State-Based Universal Health Care Act of 2025
- Bill Number
- S. 2286
- Origin Chamber
- Senate
- Congress
- 119th Congress, Session 1
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2025-07-15: Read twice and referred to the Committee on Finance.
- Last Updated
- 2025-12-05T21:50:37Z
AI-Generated Summary
Summary of S. 2286: State-Based Universal Health Care Act of 2025
Purpose
The legislation amends Title I of the Patient Protection and Affordable Care Act to create a framework allowing states to establish and receive federal support for comprehensive, universal health care systems covering state residents. It aims to provide flexibility for states to implement such plans while maintaining certain standards of coverage, affordability, and administration.
Key Provisions
- Waiver Process: Adds Section 1335 to the ACA, enabling states to apply for waivers of multiple federal requirements (including ACA provisions, Medicare, Medicaid, CHIP, FEHBP, TRICARE, and ERISA Section 514) starting in plan year 2026.
- Application Requirements: States must submit legislation or legal authority, a plan to achieve 95% resident coverage within 5 years, and a 10-year budget-neutral plan for the federal government. Applications require public notice, comment, and periodic reporting.
- Funding Passthrough: Federal funds otherwise spent on specified programs (adjusted for inflation and caseload growth) are redirected to states; savings may be reinvested in health services.
- Coverage Standards: Plans must offer benefits at least as comprehensive and affordable as federal programs, cover all residents (except those eligible for Indian Health Service or VA benefits), include reproductive health services (abortion, contraception, gender-affirming care), ensure public administration, and provide complaint/appeal processes.
- Independent Assessment Panel: Establishes an 11-member panel to review waiver applications and 5-year reports, with members appointed from congressional leaders, governors' associations, patient advocates, labor groups, physicians, and rural providers.
- Five-Year Reviews: States must submit independent reports on spending, coverage rates, affordability, and quality; failure to reach 95% coverage triggers technical assistance and potential waiver termination.
- Coordination and Indian Health Provisions: Requires interagency coordination for waivers; includes specific guidance protecting Indian health services, prohibiting certain charges for Indians, and ensuring tribal consultation.
- Regional Options: Allows multiple states to submit joint applications for regional plans.
Significant Changes to Existing Law
- Introduces a new waiver mechanism under the ACA that permits states to opt out of major federal health programs (Medicare, Medicaid, CHIP, exchanges, and subsidies) and related tax provisions, distinct from existing Section 1332 waivers.
- Waives ERISA preemption restrictions and federal employee/military health program mandates in approved states.
- Redirects federal appropriations directly to states rather than through existing program structures, while maintaining budget neutrality.
- Mandates coverage for specific services like gender-affirming care and abortion, which are not uniformly required under current federal programs.
Potential Impacts
- Government Agencies: Requires coordination among HHS, Treasury, Defense, Labor, and OPM via memorandum of understanding; agencies must handle redirected funding, evaluations, and technical assistance.
- Citizens: Enables states to create universal coverage systems potentially expanding access, but outcomes depend on state implementation; excludes certain federal program eligibles and maintains options for supplemental insurance.
- International Relations: No provisions address or impact international relations.
Main Stakeholders Affected
- State governments and legislatures seeking to implement universal plans.
- Federal agencies responsible for health programs and funding.
- State residents, including those currently covered by federal programs.
- Health care providers, insurers, and labor organizations.
- Indian tribes, urban Indian health programs, and American Indian/Alaska Native individuals.
- Patient advocacy groups and primary care/rural health representatives.
Notable Legal, Constitutional, or Political Implications
- Creates a statutory waiver authority that overrides numerous federal health statutes, potentially leading to varied state-level systems.
- Includes provisions stating that protections for Indian health services do not constitute invidious racial discrimination under the Fifth or Fourteenth Amendments.
- Requires states to enact specific laws or executive orders to implement waivers, with options for repeal.
- Establishes processes for public input and independent review to ensure compliance and transparency.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Cosponsors (3)
Sen. Warren, Elizabeth [D-MA], Sen. Merkley, Jeff [D-OR], Sen. Padilla, Alex [D-CA]
Recent Actions
- 2025-07-15: Read twice and referred to the Committee on Finance.
- 2025-07-15: Introduced in Senate
Bill Versions
- State-Based Universal Health Care Act of 2025 — issued 2025-07-15 — PDF (30 pages)