Sponsors (36)
Official title: To amend title I of the Patient Protection and Affordable Care Act to authorize the establishment of, and provide support for, State-based universal health care systems that provide comprehensive health benefits to State residents, and for other purposes.
Introduced July 15, 2025 by Ro Khanna · Last progress July 15, 2025
The bill gives States new authority to pursue near‑universal, tailored health coverage with potential savings, improved coordination, and stronger transparency — but does so at the risk of large and uncertain public costs, uneven state-by-state outcomes, potential disruption during transitions, workforce strain, and market and administrative uncertainty.
Uninsured and underinsured residents could gain near‑universal comprehensive coverage if their State adopts a plan, with States required to aim for ≥95% coverage within 5 years.
State governments get explicit legal authority and a flexible framework to design and expand comprehensive, state‑level health coverage models tailored to local needs.
States can improve care coordination and reinvest demonstrated savings (including administrative savings) into health services, which could reduce uncompensated care burdens on hospitals and local health systems.
Taxpayers and Federal and State budgets could face large, uncertain new costs as passthrough payments replace multiple federal programs and States expand coverage.
If a State fails to meet standards or a waiver is terminated, beneficiaries could experience coverage disruption or gaps during transitions.
Access and benefits could vary widely by State depending on political choices and funding capacity, producing uneven coverage and protections across the country.
Based on analysis of 2 sections of legislative text.
Creates a federal waiver pathway allowing States to replace or modify many ACA rules to run State universal health care programs subject to HHS approval and guardrails.
Creates a federal waiver pathway that lets States seek permission from HHS to replace or modify many Affordable Care Act requirements in order to run a Statewide universal health care program that covers all residents. States must submit detailed applications showing program design, financing, benefits, consumer protections, continuity for people with preexisting conditions, provider networks, and how the program will preserve Medicare and Medicaid protections and coordinate with federal programs. HHS would review applications within 180 days, can negotiate terms, require monitoring and evaluations, and may terminate waivers for noncompliance. Waivers may not change Medicare entitlement rules, mandatory Medicaid eligibility/benefits, or expand federal payment obligations; States remain responsible for financing and must comply with certain federal laws like COBRA and ERISA as specified.