Sponsors (35)
Introduced July 15, 2025 by Ro Khanna · Last progress July 15, 2025
The bill empowers States to pursue near‑universal, tailored health coverage and preserves key protections, but it shifts large fiscal risk and operational complexity to federal/state budgets and could produce uneven access, market disruptions, and rollout challenges.
Uninsured and underinsured residents could gain near‑universal, comprehensive coverage if their State adopts a plan (States must aim for ≥95% coverage within 5 years).
Residents keep at‑least‑equivalent benefits and protections (including continuity for preexisting conditions) and Indian beneficiaries retain no cost‑sharing plus Tribal consultation—preserving key rights and access protections.
State governments gain legal authority and a flexible framework to design and expand comprehensive, state‑specific coverage models (enabling states to pursue tailored universal coverage approaches).
Taxpayers and Federal/state budgets face large, uncertain new costs as passthrough payments replace multiple federal programs and states expand coverage—potentially requiring higher taxes or budget reallocation.
Coverage and benefits could become uneven or disrupted across states—state variation, waiver terminations, or restrictive state design choices (including reshaping private markets) could create gaps or unequal access.
Coordination requirements with COBRA, ERISA, and employer plans could disrupt employer‑sponsored coverage and impose transition costs on employers and workers.
Based on analysis of 2 sections of legislative text.
Creates a federal waiver process letting States replace many ACA rules to run state universal health programs if they meet financing, benefit, and protection requirements.
Creates a federal waiver pathway that lets a State obtain permission to replace or modify many Affordable Care Act rules so the State can operate a state-run universal health care program covering all residents. The law sets application requirements, approval conditions, reporting and monitoring rules, limits on what federal responsibilities can be changed, and requirements that States demonstrate financial sustainability and preserve Medicare and Medicaid protections.