S. 2286, the State-Based Universal Health Care Act of 2025, allows states to establish universal health care systems by obtaining federal waivers that exempt them from most existing federal health care requirements. States seeking waivers must demonstrate they can cover at least 95% of residents within five years, provide a budget-neutral 10-year plan, and ensure coverage is at least as comprehensive as current federal programs while maintaining affordability protections—all while publicly administering the program and including reproductive health services. The bill requires states to submit annual progress reports, with an 11-member Independent Assessment Panel reviewing applications and overseeing accountability, and states that fail to meet coverage targets face potential waiver termination after a 12-month grace period. The legislation allows waivers to apply to major federal health programs including Medicare, Medicaid, CHIP, federal employee benefits, and ACA subsidies and tax credits, with federal agencies coordinating their waiver processes into a single application system. The bill effectively shifts universal health care policy decisions to individual states while maintaining federal oversight through reporting requirements and an independent review process.
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