US SB2286

States may apply to the Secretary of Health and Human Services for waivers to implement comprehensive universal health care systems covering all state residents, with plan years beginning on or after January 1, 2026

Waivers can cover multiple federal health programs including Medicare, Medicaid, CHIP, FEHB, TRICARE, and ACA marketplace requirements, with federal funds that would have been spent on these programs redirected to the state as passthrough funding

State plans must achieve at least 95% health coverage of residents within 5 years, provide benefits at least as comprehensive as existing federal programs, cover reproductive health care including abortion and gender-affirming care, and be publicly administered

An 11-member Independent Assessment Panel for Comprehensive Health Care would review waiver applications within 90 days and provide recommendations to the Secretary, with members appointed by congressional leaders, governors' associations, and healthcare stakeholder groups

States must submit independent reports every 5 years documenting spending, coverage rates, and affordability changes; failure to maintain 95% coverage after a 12-month grace period may result in waiver termination at the Secretary's discretion