Health Care Compact

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Health Care Compact
Formation date:	2011
Member jurisdictions:	9
Issue(s):	Healthcare

The Health Care Compact (HCC) is an interstate compact among nine states. The nine member states are Alabama, Georgia, Indiana, Kansas, Missouri, Oklahoma, South Carolina, Texas and Utah. The compact is designed to transfer the responsibility and authority for regulating healthcare from the federal government to the member states. An initiative of the Health Care Compact Alliance, a nonpartisan 501(c)(4) organization, the final language of the HCC was published on February 23, 2011. In order for the compact to become law, it must be passed by both houses of each member state's General Assembly, signed by the governor, and approved through Congress. The compact does not need the signature of the president to take effect.

The Health Care Compact has seven primary components:

1. Pledge — Member states pledge to take action to secure congressional consent to the compact, and to improve healthcare policy within their respective jurisdictions.^[1]
2. Legislative power — The legislature of each member state assumes primary responsibility for the regulation of healthcare in their respective state.^[1]
3. State control — Member states are granted the authority to enact healthcare laws that supersede federal regulations within the state.^[1]
4. Funding — Member states will receive federal funding appropriated by Congress, based on the federal funds spent in their respective states on healthcare in 2010.^[1]
5. Interstate Advisory Health Care Commission — Member states appoint individuals to an advisory commission. The commission is tasked with collecting information relevant to the regulation of healthcare, and with making recommendations to member states.^[1]
6. Amendments — Member states can amend the compact by unanimous agreement among themselves without additional congressional consent.^[1]
7. Withdrawal — Any member state can withdraw from the compact by adopting a law to that effect. The compact will be dissolved if all but one of the member states withdraws.^[1]

History[edit]

The introduction of this legislation came less than a year after the passage of the Patient Protection and Affordable Care Act.^[2] While the HCC does not conflict with efforts to repeal the act, it renders regulations contained in the Affordable Care Act ineffective in HCC member states. The purpose of the HCC is three-fold: to give member states primary responsibility for healthcare regulation; to ensure that relevant state laws supersede conflicting federal laws and regulations; and to secure federal funding for states that choose to invoke their authority under the compact.^[1]

Nine states have already enacted compact legislation.

On April 20, 2011, Georgia became the first state to adopt the HCC, as Gov. Nathan Deal signed HB 461 into law. Alabama Indiana, Kansas, Oklahoma, Missouri, Texas, Utah and South Carolina have since joined the compact, and similar resolutions have been introduced in several other states.^[3][4]

Role of Congress[edit]

See also: Congressional consent

Legal debates surrounding the enactment of the Health Care Compact have to do with the role of Congress and the President and raise questions that may be resolved in the courts.

Supporters of the compact point to the 10th Amendment of the United States Constitution, which states, "The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people."

Additionally, they reference the Commerce Clause of Article I, section 10, which reads in part, "No State shall, without the Consent of Congress, ... enter into any Agreement or Compact with another State." Under this, they argue, Congress is only required to vote on the measure without ever sending it to the President.^[5]

Adam Winkler, professor of law at UCLA School of Law, argues that the HCC requires the approval of Congress and must be presented to the President for his signature, citing the Presentment Clause of Article I, Section 7. It states in part that every bill and "Every Order, Resolution, or Vote to which the Concurrence of the Senate and House of Representatives may be necessary . . . shall be presented to the President of the United States; and before the Same shall take Effect, shall be approved by him..."^[5]

The clause continues, "being disapproved by him, shall be repassed by two thirds of the Senate and House of Representatives, according to the Rules and Limitations prescribed in the Case of a Bill." Thus, some argue that it is possible that the compact may have to be sent to the President, but could still be passed without his signature.

Another question involving Congress and the HCC is whether the Medicare and Medicaid block-grant provisions of the compact would result in fixed spending amounts for those programs. Supporters of the compact say this is not the case. Jack McHugh, a legislative analyst for The Mackinac Center, states, "No Congress — and no previously approved multi-state compact — can decree how much any future Congress must spend. A sitting Congress can always vote to cut appropriations, and to revise the formulas by which any program’s spending levels are determined."^[6]

On May 12, 2015, Rep. Doug Collins (R-Ga.) introduced a bill in the U.S. House to grant consent of Congress to the Health Care Compact.^[7]

Attorneys general challenge the Affordable Care Act[edit]

The Health Care Compact is separate from a challenge the state attorneys general brought through the court system.

The version of the ACA that was approved by the Senate included a provision that said the federal government would pay in full for Nebraska’s newly eligible Medicaid enrollees, whereas other states would split funding with the federal government. Opponents of this provision said it was added to gain support from Sen. Ben Nelson (D-Neb.), who maintained that this was not the case.^[8] A week after the Senate had approved its draft of the ACA, 14 state attorneys general from Alabama, Colorado, Florida, Idaho, Michigan, North Dakota, Oklahoma, Pennsylvania, South Carolina, South Dakota, Texas, Utah, Virginia, and Washington, signed a letter to Democratic Congressional leadership requesting the removal of the Nebraska provision from the Senate draft of the act.^[9] The letter, organized by South Carolina’s Attorney General Henry McMaster (R), left open the possibility for further litigation.^[10][8] Democrats at the time said that the letter stemmed from political motivations on the part of the signees, some of whom were running in upcoming elections.^[11]

Attorneys general from Alabama, Colorado, Florida, Idaho, Louisiana, Michigan, Nebraska, Pennsylvania, South Carolina, South Dakota, Texas, Utah, and Washington, 11 of whom signed the December letter, filed suit against the ACA the same day it was signed into law.^[12] These states were eventually joined by Alaska, Arizona, Georgia, Indiana, Iowa, Kansas, Maine, Mississippi, Nevada, North Dakota, Ohio, Wisconsin, and Wyoming.^[13] The lawsuit challenged the constitutional legitimacy of the ACA on two grounds. The first was that the individual mandate fell outside of the federal government’s authority, while the second was that the requirement for state Medicaid expansion of coverage violated state sovereignty.^[12][14]

The United States Supreme Court released its ruling on June 28, 2012. In a 5-4 opinion written by Chief Justice John Roberts, the Court upheld the individual mandate as falling within Congress’ power to levy taxes, as opposed to its Commerce Clause authority. However, the justices found the Medicaid expansion to be unconstitutional due to the withholding of funds that would follow from noncompliance with expansion.^[15][16]

Support[edit]

Some of the arguments that have been made for the adoption of the Health Care Compact include the following:

• Healthcare is too complex to manage at the federal level.^[17]
• States will be more efficient in the regulation and oversight of their healthcare systems than the federal government.^[17]
• A healthcare compact would not mandate its member states to implement one particular healthcare system; the states would be free to choose the system that works best in their jurisdiction.^[18]
• This increased flexibility given to states will drive healthcare reform^[18] and "stimulate greater competition in the insurance markets."^[19]
• The healthcare compact will end states' dependence on federal funding support for programs like Medicare and Medicaid.^[20]

Opposition[edit]

Arguments made by opponents of the Health Care Compact include the following:

• The compact is about politics rather than healthcare, and "only provides an ideological statement about government reform. ... [It presents] no detail or direction on how to improve healthcare.^[21]
• The compact reinforces the unequal, state-by-state access to quality and affordable healthcare.^[22]
• Current Medicare recipients' healthcare services could be in jeopardy.^[22]

Governance[edit]

The compact created the Interstate Advisory Health Care Commission to oversee administration of the compact. The commission is composed of members appointed by each member state. Each state is responsible for determining the exact process by which its commissioners (no more than two per state) are chosen.^[23]

The commission is granted specific powers to do the following:

• study the issues of Health Care regulation of particular concern to the Member States
• make non-binding recommendations to the Member States
• collect information and data to assist the Member States in their regulation of Health Care, including, but not limited to, assessing the performance of various state Health Care programs and compiling information on the cost of Health Care. The Commission shall then make this information available to the legislatures of the Member States
• elect from among its membership a Chairman
• adopt and publish bylaws and policies which are not inconsistent with the compact
• meet at least once a year, and may meet more frequently, as its bylaws direct^[23]

Text of the compact[edit]

The legislature of each member state passes the laws with certain and modifications, but the core of the legislation remains the same.

See also[edit]

• Interstate compact
• Healthcare Policy
• Affordable Care Act
• Obamacare lawsuits

Ballotpedia news articles[edit]

• Utah state Senate approves bill to join interstate Health Care Compact March 7, 2012
• New Hampshire, Indiana legislatures considering joining Health Care Compact February 9, 2012
• Health care compact gains momentum with Texas and Missouri July 19, 2011

Recent news[edit]

This section links to a Google news search for the term "Health + care + compact"

See also[edit]

• Healthcare policy in the United States

External links[edit]

Suggest a link

• The Council of State Governments - National Center for Interstate Compacts
• Health Care Compact
• Health Care Compact's Facebook page
• Health Care Compact on Twitter

Footnotes[edit]