The State-Based Universal Health Care Act of 2025 allows individual states to apply for federal waivers to create their own universal health care systems, provided they can cover at least 95 percent of residents within five years while maintaining budget neutrality for the federal government. States granted waivers would be able to opt out of current federal health insurance requirements, including Medicare, Medicaid, employer-sponsored insurance rules, and ACA programs, while receiving federal funding equivalent to what would have been spent under existing programs. The bill establishes an independent 11-member Assessment Panel to review waiver applications and ongoing performance within 90 days, requires states to submit comprehensive implementation plans and conduct independent evaluations every five years to document coverage rates and healthcare affordability improvements, and provides federal technical assistance and a 12-month grace period if states fall short of coverage targets. State plans must include comprehensive coverage, including reproductive health services, while allowing residents to purchase supplemental private insurance, and affected federal programs include Medicare, Medicaid, CHIP, federal employee benefits, military coverage, and ACA insurance exchanges and subsidies.