State-Based Universal Health Care Act of 2025
Sponsored By: Representative Khanna
Introduced
Summary
Would create a new federal waiver letting states run comprehensive universal health care plans with federal passthrough funding. It would let states replace or supersede many federal rules while keeping requirements for coverage, affordability, and oversight.
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Bill Overview
Analyzed Economic Effects
5 provisions identified: 4 benefits, 0 costs, 1 mixed.
Federal dollars would flow to state plans
If a State takes over federal health programs under a waiver, the federal government would stop paying those programs directly and would pay the State instead. The annual payment would reflect what the federal government would have spent, with adjustments for caseload growth and health care inflation. It would include amounts for premium tax credits, cost‑sharing reductions, and small‑business credits when they apply. Any savings could be reinvested in the State plan. The bill also authorizes “such sums as may be necessary” to fund State outreach and enrollment help.
States could run universal plans in 2026
This bill would let a State ask federal officials for a waiver to run its own universal plan starting with plan years on or after January 1, 2026. The State would need legal authority, a 10-year federal‑budget‑neutral plan, and a plan to cover at least 95% of residents within five years. “Residents” would include citizens, nationals, and lawfully present noncitizens whose main home is in the State. Only specific listed federal health laws and programs could be waived, and agencies would create a single, coordinated application and public comment process within 180 days. An independent 11‑member panel would review applications within 90 days, and the Secretary would decide within 90 days after that.
Strong benefits and patient protections in state plans
The Secretary would approve a State plan only if it matches or improves on federal coverage, access, and costs. People who would have had Medicaid must get mandatory Medicaid benefits like EPSDT, non‑emergency transport, and retroactive coverage. The plan must cover all residents except people eligible for Indian Health Service or VA title 38 benefits. It must be run by a public agency, help people enroll, offer appeals, and include reproductive health care, including abortion, contraception, and gender‑affirming care. People could still buy private coverage for benefits the State plan does not include.
States would need to reach 95% coverage
Every five years, a State with a waiver would need an independent report on spending, affordability, quality, access, and how many people are uninsured. The State would need to reach at least 95% coverage of residents. If it falls short, the Secretary would provide help and a 12‑month grace period. If the State still misses the target, the waiver could be ended. If it meets the target, the State must plan to cover the remaining residents.
Protections for American Indian health care
States and plans using a waiver would not be allowed to charge American Indians and Alaska Natives premiums, copays, or other fees for covered services. The federal government would cover those waived costs. States could not force American Indians to enroll in waiver insurance. Plans would need to try to contract with Indian health providers and pay fair rates. States would need regular consultation with Tribes and urban Indian health programs.
Sponsors & CoSponsors
Sponsor
Khanna
CA • D
Cosponsors
Cherfilus-McCormick
FL • D
Sponsored 7/15/2025
Cohen
TN • D
Sponsored 7/15/2025
McGovern
MA • D
Sponsored 7/15/2025
Del. Norton, Eleanor Holmes [D-DC-At Large]
DC • D
Sponsored 7/15/2025
Rep. Neguse, Joe [D-CO-2]
CO • D
Sponsored 7/15/2025
Rep. Omar, Ilhan [D-MN-5]
MN • D
Sponsored 7/15/2025
Pingree
ME • D
Sponsored 7/15/2025
Rep. Salinas, Andrea [D-OR-6]
OR • D
Sponsored 7/15/2025
Smith (WA)
WA • D
Sponsored 7/15/2025
Rep. Thanedar, Shri [D-MI-13]
MI • D
Sponsored 7/15/2025
Rep. Huffman, Jared [D-CA-2]
CA • D
Sponsored 7/15/2025
Rep. Tlaib, Rashida [D-MI-12]
MI • D
Sponsored 7/15/2025
Rep. Watson Coleman, Bonnie [D-NJ-12]
NJ • D
Sponsored 7/15/2025
Rep. Jayapal, Pramila [D-WA-7]
WA • D
Sponsored 7/15/2025
Rep. Lee, Summer L. [D-PA-12]
PA • D
Sponsored 7/15/2025
Thompson (MS)
MS • D
Sponsored 7/15/2025
Rep. Ansari, Yassamin [D-AZ-3]
AZ • D
Sponsored 7/15/2025
Bonamici
OR • D
Sponsored 7/15/2025
Rep. Nadler, Jerrold [D-NY-12]
NY • D
Sponsored 7/15/2025
Rep. Ramirez, Delia C. [D-IL-3]
IL • D
Sponsored 7/15/2025
Rep. Dexter, Maxine [D-OR-3]
OR • D
Sponsored 7/15/2025
Rep. Velázquez, Nydia M. [D-NY-7]
NY • D
Sponsored 7/15/2025
Schakowsky
IL • D
Sponsored 7/16/2025
Rep. Frost, Maxwell [D-FL-10]
FL • D
Sponsored 7/17/2025
Rep. Pocan, Mark [D-WI-2]
WI • D
Sponsored 7/17/2025
Stansbury
NM • D
Sponsored 7/22/2025
Rep. Hoyle, Val T. [D-OR-4]
OR • D
Sponsored 7/29/2025
Rep. Clarke, Yvette D. [D-NY-9]
NY • D
Sponsored 8/8/2025
Rep. Pressley, Ayanna [D-MA-7]
MA • D
Sponsored 8/15/2025
Rep. Olszewski, Johnny [D-MD-2]
MD • D
Sponsored 9/26/2025
Rep. Bynum, Janelle S. [D-OR-5]
OR • D
Sponsored 10/28/2025
Rep. Deluzio, Christopher R. [D-PA-17]
PA • D
Sponsored 10/31/2025
Mfume
MD • D
Sponsored 1/15/2026
Randall
WA • D
Sponsored 2/23/2026
Roll Call Votes
No roll call votes available for this bill.
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