State-Based Universal Health Care Act of 2025

Comprehensive Coverage for Residents: The bill allows States to create plans that provide health benefits coverage to all residents, including those currently covered under various Federal health or subsidy programs (Section 2(b)(1)(A) and (D)).

Affordability Protections: States must provide coverage and cost-saring protections against excessive out-of-pocket spending that are at least as affordable as current Federal programs (Section 2(b)(1)(C)).

Reproductive Health Care Access: The bill requires State plans to provide coverage for reproductive health care services, including abortion, contraception, and gender-affirming care (Section 2(b)(1)(I)).

Protection for American Indians: The bill mandates that no enrollment fee, premium, or similar charge be imposed on an Indian who receives services through a waiver, with these costs borne by the Federal Government (Section 2(h)(1)(B)).

Support for Indian Health Care Providers: Health insurance issuers under these plans must make good faith efforts to contract with Indian health care providers and pay them at specific rates (Section 2(h)(1)(D) and (E)).

Potential for Coverage Gaps: The bill notes that certain individuals, specifically those eligible for benefits through the Indian Health Service or under title 38 of the United States Code, may not be covered under the State's universal plan (Section 2(b)(1)(D)).

Requirement for State Legal Action: To implement these plans, States must have the legal authority to do so, which may require the enactment of new State laws or executive orders (Section 2(b)(2)).

Risk of Waiver Termination: If a State fails to achieve health coverage for at least 95 percent of its residents, the Secretary has the discretion to terminate the waiver (Section 2(e)(2)(A)(iii)).