1. Short title; purpose (a) Short title This Act may be cited as the State-Based Universal Health Care Act of 2018 . (b) Purpose The purpose of this Act is to establish a flexible framework under which States can provide comprehensive universal health coverage to all of their residents. 2. Waiver for State universal health care (a) In general Title I of the Patient Protection and Affordable Care Act ( Public Law 111–148 ) is amended by striking section 1332 ( 42 U.S.C. 18052 ) and inserting the following new section: 1332. Waiver for State universal health care (a) Application (1) In general A State may apply to the Secretary (as defined in subsection (i)(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, 2019, 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; (ii) a plan for how the State will achieve in 5 years health coverage for at least 95 percent of the population of the State, with five percent of the population of the State not spending more than 10 percent of their adjusted gross income on health; and (iii) a 10-fiscal-year budget plan for such plan that is budget neutral for the Federal Government