Sponsors (4)
The bill empowers states to create near‑universal, federally funded comprehensive health programs with strong consumer protections and flexibility, but it risks a patchwork of coverage, increased state fiscal pressures, implementation complexity, and program trade‑offs or disruptions if budget neutrality or coverage targets are not met.
Low-income people, patients with chronic conditions, and uninsured residents in states that adopt the plan: could gain near‑universal comprehensive coverage (state goal: ≥95% enrollment within five years), substantially reducing uninsurance and improving access to care.
State governments: can design tailored universal coverage models and innovate in benefit design and care delivery, potentially improving coordination and system efficiency.
Uninsured individuals and Medicaid beneficiaries in adopting states: could gain stronger financial protection from medical costs through comprehensive coverage combined with affordability safeguards (limits on premiums and out‑of‑pocket spending).
Residents in states that do not opt into the program: would be left without these new protections and coverage, producing a patchwork of access across states.
State taxpayers and middle‑class families in adopting states: could face higher state taxes or new funding requirements to pay for expanded comprehensive coverage.
Hospitals, health systems, state governments, and federal staff: could experience significant administrative complexity, transitional burdens, and short‑term confusion over eligibility, payments, and continuity of care during implementation.
Based on analysis of 2 sections of legislative text.
Creates a federal waiver pathway allowing States to implement comprehensive, budget-neutral universal health programs that replace Marketplace or Basic Health Program options.
Official title: Amend title I of the Patient Protection and Affordable Care Act to authorize the establishment of, and provide support for, State-based universal health care systems that provide comprehensive health benefits to State residents, and for other purposes.
Introduced July 15, 2025 by Edward John Markey · Last progress July 15, 2025
Authorizes States to seek a federal waiver to run a comprehensive State universal health care program in place of an Exchange or Basic Health Program. States must apply with a 10-year, budget-neutral plan that aims to cover at least 95% of residents within five years, keep key consumer protections and benefit standards (including essential health benefits and affordability safeguards), accept federal passthrough funding as specified, and submit periodic reporting and audits; the HHS Secretary may approve, condition, or terminate waivers and require budget neutrality.