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 those related to the Affordable Care Act, Medicare, Medicaid, CHIP, federal employee health benefits, and TRICARE. In exchange, the federal government would provide states with funding equivalent to what would have been spent on these federal programs within that state, adjusted for inflation and caseload growth. States must demonstrate their plans will cover at least 95% of residents within five years, provide benefits at least as comprehensive as existing federal programs, and remain budget neutral for the federal government.
Key Points
- 1States can apply to waive major federal health care laws (ACA, Medicare, Medicaid, CHIP, federal employee benefits, TRICARE, and ERISA preemption) to implement state-run universal health care systems starting January 1, 2026
- 2Federal government must provide "pass-through funding" to participating states equal to what would have been spent on federal health programs in that state, including premium tax credits, cost-sharing reductions, and administrative costs, adjusted for inflation
- 3States must achieve 95% coverage of residents within 5 years and provide benefits at least as comprehensive and affordable as existing federal programs, with special protections for former Medicaid recipients
- 4An 11-member Independent Assessment Panel will review state applications and provide recommendations to the Secretary within 90 days, with the Secretary making final determinations within 90 days after receiving recommendations
- 5States must submit independent reports every 5 years on coverage rates, spending, affordability, and quality; failure to maintain 95% coverage after a 12-month grace period could result in waiver termination