Sponsors (35)
Introduced July 15, 2025 by Ro Khanna · Last progress July 15, 2025
The bill hands states funding and authority to pursue near‑universal, state‑run health coverage—potentially expanding access—while shifting fiscal responsibility, creating risks of uneven protections, transition disruptions (including for military/veteran coverage), and strain on providers and oversight systems.
Uninsured and low-income residents: the bill enables states to create universal, state-run health plans intended to cover the vast majority of residents (aiming for ≥95% in five years), which could substantially expand insurance coverage.
State governments and residents: federal funding that would have gone to federal programs is provided to states as passthrough payments so states retain funding continuity while administering benefits locally.
State governments: the statute authorizes and empowers states with flexibility to design coverage models tailored to local needs, allowing diverse approaches to reach universal coverage goals.
State residents and taxpayers: expanding state-run universal coverage and assuming federal program funding may increase state fiscal obligations and risk higher state taxes or cuts elsewhere—compounded by a 10-year budget-neutrality certification that could force cost containment.
Medicaid beneficiaries, people with disabilities, and other residents: coverage, benefits, cost-sharing, and protections could vary or be reduced if state plans are not truly equivalent to federal programs or if enforcement is weak, producing a patchwork of unequal access across states.
Military families, veterans, and federal employees: including TRICARE, FEHB, and VA-related programs among waivable authorities risks disrupting coverage for these groups if coordination or passthrough calculations are mishandled during transitions.
Based on analysis of 2 sections of legislative text.
Establishes a statutory waiver process allowing States to run comprehensive universal health care programs if they meet coverage and federal budget-neutrality requirements.
Allows States to apply for a new federal waiver to operate a comprehensive state-run universal health care program. States must submit a formal application showing legal authority, a 5-year plan to cover at least 95% of residents, and a 10-fiscal-year budget plan that is budget-neutral for the Federal Government; approved waivers can exempt States from specified ACA, Social Security Act, ERISA, and other federal requirements for plan years beginning on or after January 1, 2026.