PRIA Logo™
S2286119th CongressWALLET

State-Based Universal Health Care Act of 2025

Sponsored By: Senator Markey, Edward J. [D-MA]

Introduced

Summary

This bill would create a framework letting states implement state-based universal health care plans while requiring federal budget neutrality and a 95 percent coverage goal within five years.

Show full summary
  • States: Would be able to apply for waivers to run comprehensive state plans that must be budget neutral for the Federal government and include a plan to reach 95 percent coverage within 5 years.
  • Residents and families: Would get coverage that must be at least as comprehensive and as affordable as comparable Federal programs and must include reproductive and gender-affirming care.
  • American Indian and Alaska Native communities: Would receive special protections that bar premiums, deductibles, copays, or similar charges for Indian individuals and require good-faith contracting and payment rules for Indian health care providers.

Personalized for You

How does this bill affect your finances?

Personalize government policy and PRIA will tell you what this bill means for your household, plus every other piece of legislation we track. PRIA reads each provision against your financial profile to show you exactly what matters to your wallet.

Free to download

Bill Overview

Analyzed Economic Effects

5 provisions identified: 2 benefits, 0 costs, 3 mixed.

State plans must match federal protections

If enacted, an approved State plan would have to provide coverage at least as comprehensive and affordable as the federal programs it replaces. For Medicaid-related waivers that means mandatory Title XIX benefits like EPSDT, non‑emergency transportation, and retroactive coverage. The plan would need complaint, appeals, and independent review processes and public education and enrollment help. Congress could provide "such sums as may be necessary" to help with outreach. Every five years the State must submit an independent report and show whether it reached at least 95% resident coverage; missing that target would trigger technical help and a 12‑month chance to comply before possible termination.

States can apply for universal health waivers

If enacted, a State could apply for a federal waiver to run a statewide universal health plan for plan years starting Jan 1, 2026. Applications would need state legal authority and a 10‑fiscal‑year budget plan that is budget neutral for the federal government. The waiver would only apply to the federal laws listed in the bill — for example Medicare, Medicaid, CHIP, ACA exchanges and subsidies, certain tax credits, FEHB, and TRICARE. A State could not use this waiver for any plan year where it already has a section 1332 waiver.

Federal funding passthrough to States

If enacted, when a State takes over covered federal health programs the federal government would stop spending program funds directly and instead pay the State an annual aggregate amount. That amount must include funds equal to premium tax credits, cost‑sharing reductions, and small‑business credits that would have been available. The payment would be adjusted for caseload growth and healthcare inflation, and any savings could be reinvested by the State in its health plan.

Stronger protections for Native health

If enacted, the Secretary would have to issue rules to protect American Indian and Alaska Native people under waivers. The rules would ban enrollment fees, premiums, deductibles, copays, and similar charges for Indians for services under a waiver, with the federal government covering those waived charges. States could not force Indians to enroll in waiver plans, and plans must try to contract with Indian health providers and use a standard contract addendum developed with Tribes.

New federal waiver review and coordination

If enacted, HHS, Treasury, Defense, Labor, and OPM would have to adopt a single coordinated waiver process within 180 days so States can submit one application and rules line up. The bill would also create an 11‑member independent panel to review waiver applications and 5‑year reports and give recommendations within 90 days. The Secretary would have 90 days to decide after getting the panel's recommendations.

Sponsors & CoSponsors

Sponsor

Markey, Edward J. [D-MA]

MA • D

Cosponsors

  • Sen. Warren, Elizabeth [D-MA]

    MA • D

    Sponsored 7/15/2025

  • Sen. Merkley, Jeff [D-OR]

    OR • D

    Sponsored 7/15/2025

  • Sen. Padilla, Alex [D-CA]

    CA • D

    Sponsored 7/15/2025

Roll Call Votes

No roll call votes available for this bill.

View on Congress.gov
Back to Legislation