Civics lessons abound these days, it seems. I couldn’t recall the last time I’d even heard the word “nullification” mentioned, for example, until it started cropping up recently in various states across the country in response to PPACA. State insurance commissioner names have found their way into the comments section of blogs, editorials, and op-ed pieces like never before. The realities of just what it takes to recall a governor, impeach a President, amend a constitution, or criminalize implementation of federal mandates at the state level have suddenly become fodder for dinner table conversation.
And sometimes, along comes something (almost) completely different: enter health care compacts.
Time was, when I heard “compact” in connection with insurance, I thought IIPRC. (Not that interstate compacts are new — they actually go back to pre-Revolutionary times.) The idea of a compact allowing for the purchase of health insurance across state lines was being floated at least as far back as 2009 when Minnesota Governor Tim Pawlenty outlined a proposed Interstate Health Insurance Compact. But now compacts such as the Interstate Health Care Freedom Compact, presenting outright challenges to federal health care reform under PPACA, are starting to appear on legislative radar screens in a number of states.
The Health Care Freedom Compact seeks to establish cooperation of member states in prohibiting any governmental agent from depriving any resident of a party state of the rights guaranteed under healthcare freedom laws in their state or penalizing them for exercising their rights under such laws. Freedom Compact bills such as Montana’s HB 312, Tennessee’s SB 79, New Mexico’s HB 323, and Arizona’s SB 1214 have been introduced; North Dakota’s version, HB 1291, was recently passed in committee but defeated on the house floor. These bills cite 4 USC 112, which permits interstate compacts for cooperation in enforcement and prevention of crimes, and call for criminal prosecution of anyone who violates the health care freedom criminal laws of a party state. They also state that they are not intended to control which health care services are permitted by state or federal law.
Meanwhile, another Health Care Compact is attracting attention, and a final version has just been published. This compact, upon which bills like Montana’s HB 526, Missouri’s HB 423, and Tennessee’s SB 326 and HB 369 are based, takes a different approach from the Freedom Compact. An Interstate Advisory Health Care Commission would be established with representatives from each participating state to study health care regulation issues and adopt bylaws and policies. Federal laws and regulations regarding health care deemed inconsistent with those adopted by the member state pursuant to the compact could be suspended by the states. Federal funds would be directed to the member states, which would be free to determine the levels of health care regulation they choose for their citizens; this funding would not be conditioned upon “any specific action of or regulation, policy, law or rule” adopted by the member state.
It’s not altogether clear how optimistic bill sponsors and supporters are for actually prevailing in the effort to establish the compacts, which, even if such bills end up on the Governor’s desk and are signed, would probably require approval of both houses of Congress. While only two states are technically needed to create a compact, even some of the most ardent proponents fear that congressional approval would be difficult if not unlikely to obtain.
At the same time, a number of states, companies, and unions have sought and received waivers on implementation of provisions in the law addressing annual limits on required benefits, and various bills have been filed across the country opposing things like the individual mandate, abortion funding under PPACA, and purchasing health insurance out of state. Montana and Wyoming have seen bills introduced seeking to criminalize enforcement of PPACA by any public officer, complete with possible fines and jail time.
In the meantime, however, many states — even where opposition to PPACA is strong — continue to move forward on things like establishment of exchanges and more strenuous oversight concerning rate increases and medical loss ratios. Many states have received federal grants to assist in implementing provisions of the health care reform law, although Florida has made some news recently by returning grant money to the federal government in the wake of recent federal court decisions involving the constitutionality of the law.
Last week I actually had to acquaint my college freshman son with the concept of “collective bargaining.” Up next? Interstate compacts, and, I suspect, lots more before all is said and done on PPACA.
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