S. 2286 — State-Based Universal Health Care Act of 2025

This section provides a short title for the Act—“State-Based Universal Health Care Act of 2025”—and states its purpose as establishing a flexible framework under which states can provide comprehensive universal health coverage to their residents.

This section establishes a new waiver program under ACA §1335 allowing a state to apply to waive requirements of ACA §§1301-1324 (exchanges and related provisions), §1402 (premium subsidies), IRC §§36B and 4980H (premium tax credits and employer mandate), SSA Titles XI, XVIII, XIX, and XXI (Medicare, Medicaid, and CHIP), FEHB (5 U.S.C. ch. 89), TRICARE (10 U.S.C. ch. 55), and ERISA §514 for plan years beginning on or after January 1, 2026, to implement a comprehensive state universal health care plan. State applications must include (1) a description of the state legislation or authority and program details, (2) a plan to achieve health coverage for at least 95% of state residents within five years, and (3) a 10-fiscal-year budget plan that is budget neutral for the federal government; states must assure legal authority for implementation. For approved waivers where the state assumes responsibility for specified federal programs, the Secretary provides passthrough funding equal to the amount that would otherwise have been spent federally (including for administrative costs, caseload growth, and inflation in state health care costs), with any savings available to the state for reinvestment. (Thus, states may redirect federal health funds to their universal plan while maintaining federal budget neutrality.) The section directs the Secretary to issue regulations within 180 days of enactment governing the waiver process, including public notice and comment akin to Medicaid §1115 waivers, application transparency, periodic state reporting and evaluation, and technical assistance for states developing universal coverage programs.