States can now build universal health care—if they can afford it

What it does

This bill creates a new federal waiver process allowing states to establish universal health care systems covering at least 95% of their residents. States can apply to waive federal health insurance requirements (Medicare, Medicaid, ACA marketplace rules, federal employee health benefits, TRICARE, and others) and receive consolidated federal funding equal to what would have been spent on those programs, adjusted for inflation and caseload growth. States must provide comprehensive coverage at least as good as current federal programs, with no excessive out-of-pocket costs, and must be publicly administered. An independent panel reviews applications; states must report every 5 years on coverage rates, affordability, and quality.

Why we flagged it

The bill's core mechanism is a waiver authority that allows states to consolidate federal health program funding and requirements into state-administered universal systems. It is neither a mandate nor a prohibition, but an opt-in federal-state partnership structure with conditions and oversight.

What the text implies

• States that fail to achieve 95% coverage after 5 years face a 12-month grace period, then potential waiver termination—creating pressure to cut benefits or shift costs to meet targets rather than expand coverage.
• Bill permits private supplemental insurance, which could fragment the universal system if high-income residents opt out, undermining risk pooling and cross-subsidization.
• Federal funding is 'budget neutral'—states receive only what would have been spent under current programs. States cannot expand coverage beyond current federal spending without new state revenue, capping ambition.
• Independent Assessment Panel includes labor representatives and patient advocates but no insurance industry voice; panel recommendations are advisory only, giving Secretary final discretion.
• Reproductive health care (including abortion) is a mandatory benefit—states cannot waive this requirement, creating a flashpoint for conservative states and potential legal challenges.

Section numbers refer to the bill text the analysis read — linked under Primary records below.

Who it affects

Citizens in participating states gain potential access to comprehensive universal coverage with no cost-sharing barriers and unified administration, addressing fragmentation and coverage gaps in current federal programs. However, the bill's success depends entirely on state implementation, political will, and whether states actually achieve the 95% coverage target; states could also reduce benefits or shift costs to residents, and the bill permits private supplemental insurance which could under

Who stands to gain

• State health care agencies (administrative consolidation and funding flow)
• Health care providers (unified payment systems, potential for higher negotiated rates)
• Pharmaceutical and medical device manufacturers (expanded coverage may increase utilization)

Named in the bill

Secretary of Health and Human Services, Secretary of the Treasury, Secretary of Defense, Secretary of Labor, Director of Office of Personnel Management, Independent Assessment Panel for Comprehensive Health Care, Medicare (Title XVIII, Social Security Act), Medicaid (Title XIX, Social Security Act), Children's Health Insurance Program (Title XXI, Social Security Act), Federal Employees Health Benefits Plan (Chapter 89, Title 5, U.S. Code), TRICARE (Chapter 55, Title 10, U.S. Code), ACA Exchanges and subsidies (Sections 36B, 1402, 45R) — and 3 more

Where it stands

35 cosponsors: 35 Democrats.

• Jul 15, 2025 — Introduced · Congress.gov: “Introduced in House”
• Jul 15, 2025 — Referred to House Committee on Education and Workforce and House Committee on Oversight and Government Reform · Congress.gov: “Referred to the Committee on Energy and Commerce, and in addition to the Committees on Armed Services, Ways…”

Dates and quoted wording are Congress.gov's action record; the timeline shows status changes, not every procedural step.

Money around this bill

1 lobbying clients named this bill on 1 disclosure filings across 1 quarter, Jun 2026 to Jun 2026. Those filings disclosed $3,010,000 in lobbying spend. A filing names 77 bills on average, so that figure is what each filing reported, not a share belonging to this bill.

More lobbying clients named this bill than 0% of bills with at least one filing.

Ro Khanna, the sponsor, reported $0 in PAC receipts in the 2026 cycle.

• America's Health Insurance Plans Inc (ahip) — $3,010,000 on 1 filing

Lobbying Disclosure Act filings through Jul 20, 2026. A filing shows who paid to lobby on a bill it names, not what changed.