March 29, 2011- The tea party has a new plan to attack health care reform. While some conservative activists are still fighting to get the law defunded and eventually repealed, others are organizing behind a radical, states'-rights proposal that would go beyond merely derailing health reform. Egged on by tea partiers, at least a dozen states are now contemplating legislation that supporters believe would allow them to seize control of and administer virtually all federal health care programs operating in their states and exempt them from the requirements of the health care law. That includes Medicare, the government health care program for the elderly on which a sizable number of tea partiers rely.
The vehicle for this reform end run is called the health care compact, an interstate compact not very different in theory from the ones states use to create regional transit authorities, for instance. Recently, the nation's largest tea party group, the Tea Party Patriots, has thrown its weight behind the concept, seeing it as another way of downsizing the federal government. But the group may have other motivations, too. TPP has received a significant amount of money from the measure's backer, the Health Care Compact Alliance, an organization bankrolled by the right-wing heir to a Texas construction company fortune. Last month, the Alliance underwrote TPP's policy summit in Phoenix for a sponsorship advertised at $250,000. It has also become a regular advertiser on TPP's website and email promotions.
Along with TPP's endorsement comes its considerable army of activists, who are working to persuade state legislatures to pass laws to join the interstate compact rather than to implement parts of the new federal health care reform law. The Georgia House, which recently refused to move legislation that would create health insurance "exchanges" as required under the Affordable Care Act, also passed health care compact legislation. States including Tennessee, Oklahoma, Montana, Arizona, and Missouri are currently considering similar bills.
Despite the flurry of legislative activity, the compact is a longshot. The Alliance website promoting the proposal describes it as "simply an agreement between two or more states that is consented to by Congress—that restores authority and responsibility for health care regulation to the member states (except for military health care, which will remain federal), and provides the funds to the states to fulfill that responsibility." Proponents seem to believe that the compact is actually a shortcut to their goal of defunding reform because of its alleged simplicity. Once two or more states sign on, all they think they need is congressional consent, and billions in federal health dollars will suddenly be turned over to the states without any strings attached—and without the signature of the president. Easy, right?
Opponents have their doubts. They say there's no precedent for using interstate compacts in this way. Typically, states employ such agreements for things like managing ports, fishing rights, and water allocation—not to nullify federal regulations. And they say that it's unlikely Congress would sign off—even under Republican control.