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POSITIVE Healthcare 119th Congress

H.R.4406 State-Based Universal Health Care Act of 2025

Allows states to create their own single-payer universal healthcare systems using federal waivers (119th Congress)

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Legal & Constitutional Grounding

U.S. admin costs are 34% of health spending vs. 17% in single-payer systems.

Himmelstein et al., Annals (2020) — U.S. admin costs 34.2% vs. 17% in Canada
  • ACA § 1332, 42 U.S.C. § 18052 — State Innovation Waiver

Allows states to create single-payer universal healthcare via federal waivers. State-level single-payer systems can achieve universal coverage while reducing administrative costs that consume an estimated 34% of U.S. healthcare spending.