State-Based Universal Health Care Act of 2015

SECTION 1. SHORT TITLE; PURPOSE.

    (a) Short Title.--This Act may be cited as the ``State-Based 
Universal Health Care Act of 2015''.
    (b) Purpose.--The purpose of this Act is to establish a flexible 
framework under which each State can provide comprehensive universal 
health coverage to all of its residents.

SEC. 2. WAIVER FOR STATE UNIVERSAL HEALTH CARE.

    (a) In General.--Subtitle D of title I of the Patient Protection 
and Affordable Care Act (Public Law 111-148) is amended by inserting 
after section 1332 (42 U.S.C. 18052) the following new section:

``SEC. 1332A. WAIVER FOR STATE UNIVERSAL HEALTH CARE.

    ``(a) Application.--
            ``(1) In general.--A State may apply to the Secretary (as 
        defined in subsection (g)(3)) for the waiver of so much of the 
        requirements described in paragraph (2) with respect to health 
        benefits coverage within that State for plan years beginning on 
        or after January 1, 2016, as is necessary to implement a 
        comprehensive State universal health care plan in the State 
        under this section. Such application shall--
                    ``(A) be filed at such time and in such manner as 
                the Secretary may require;
                    ``(B) contain such information as the Secretary may 
                require, including--
                            ``(i) a comprehensive description of the 
                        State legislation and program to implement a 
                        plan meeting the requirements for a waiver 
                        under this section; and
                            ``(ii) a 10-fiscal-year budget plan for 
                        such plan that is budget neutral for the 
                        Federal Government; and
                    ``(C) provide an assurance that the State has 
                enacted the law described in subsection (b)(2).
            ``(2) Requirements.--The requirements described in this 
        paragraph with respect to health benefits coverage within the 
        State for plan years beginning on or after January 1, 2016, are 
        as follows:
                    ``(A) Parts I, II, and III of subtitle D.
                    ``(B) Section 1402.
                    ``(C) Sections 36B, 4980H, and 5000A of the 
                Internal Revenue Code of 1986.
                    ``(D) Title XI of the Social Security Act.
                    ``(E) Title XVIII of the Social Security Act.
                    ``(F) Title XIX of the Social Security Act.
                    ``(G) Title XXI of the Social Security Act.
                    ``(H) Chapter 89 of title 5 of the United States 
                Code.
                    ``(I) Chapter 55 of title 10, United States Code, 
                including coverage under the TRICARE program.
                    ``(J) Section 514 of the Employee Retirement Income 
                Security Act of 1974.
            ``(3) Pass through of funding.--With respect to a State 
        waiver under paragraph (1), under which the State assumes 
        responsibility for health coverage under a specified Federal 
        health program, including under each of the Federal health care 
        or subsidy programs specified in subparagraphs (B), (C), (E), 
        (F), (G), and (H) of paragraph (2), the Secretary shall not 
        spend Federal health funds that would otherwise have been spent 
        for such program and shall provide for an alternative means by 
        which the aggregate amount of such funds shall be paid to the 
        State for purposes of implementing the State plan under the 
        waiver. Such amount shall be determined annually by the 
        Secretary, taking into account the amount that would otherwise 
        have been spent under such Federal health program with respect 
        to residents of such State, if such waiver did not apply. Such 
        amount shall include funds equal to the amount of premium tax 
        credits, cost-sharing reductions, or small-business credits 
        under sections 36B and 45R of the Internal Revenue Code of 1986 
        or under section 1402 that would have been available to 
        individuals and businesses in the State if such waiver did not 
        apply.
            ``(4) Waiver consideration and transparency.--
                    ``(A) In general.--An application for a waiver 
                under this section shall be considered by the Secretary 
                in accordance with the regulations described in 
                subparagraph (B).
                    ``(B) Regulations.--Not later than 180 days after 
                the date of enactment of the State-Based Universal 
                Health Care Act of 2015, the Secretary shall promulgate 
                regulations relating to waivers under this section that 
                provide--
                            ``(i) a process for public notice and 
                        comment at the State level, including public 
                        hearings, sufficient to ensure a meaningful 
                        level of public input;
                            ``(ii) a process for the submission of an 
                        application that ensures the disclosure of--
                                    ``(I) the provisions of law that 
                                the State involved seeks to waive; and
                                    ``(II) the specific plans of the 
                                State to ensure that the waiver will be 
                                in compliance with subsection (b);
                            ``(iii) a process for providing public 
                        notice and comment after the application is 
                        received by the Secretary, that is sufficient 
                        to ensure a meaningful level of public input 
                        and that does not impose requirements that are 
                        in addition to, or duplicative of, requirements 
                        imposed under the Administrative Procedure Act, 
                        or requirements that are unreasonable or 
                        unnecessarily burdensome with respect to State 
                        compliance;
                            ``(iv) a process for the submission to the 
                        Secretary of periodic reports by the State 
                        concerning the implementation of the program 
                        under the waiver; and
                            ``(v) a process for the periodic evaluation 
                        by the Secretary with respect to waivers 
                        granted under this section.
                    ``(C) Report.--The Secretary shall annually report 
                to Congress concerning actions taken by the Secretary 
                with respect to applications for waivers, and programs 
                conducted through waivers granted, under this section.
    ``(b) Granting of Waivers.--
            ``(1) In general.--The Secretary may grant a request for a 
        waiver under subsection (a)(1) only if the Secretary determines 
        that the State plan--
                    ``(A) will provide health benefits coverage to 
                State residents that is at least as comprehensive as 
                the health benefits coverage that such residents would 
                have received under the specified Federal health 
                program for which such residents would have been 
                eligible, absent such waiver;
                    ``(B) will provide coverage and cost sharing 
                protections against excessive out-of-pocket spending to 
                State residents that are at least as affordable as the 
                coverage and cost sharing protections under the 
                specified Federal health program for which such 
                residents would have been eligible, absent such waiver;
                    ``(C) will provide coverage to substantially all 
                residents of the State, including substantially all 
                those otherwise covered under the Federal health care 
                or subsidy programs specified in subparagraphs (B), 
                (C), (E), (F), (G), and (H) of subsection (a)(2), 
                except individuals who are eligible for benefits 
                through the Indian Health Service or for benefits and 
                services under title 38, United States Code;
                    ``(D) will be publicly administered by an agency of 
                the State; and
                    ``(E) will not increase the Federal deficit.
        Subparagraph (D) shall not be construed as limiting a State 
        from contracting with one or more private entities to 
        administer the plan.
            ``(2) Requirement to enact a law.--
                    ``(A) In general.--A law described in this 
                paragraph is a State law that provides for State 
                actions under a waiver under this section, including 
                the implementation of the State plan under subsection 
                (a)(1)(B).
                    ``(B) Termination of opt out.--A State may repeal a 
                law described in subparagraph (A) and terminate the 
                authority provided under the waiver with respect to the 
                State.
    ``(c) Scope of Waiver.--
            ``(1) In general.--The Secretary shall determine the scope 
        of a waiver of a requirement described in subsection (a)(2) 
        granted to a State under subsection (a)(1).
            ``(2) Limitation.--Under this section, the Secretary may 
        not waive any Federal law or requirement that is not listed in 
        subsection (a)(2).
    ``(d) Determinations by Secretary.--
            ``(1) Time for determination.--The Secretary shall make a 
        determination under subsection (a)(1) not later than 180 days 
        after the receipt of an application from a State under such 
        subsection.
            ``(2) Effect of determination.--
                    ``(A) Granting of waivers.--If the Secretary 
                determines to grant a waiver under subsection (a)(1), 
                the Secretary shall notify the State involved of such 
                determination and the terms and effectiveness of such 
                waiver.
                    ``(B) Denial of waiver.--If the Secretary 
                determines a waiver should not be granted under 
                subsection (a)(1), the Secretary shall notify the State 
                involved and the appropriate committees of Congress of 
                such determination and the reasons therefor.
    ``(e) Term of Waiver.--No waiver under this section may extend over 
a period of longer than 5 years unless the State requests continuation 
of such waiver, and such request shall be deemed granted unless the 
Secretary, within 90 days after the date of its submission to the 
Secretary, either denies such request in writing or informs the State 
in writing with respect to any additional information which is needed 
in order to make a final determination with respect to the request.
    ``(f) Assuring Coordination.--
            ``(1) In general.--Not later than 180 days after the 
        enactment of the State-Based Universal Health Care Act of 2015, 
        the Secretary of Health and Human Services, the Secretary of 
        the Treasury, the Director of the Office of Personnel 
        Management, the Secretary of Defense, and the Secretary of 
        Labor shall, through the execution of an interagency memorandum 
        of understanding among such Secretaries and the Director--
                    ``(A) develop a process for coordinating and 
                consolidating the State waiver processes applicable 
                under the provisions of this section, and the existing 
                waiver processes applicable under--
                            ``(i) titles XI, XVIII, XIX, and XXI of the 
                        Social Security Act; and
                            ``(ii) any other Federal law relating to 
                        the provision of health care items or services; 
                        and
                    ``(B) ensure that--
                            ``(i) regulations (including regulations 
                        required under subsection (a)(4)(B)), rulings, 
                        and interpretations issued by such Secretaries 
                        and the Director relating to the same matter 
                        over which two or more such Secretaries or 
                        Director have responsibility under this section 
                        are administered so as to have the same effect 
                        at all times; and
                            ``(ii) coordination of policies relating to 
                        the granting, implementation, and continuation 
                        of waivers through such Secretaries and 
                        Director in order to have a coordinated 
                        strategy that avoids duplication of effort by 
                        the States or Secretaries and Director and 
                        ensures clarity about waiver application status 
                        and approval.
            ``(2) Single application.--The process under paragraph 
        (1)(A) shall permit a State to submit a single application for 
        a waiver under all of the provisions of this section and the 
        provisions of law listed under clauses (i) and (ii) of such 
        paragraph.
            ``(3) Submission of conforming amendments.--The Secretary 
        of Health and Human Services, in coordination with the other 
        Secretaries (including the Director of the Office of Personnel 
        Management), shall submit to Congress such recommendations for 
        such technical and conforming amendments to law as may be 
        appropriate to assist in the implementation of this section.
    ``(g)  Definitions.--In this section:
            ``(1) Health benefits coverage.--The term `health benefits 
        coverage'--
                    ``(A) means--
                            ``(i) health insurance coverage, as such 
                        term is defined in section 2791(b) of the 
                        Public Health Service Act (42 U.S.C. 300gg-
                        91(b)); and
                            ``(ii) coverage under a group health plan, 
                        as such term is defined in section 2791(a) of 
                        the Public Health Service Act (42 U.S.C. 300gg-
                        91(a)); and
                    ``(B) includes any medical coverage or health 
                benefits provided under any specified Federal health 
                program described in subparagraphs (A) through (E) of 
                paragraph (4).
            ``(2) Resident.--With respect to a State, the term 
        `resident' means an individual who is a citizen or national of 
        the United States or an alien lawfully residing in the State, 
        and whose primary residence (as defined by the State) is 
        located in the State.
            ``(3) Secretary.--The term `Secretary' means--
                    ``(A) the Secretary of Health and Human Services 
                with respect to waivers relating to the provisions 
                described in subparagraphs (A), (B), and (D) through 
                (G) of paragraph (2) of subsection (a);
                    ``(B) the Secretary of the Treasury with respect to 
                waivers relating to the provisions described in 
                subparagraph (C) of such paragraph;
                    ``(C) the Director of the Office of Personnel 
                Management with respect to waivers relating to the 
                provisions described in subparagraph (H) of such 
                paragraph;
                    ``(D) the Secretary of Defense with respect to 
                waivers relating to the provisions described in 
                subparagraph (I) of such paragraph; and
                    ``(E) the Secretary of Labor with respect to 
                waivers relating to the provisions described in 
                subparagraph (J) of such paragraph.
            ``(4) Specified federal health program.--The term 
        `specified Federal health program' means all of the following 
        programs:
                    ``(A) The Medicare program under title XVIII of the 
                Social Security Act.
                    ``(B) The Medicaid program under title XIX of the 
                Social Security Act.
                    ``(C) The Children's Health Insurance Program under 
                title XXI of the Social Security Act.
                    ``(D) The Federal Employees Health Benefits Plan 
                under chapter 89 of title 5 of the United States Code.
                    ``(E) Medical coverage under chapter 55 of title 
                10, United States Code, including coverage under the 
                TRICARE program.
                    ``(F) An Exchange established under this subtitle.
                    ``(G) Subsidies under section 1402.
                    ``(H) Tax credits under sections 36B and 45R of the 
                Internal Revenue Code of 1986.''.
    (b) Clerical Amendment.--The table of contents in section 1(b) of 
such Act is amended by inserting after the item relating to section 
1332 the following new item:

``Sec. 1332A. Waiver for State universal health care.''.

Summary: State-Based Universal Health Care Act of 2015 This bill amends the Patient Protection and Affordable Care Act to allow states to apply for waivers to health benefits coverage requirements in order to implement a universal health care plan. The state universal health care plan must be at least as comprehensive and affordable as coverage under federal health programs and cover substantially all state residents. States may apply to waive requirements for: health insurance exchanges, plans sold on exchanges, and the program to support nonprofit insurance issuers, reduced cost-sharing for individuals meeting income criteria. Health insurance premium subsidies, employer shared responsibility payments, and minimum essential coverage. Health benefits under titles XI , XVIII (Medicare), XIX (Medicaid), and XXI (CHIP) of the Social Security Act, federal employee health benefits, health benefits for members of the military. And health insurance under the Employee Retirement Income Security Act of 1974 (ERISA). The Department of Health and Human Services (HHS) must pay a state that assumes responsibility for health coverage currently provided under a federal health program the amount that would otherwise have been spent under the program. HHS, the Office of Personnel Management, and the Departments of the Treasury, Defense, and Labor must coordinate and consolidate this state waiver process with existing waiver processes to ensure consistency and avoid duplication of effort.