Sponsors (4)
The bill lets states use federal passthrough funding and new waiver authority to build state-specific universal coverage programs that could dramatically cut the uninsured rate and preserve many consumer protections, but it concentrates fiscal risk, risks uneven protections across states, and creates transition and administrative challenges that could disrupt beneficiaries and markets.
Uninsured individuals and state residents: Participating states can create State-Universal Health Coverage (SUHC) programs designed to expand health insurance access with a goal of reaching at least 95% insured within five years.
Medicaid-eligible and Marketplace-eligible consumers: SUHC waivers must preserve parity of eligibility/enrollment and maintain or replace premium assistance and cost‑sharing protections, and plans must keep core beneficiary protections (EHBs, appeals, continuity of care, network adequacy).
State governments: The bill gives states clearer federal authority and access to passthrough federal funds equal to federal dollars that would otherwise be spent, providing resources and a federal framework to implement statewide coverage reforms.
Taxpayers and state budgets: Expanding SUHCs and using passthrough funding raises substantial fiscal risk—higher state or federal costs, potential tax increases or spending reallocation—and complex budget-neutrality accounting could mask true costs.
Residents across states: Allowing each state to design its own SUHC risks large interstate variation in coverage levels and benefits, creating unequal access and protections depending on where someone lives.
Medicare and Medicaid beneficiaries: State takeover/administration and transitions could cause coverage differences, administrative disruption, or coordination failures that harm continuity of care for existing beneficiaries.
Based on analysis of 2 sections of legislative text.
Creates a federal waiver allowing states to operate comprehensive state universal health care systems replacing specified Marketplace and subsidy functions if federally approved and budget‑neutral.
Introduced July 15, 2025 by Edward John Markey · Last progress July 15, 2025
Creates a federal waiver process that lets a State replace parts of the federal individual Marketplace, premium tax credits, and cost‑sharing reduction programs with a State-run comprehensive universal health care system. States must apply to HHS with a legal and financial plan showing fiscal solvency, coverage for at least 95% of residents within five years, a 10‑year federal budget‑neutral plan, beneficiary protections, coordination with Medicare and Medicaid, and detailed reporting and transition plans; HHS may approve, monitor, and revoke time‑limited waivers.