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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)

View on Congress.gov

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

Bill activity

Introduced Jul 15, 2025 by Ro Khanna (D-CA) with 22 original cosponsors. 35 cosponsors as of Jul 2, 2026.

Rep. Pat Ryan (D-NY-18) is not listed among the cosponsors of this bill.
  1. IntroducedJul 15, 2025
  2. Passed House 
  3. Passed Senate 
  4. To President 
  5. Became Law 

Latest action Jul 15, 2025: Referred to the House Committee on Energy and Commerce, and in addition to the Committees on Armed Services, Ways and Means, Oversight and Government Reform, and Education and Workforce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.

Cosponsors during the cosponsorship window

119th Congress (Jan 2025 to Jan 2027)

Sep 2025OctNovDecJan 2026FebMarAprMayJunJulAugSepOctJul 15, 2025Oct 16, 2026 (still open)22 originalAdam Smith (D-WA-9). Cosponsored Jul 15, 2025, on the day of introduction. Original cosponsor.Andrea Salinas (D-OR-6). Cosponsored Jul 15, 2025, on the day of introduction. Original cosponsor.Bennie G. Thompson (D-MS-2). Cosponsored Jul 15, 2025, on the day of introduction. Original cosponsor.Bonnie Watson Coleman (D-NJ-12). Cosponsored Jul 15, 2025, on the day of introduction. Original cosponsor.Chellie Pingree (D-ME-1). Cosponsored Jul 15, 2025, on the day of introduction. Original cosponsor.Delia C. Ramirez (D-IL-3). Cosponsored Jul 15, 2025, on the day of introduction. Original cosponsor.Eleanor Holmes Norton (D-DC). Cosponsored Jul 15, 2025, on the day of introduction. Original cosponsor.Ilhan Omar (D-MN-5). Cosponsored Jul 15, 2025, on the day of introduction. Original cosponsor.James P. McGovern (D-MA-2). Cosponsored Jul 15, 2025, on the day of introduction. Original cosponsor.Jared Huffman (D-CA-2). Cosponsored Jul 15, 2025, on the day of introduction. Original cosponsor.Jerrold Nadler (D-NY-12). Cosponsored Jul 15, 2025, on the day of introduction. Original cosponsor.Joe Neguse (D-CO-2). Cosponsored Jul 15, 2025, on the day of introduction. Original cosponsor.Maxine Dexter (D-OR-3). Cosponsored Jul 15, 2025, on the day of introduction. Original cosponsor.Nydia M. Velázquez (D-NY-7). Cosponsored Jul 15, 2025, on the day of introduction. Original cosponsor.Pramila Jayapal (D-WA-7). Cosponsored Jul 15, 2025, on the day of introduction. Original cosponsor.Rashida Tlaib (D-MI-12). Cosponsored Jul 15, 2025, on the day of introduction. Original cosponsor.Sheila Cherfilus-McCormick (D-FL-20). Cosponsored Jul 15, 2025, on the day of introduction. Original cosponsor.Shri Thanedar (D-MI-13). Cosponsored Jul 15, 2025, on the day of introduction. Original cosponsor.Steve Cohen (D-TN-9). Cosponsored Jul 15, 2025, on the day of introduction. Original cosponsor.Summer L. Lee (D-PA-12). Cosponsored Jul 15, 2025, on the day of introduction. Original cosponsor.Suzanne Bonamici (D-OR-1). Cosponsored Jul 15, 2025, on the day of introduction. Original cosponsor.Yassamin Ansari (D-AZ-3). Cosponsored Jul 15, 2025, on the day of introduction. Original cosponsor.Janice D. Schakowsky (D-IL-9). Cosponsored Jul 16, 2025, 1 day after introduction.Mark Pocan (D-WI-2). Cosponsored Jul 17, 2025, 2 days after introduction.Maxwell Frost (D-FL-10). Cosponsored Jul 17, 2025, 2 days after introduction.Melanie A. Stansbury (D-NM-1). Cosponsored Jul 22, 2025, 7 days after introduction.Val T. Hoyle (D-OR-4). Cosponsored Jul 29, 2025, 14 days after introduction.Yvette D. Clarke (D-NY-9). Cosponsored Aug 8, 2025, 24 days after introduction.Ayanna Pressley (D-MA-7). Cosponsored Aug 15, 2025, 31 days after introduction.Johnny Olszewski (D-MD-2). Cosponsored Sep 26, 2025, 73 days after introduction.Janelle S. Bynum (D-OR-5). Cosponsored Oct 28, 2025, 105 days after introduction.Christopher R. Deluzio (D-PA-17). Cosponsored Oct 31, 2025, 108 days after introduction.Kweisi Mfume (D-MD-7). Cosponsored Jan 15, 2026, 184 days after introduction.Emily Randall (D-WA-6). Cosponsored Feb 23, 2026, 223 days after introduction.Becca Balint (D-VT). Cosponsored Jul 2, 2026, 352 days after introduction. Nov 2025Feb 2026MayJulSepJul 15, 2025Oct 16, 2026 (still open)22 originalAdam Smith (D-WA-9). Cosponsored Jul 15, 2025, on the day of introduction. Original cosponsor.Andrea Salinas (D-OR-6). Cosponsored Jul 15, 2025, on the day of introduction. Original cosponsor.Bennie G. Thompson (D-MS-2). Cosponsored Jul 15, 2025, on the day of introduction. Original cosponsor.Bonnie Watson Coleman (D-NJ-12). Cosponsored Jul 15, 2025, on the day of introduction. Original cosponsor.Chellie Pingree (D-ME-1). Cosponsored Jul 15, 2025, on the day of introduction. Original cosponsor.Delia C. Ramirez (D-IL-3). Cosponsored Jul 15, 2025, on the day of introduction. Original cosponsor.Eleanor Holmes Norton (D-DC). Cosponsored Jul 15, 2025, on the day of introduction. Original cosponsor.Ilhan Omar (D-MN-5). Cosponsored Jul 15, 2025, on the day of introduction. Original cosponsor.James P. McGovern (D-MA-2). Cosponsored Jul 15, 2025, on the day of introduction. Original cosponsor.Jared Huffman (D-CA-2). Cosponsored Jul 15, 2025, on the day of introduction. Original cosponsor.Jerrold Nadler (D-NY-12). Cosponsored Jul 15, 2025, on the day of introduction. Original cosponsor.Joe Neguse (D-CO-2). Cosponsored Jul 15, 2025, on the day of introduction. Original cosponsor.Maxine Dexter (D-OR-3). Cosponsored Jul 15, 2025, on the day of introduction. Original cosponsor.Nydia M. Velázquez (D-NY-7). Cosponsored Jul 15, 2025, on the day of introduction. Original cosponsor.Pramila Jayapal (D-WA-7). Cosponsored Jul 15, 2025, on the day of introduction. Original cosponsor.Rashida Tlaib (D-MI-12). Cosponsored Jul 15, 2025, on the day of introduction. Original cosponsor.Sheila Cherfilus-McCormick (D-FL-20). Cosponsored Jul 15, 2025, on the day of introduction. Original cosponsor.Shri Thanedar (D-MI-13). Cosponsored Jul 15, 2025, on the day of introduction. Original cosponsor.Steve Cohen (D-TN-9). Cosponsored Jul 15, 2025, on the day of introduction. Original cosponsor.Summer L. Lee (D-PA-12). Cosponsored Jul 15, 2025, on the day of introduction. Original cosponsor.Suzanne Bonamici (D-OR-1). Cosponsored Jul 15, 2025, on the day of introduction. Original cosponsor.Yassamin Ansari (D-AZ-3). Cosponsored Jul 15, 2025, on the day of introduction. Original cosponsor.Janice D. Schakowsky (D-IL-9). Cosponsored Jul 16, 2025, 1 day after introduction.Mark Pocan (D-WI-2). Cosponsored Jul 17, 2025, 2 days after introduction.Maxwell Frost (D-FL-10). Cosponsored Jul 17, 2025, 2 days after introduction.Melanie A. Stansbury (D-NM-1). Cosponsored Jul 22, 2025, 7 days after introduction.Val T. Hoyle (D-OR-4). Cosponsored Jul 29, 2025, 14 days after introduction.Yvette D. Clarke (D-NY-9). Cosponsored Aug 8, 2025, 24 days after introduction.Ayanna Pressley (D-MA-7). Cosponsored Aug 15, 2025, 31 days after introduction.Johnny Olszewski (D-MD-2). Cosponsored Sep 26, 2025, 73 days after introduction.Janelle S. Bynum (D-OR-5). Cosponsored Oct 28, 2025, 105 days after introduction.Christopher R. Deluzio (D-PA-17). Cosponsored Oct 31, 2025, 108 days after introduction.Kweisi Mfume (D-MD-7). Cosponsored Jan 15, 2026, 184 days after introduction.Emily Randall (D-WA-6). Cosponsored Feb 23, 2026, 223 days after introduction.Becca Balint (D-VT). Cosponsored Jul 2, 2026, 352 days after introduction.
Democratic 35

Each dot is one cosponsor. Dots stack by sign-on day, or by week when the window is long. The block at the left holds the original cosponsors.

Still open as of Oct 16, 2026 (119th Congress): not yet reported by the House Energy and Commerce Committee and the House Armed Services Committee and the House Ways and Means Committee and the House Oversight and Government Reform Committee and the House Education and Workforce Committee.

Activity log

Source: Congress.gov actions
  1. Introduced in House
  2. Referred to the House Committee on Energy and Commerce, and in addition to the Committees on Armed Services, Ways and Means, Oversight and Government Reform, and Education and Workforce, for a period to be subsequently determined by the...
  3. 22 original cosponsors on the day of introduction
  4. Janice D. Schakowsky cosponsored (D-IL)
  5. 2 members cosponsored
  6. Melanie A. Stansbury cosponsored (D-NM)
  7. Val T. Hoyle cosponsored (D-OR)
  8. Yvette D. Clarke cosponsored (D-NY)
  9. Ayanna Pressley cosponsored (D-MA)
  10. Johnny Olszewski cosponsored (D-MD)
  11. Janelle S. Bynum cosponsored (D-OR)
  12. Christopher R. Deluzio cosponsored (D-PA)
  13. Kweisi Mfume cosponsored (D-MD)
  14. Emily Randall cosponsored (D-WA)
  15. Becca Balint cosponsored (D-VT)

Votes on this bill

No recorded votes yet on this measure.

Cosponsors

35 cosponsored

Sponsor Introduced by Ro Khanna (D-CA) on Jul 15, 2025

MemberParty/StateDateDays after introductionOriginalGrade
Adam SmithD-WAJul 15, 20250OriginalB+
Andrea SalinasD-ORJul 15, 20250OriginalB+
Bennie G. ThompsonD-MSJul 15, 20250OriginalB+
Bonnie Watson ColemanD-NJJul 15, 20250OriginalB+
Chellie PingreeD-MEJul 15, 20250OriginalA-
Delia C. RamirezD-ILJul 15, 20250OriginalB+
Eleanor Holmes NortonD-DCJul 15, 20250Original—
Ilhan OmarD-MNJul 15, 20250OriginalA+
James P. McGovernD-MAJul 15, 20250OriginalB+
Jared HuffmanD-CAJul 15, 20250OriginalB+
Jerrold NadlerD-NYJul 15, 20250OriginalB+
Joe NeguseD-COJul 15, 20250OriginalC
Maxine DexterD-ORJul 15, 20250OriginalB+
Nydia M. VelázquezD-NYJul 15, 20250OriginalB+
Pramila JayapalD-WAJul 15, 20250OriginalA+
Rashida TlaibD-MIJul 15, 20250OriginalA+
Sheila Cherfilus-McCormickD-FLJul 15, 20250OriginalB+
Shri ThanedarD-MIJul 15, 20250OriginalA
Steve CohenD-TNJul 15, 20250OriginalA
Summer L. LeeD-PAJul 15, 20250OriginalB+
Suzanne BonamiciD-ORJul 15, 20250OriginalB+
Yassamin AnsariD-AZJul 15, 20250OriginalB+
Janice D. SchakowskyD-ILJul 16, 20251A+
Mark PocanD-WIJul 17, 20252A+
Maxwell FrostD-FLJul 17, 20252B+
Melanie A. StansburyD-NMJul 22, 20257B
Val T. HoyleD-ORJul 29, 202514B
Yvette D. ClarkeD-NYAug 8, 202524B
Ayanna PressleyD-MAAug 15, 202531B
Johnny OlszewskiD-MDSep 26, 202573C+
Janelle S. BynumD-OROct 28, 2025105C
Christopher R. DeluzioD-PAOct 31, 2025108B+
Kweisi MfumeD-MDJan 15, 2026184C+
Emily RandallD-WAFeb 23, 2026223B+
Becca BalintD-VTJul 2, 2026352B

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.