The State-Based Universal Health Care Act of 2025 aims to create a flexible framework for states to establish comprehensive universal health coverage for their residents. It authorizes states to apply for waivers from various federal health care requirements, including those under the Patient Protection and Affordable Care Act (ACA) , Medicare , Medicaid , and other federal programs like CHIP, FEHBP, and TRICARE. To receive a waiver, a state must submit a detailed plan, commit to covering at least 95% of its residents within five years, and provide a 10-fiscal-year budget plan that is budget-neutral for the federal government. Upon approval, the federal government will provide the state with funds equivalent to what would have been spent on the waived federal programs, adjusted for inflation and caseload growth, allowing for reinvestment of any health care savings. Approved state plans must ensure coverage that is at least as comprehensive and affordable as existing federal programs, publicly administered by a state agency or independent public entity. Key requirements include providing coverage to all state residents (excluding those eligible for Indian Health Service or VA benefits), offering robust complaint and appeal systems, and covering reproductive health care services, including abortion, contraception, and gender-affirming care. The bill establishes an Independent Assessment Panel for Comprehensive Health Care to review waiver applications and state reports, providing recommendations to the Secretary of Health and Human Services. States are required to submit independent reports every five years on their progress, and failure to achieve 95% coverage after a grace period could lead to waiver termination. Interagency coordination is mandated to streamline waiver processes, and specific guidance is included to protect the health care rights and benefits of American Indians and Alaska Natives.