State-Based Universal Health Care Act of 2025
The State-Based Universal Health Care Act of 2025 would allow states to apply for federal waivers to establish their own universal health care systems that provide comprehensive coverage to all state residents. States could waive numerous federal health care requirements—including provisions of the Affordable Care Act, Medicare, Medicaid, CHIP, federal employee health benefits, and TRICARE—and receive consolidated federal funding that would otherwise have been spent on these programs. The bill establishes a framework for states to create publicly-administered health systems while maintaining federal funding levels adjusted for inflation and caseload growth, with the goal of achieving at least 95% coverage of state residents within five years.
Key Points
- 1States can apply for waivers beginning January 1, 2026, to establish universal health care systems that replace multiple federal programs with a single state-run system
- 2Federal funding from waived programs (Medicare, Medicaid, ACA subsidies, etc.) would be consolidated and passed through to participating states, adjusted annually for inflation and caseload growth
- 3State plans must provide coverage at least as comprehensive and affordable as existing federal programs, be publicly administered, and cover all residents except those eligible for Indian Health Service or VA benefits
- 4An Independent Assessment Panel for Comprehensive Health Care would be established to review state applications and provide recommendations to the Secretary within 90 days
- 5States must achieve 95% resident coverage within five years and submit independent reports every five years; failure to meet coverage targets could result in waiver termination after a 12-month grace period