Sponsors (4)
The bill lets states consolidate federal funding to create state-run comprehensive health plans that can expand coverage and affordability locally, but it risks uneven nationwide access, significant fiscal pressure and trade-offs for states, and administrative disruptions during transition.
Residents in states that adopt a state-run comprehensive plan can gain near-universal health coverage (target ≥95% within five years) with required essential benefits and consumer protections.
Low- and middle-income residents would have stronger financial protection from medical costs due to required affordability safeguards (premium and out‑of‑pocket limits) and consolidated coverage.
States can receive passthrough federal funds equivalent to federal spending that would have occurred under federal programs, enabling consolidated state funding and potentially simpler budgeting for state plans.
States assuming control must meet 10-year federal budget neutrality and may need new state funding, which could lead to higher state taxes or benefit/design trade-offs that affect residents.
People in states that choose not to adopt a state plan (or fail to sustain one) would face uneven access to coverage nationwide, creating geographic disparities in who benefits.
If a state misses coverage targets or during the transition from federal to state control, enrollees risk disruptions in coverage, continuity of care, eligibility, and payments (including potential termination of waivers).
Based on analysis of 2 sections of legislative text.
Allows states to seek federal waivers to replace federal programs with state-run universal health care plans that meet coverage, benefit, and budget-neutrality requirements.
Introduced July 15, 2025 by Edward John Markey · Last progress July 15, 2025
Allows states to apply for a federal waiver to run their own universal health care program in place of some federal programs and insurance market rules. To get approval, a state must show legal authority, a plan to cover at least 95% of residents within five years, a 10-year budget that is budget-neutral to the federal government, and maintain key consumer protections and benefit standards. The Secretary of Health and Human Services must review applications, can require budget neutrality, may approve passthrough funding, and can terminate waivers that fail to meet requirements; states must submit regular reports and audits to HHS and Congress. The waiver option could take effect for plan years starting January 1, 2026, if approved.