legislation allows states or groups of states to replace existing federal health programs—such as Medicare, Medicaid, and ACA marketplace plans—with their own state-administered universal health care systems. Participating states would receive the federal funds that would have otherwise gone to those programs and subsidies, provided the state system does not add to overall federal costs. To qualify and maintain funding, a state plan must cover at least 95 percent of its residents within five years, offer benefits at least as comprehensive and affordable as the federal programs it replaces, and include coverage for reproductive care, abortion, and gender-affirming services.
People affected—Not determinable from the text provided; total population affected depends on which and how many states enact authorizing legislation and obtain approved federal waivers to cover at least 95 percent of their residents.
Fiscal magnitude—no CBO estimate published
Reach62provisional · pending reviewrigor: heuristic llm
What this bill touches.
LGBTQ+ policy+40Government role in coverage+65Federal vs. state/local−40Native American affairs+45Abortion policy+45
Who it helps · who it burdens.
Who it helps
- State governmentsCan apply for federal statutory waivers to consolidate federal health programs (including Medicare, Medicaid, CHIP, TRICARE, FEHBP, and ACA provisions) and receive aggregate federal passthrough funding, subsidies, and administrative savings to operate a state universal health plan (Sec. 2(a)(1335)(a)(1)-(3)).
- Residents in states with approved waiversGain access to publicly administered universal health coverage aimed at covering at least 95 percent of residents within five years, with benefits, affordability, and cost protections at least as comprehensive as replaced federal programs, including coverage for reproductive health services, contraception, abortion, and gender-affirming care (Sec. 2(a)(1335)(a)(1)(B)(ii), (b)(1)).
- Native AmericansAre exempt from mandatory enrollment in state waiver plans, are protected from all premiums, enrollment fees, and cost-sharing under waiver plans, and are guaranteed ongoing state consultation with tribal programs on waiver operations (Sec. 2(a)(1335)(h)(1)(B)-(C), (H)).
- Indian health care providersGain guaranteed payment rates from participating insurance issuers—equal to negotiated rates or standard participating-provider rates even if nonparticipating—and issuers must make good-faith efforts to contract with them using standard tribal contract addenda (Sec. 2(a)(1335)(h)(1)(D)-(F)).
Who it burdens
- State governments implementing waiversMust enact authorizing state legislation or executive orders, develop 10-year budget-neutral plans, achieve at least 95 percent population coverage within five years, conduct independent 5-year reviews with public hearings, and consult regularly with tribal programs (Sec. 2(a)(1335)(a)(1), (b)(1)-(2), (e)(1), (h)(1)(H)).
- Health insurance issuers offering coverage under state waiversMust make good-faith efforts to contract with local Indian health care providers, incorporate standardized tribal contract addenda, and reimburse Indian health providers at specified minimum rates regardless of network participation (Sec. 2(a)(1335)(h)(1)(D)-(F)).
Who backs it
- Federal governmentTransfers equivalent federal program allocations, tax credits, and administrative funds directly to participating states, pays all costs for waiving cost-sharing for Native Americans, and funds public outreach grants and assessment panel operations (Sec. 2(a)(1335)(a)(3), (a)(7), (g)(8), (h)(1)(B)).