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.