Under a bill pending in the state Senate, Texas could become the second state seeking to opt out of the new federal health care law by taking advantage of a clause in the U.S. Constitution allowing states to work together by forming a “compact.”
The health care compact, as envisioned by Republican supporters, would provide member states with their shares of federal money for Medicaid, Medicare and children’s health insurance to spend on health care as each state sees fit.
Supporters believe that with greater flexibility and no federal strings attached, the money would be spent more efficiently on needs that are better understood by state officials. The idea enjoys strong support from Republicans, tea party activists and others opposed to the health care reforms pushed by President Barack Obama.
But there’s a big catch.
Congress must approve compacts, and state Democrats are skeptical that federal officials would allow member states to suspend, as the Texas bill says, “all federal laws, rules, regulations and orders” that conflict with local health care policies.
Even Republicans are cautious about the plan’s prospects.
“If you don’t ask, it won’t happen,” Kyle Janek, a former Republican state senator from 2003-08 who now lobbies in favor of a compact, told senators at a committee hearing this week. “But at least it sends a message to those lawmakers and federal officials that we’re getting tired of all the strings that you attach.”
“If 15 or 20 states do it, I think D.C. will get the message,” said Janek, a lobbyist for the Health Care Compact Alliance, a national group whose vice chairman is Leo Linbeck III, a Houston builder and son of conservative activist Leo Linbeck Jr.
Thus far, Georgia is the only state to join the health care compact.
Arizona’s Republican governor vetoed a compact bill in April, saying the law infringed on executive power and complicated efforts to reform a state-run health care system. GOP-led legislatures in Missouri and Montana sent compact bills to their states’ Democratic governors, who have yet to act.
The effort in Texas, led by Rep. Lois Kolkhorst, R-Brenham, would have the state join the compact before working out how to implement the health care policy.
Creating a compact is so complicated, Janek said, that it makes sense to seek congressional approval first, and then work out the details. Toward that end, a related bill would create a study committee of legislators and citizens to advise the Legislature on establishing a state-run health system.
Each state in the compact would design its own health care system while being free to enter into agreements with member states on such matters as combining their purchasing power for lower-cost drugs, Janek said.
The House voted 104-41 to approve Kolkhorst’s House Bill 5, with four Democrats voting in favor and no Republicans against. It and the related study bill could be debated by the full Senate early next week.
In the Senate, the health committee approved the bill over sharp objections from Democrats, who have not yet decided how to approach the measure when it comes to the floor.
Sen. Royce West, D-Dallas, said he doubted Texas could do a better job than the federal government, noting that the state is at the bottom in the percentage of citizens uninsured and in per-person spending on health care.
Sen. José Rodríguez, D-El Paso, said during this week’s hearing of the Health and Human Services Committee that the effort seemed like a poorly disguised attack on federal health care reform, which opponents deride as “Obamacare.”
The law, Janek replied, “was sort of the last straw, but that is not what started this movement through the years.”
“The purpose is to give states more flexibility with their federal health care dollars,” Janek said. “We are telling the federal government that, with your permission and with the funding that goes along with it, (Texas will) design a system that works best for our state.”