Creates a new Affordable Care Act waiver pathway that lets a State request permission to run a comprehensive universal health coverage plan starting with plan years beginning on or after January 1, 2026. The law sets application requirements, standards for approval, a mechanism to pass federal funds through to the State, federal oversight and reporting rules, periodic reviews (including a 5‑year review with possible termination if coverage goals are not met), and an Independent Assessment Panel to evaluate applications and reports.

Approvals require States to meet federal standards and reporting obligations; federal agencies must issue implementing regulations and coordinate review and funding flows. The waiver is optional for States but, if approved, redirects certain federal funding streams to support the State plan while subjecting the plan to ongoing federal review and potential termination for failure to meet coverage targets.