# Plain Language Summary: State-Based Universal Health Care Act of 2023

This bill would let individual states create their own universal health care systems that cover all their residents, rather than relying solely on the current mix of private insurance, Medicare, Medicaid, and the Affordable Care Act marketplace. Essentially, it gives states permission to opt out of certain federal health care rules if they can prove they'll provide better coverage to more people. A state would need to apply for a waiver from the federal government, showing that their plan covers at least 95 percent of residents within five years, costs no more than what the federal government currently spends on health care in that state, and provides coverage that's at least as good as what people currently get through Medicare, Medicaid, and other federal programs.

The bill sets specific requirements for any state plan that gets approved. The state's system must be run by a public agency (not a private company), cover everyone in the state except those already covered by the Veterans Administration or Indian Health Service, and include reproductive health services. States would receive all the federal money that currently goes toward health care in their state—including Medicare, Medicaid, and tax credits people use to buy insurance—and could use any savings to expand or improve their health care system. The federal government would have to make a decision on a state's application within 90 days of receiving expert panel recommendations, and states would have to report every five years on how many people they've covered and whether their system is working.

This bill essentially creates a pathway for states to experiment with universal health care without needing permission from Congress each time. However, it's important to note that this is just an authorization—states would still need to pass their own laws to actually set up these systems, and the federal government would need to approve each state's specific plan. The bill doesn't force any state to do this; it simply removes the legal barriers that currently prevent states from trying.

State-Based Universal Health Care Act of 2023

State-Based Universal Health Care Act of 2023 This bill establishes the option for states, or groups of states, to apply to waive certain federal health insurance requirements and provide residents with health insurance benefits plans through a state-administered program. Such programs must cover 95% of the residents in the state within five years and plan benefits must be at least as comprehensive and affordable as the coverage under the equivalent federal program. State programs are supported with funds from the federal programs the state programs replace, which may include Medicare, Medicaid, the Children's Health Insurance Program, the Federal Employee Health Benefits program, certain federal tax credits, and premium-assistance funds, among others. The bill requires the Department of Health and Human Services to appoint an Independent Assessment Panel for Comprehensive Care to review and recommend whether to approve state applications. Each approved state program must be independently reviewed every five years to evaluate changes in health benefits access, quality, and coverage, including whether the state has met the 95% coverage requirement. The federal government must pay all health insurance costs for American Indians and Alaska Natives who enroll in a plan through a state insurance program.