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Introduced July 15, 2025 by Edward John Markey · Last progress July 15, 2025
Creates a new federal waiver pathway that lets States or multi-State regions seek permission to replace existing federal health program rules with a State-run, comprehensive universal health coverage system for residents beginning in plan years on or after January 1, 2026. States must submit a detailed application showing legal authority, a 5-year plan to cover at least 95% of residents, and a 10-year federal-budget neutral financing plan; federal program funds would be passed through to the State, adjusted annually, and States may reinvest savings. Establishes application, public comment, reporting, evaluation, and technical-assistance rules; sets up an independent 11-member assessment panel to review plans; requires interagency coordination so a single combined application can cover multiple federal programs; and includes special protections for American Indian and Alaska Native beneficiaries. Grants may be approved only if plans meet detailed coverage, benefits, affordability, access, consumer protection, and public-education standards. Waivers are limited to listed federal statutes/programs and include periodic independent reviews with possible termination if coverage targets aren’t met.
The bill offers states a flexible pathway to expand near-universal, publicly administered coverage and administrative savings, but it creates uneven protections across states, fiscal risks for taxpayers and states, and implementation uncertainty that could disrupt coverage for some populations.
State governments can adopt a flexible federal framework and (if they choose) consolidate federal health funds into a single publicly administered plan, simplifying administration and allowing programs tailored to local needs.
Low-income and uninsured residents in states that implement the program can gain comprehensive or near-universal coverage (the statute requires reaching ~95% resident coverage within 5 years).
Consumers (including people with disabilities and chronic conditions) can keep the option to purchase supplemental private plans and receive consumer protections such as appeals, independent review, and access standards at least as strong as federal programs.
Residents in nonparticipating States or in States that seek waivers could face substantial variation in coverage and protections, leaving people in some States without the new benefits.
State implementation could create new state-level costs or require taxes/reallocations, and taxpayers could face increased federal budget complexity or liabilities if ten-year budgets or passthrough calculations are misestimated.
If a State fails to meet the 95% coverage target, residents could lose the waiver program (and associated coverage) after a grace period, risking coverage disruption for enrollees.