The vehemence of the opposition to President Barack Obama’s overhaul of health care has spawned an assortment of strategies for killing it. The newest and most ambitious would create a health care compact among the states and use it to switch control of health care programs from the federal government to the states.
If that sounds like a long shot, it is no more so than the other schemes for nullifying Obamacare. These include repeal by Congress or by constitutional amendment, lawsuits to strike down Obamacare’s individual mandate, and actions by governors and House Republicans to slow down its implementation.
Those are worthy efforts. But a health care compact would do more. If successful — a very big “if” — it would reduce the scope of Washington, D.C.’s power. States — not Congress, the White House or federal bureaucrats — would set the rules for health care from top to bottom, from Medicare and Medicaid to individual insurance policies.
And as ambitious as that sounds, it is merely the initial goal of the group of conservative activists leading the compact drive. They want to use compacts to return other areas of federal control — the environment, drug and medical device regulation, and education, to name three possibilities — to the states or even local governments.
Interstate compacts are not a wild idea. They just have not been tapped before for such a political purpose. The authority for compacts was established in the U.S. Constitution (Article 1, Section 10) and more than 200 have been set up. One example: the agreement uniting Maryland, Virginia and the District of Columbia to build and operate the Washington area’s Metro subway system.
An issue of interest to two or more states can lead to a compact. It works this way: State legislatures approve a proposal, the states agree on the parts of mutual concern (such as buying insurance across state lines), then the compact is dispatched to Washington for ratification by Congress and the president (though the need for White House assent is not spelled out in the Constitution). Ratification turns the compact into federal law.
However, there is a bigger reason for forming a compact against Obamacare. By banding together, states would have far more political clout in Washington. Backers of the health care compact figure they need more than 20 states to pressure Washington to go along. Their assumption is members of Congress (even Democrats who support Obamacare) would be inclined to vote for a formal request from their home state. Members who oppose Obamacare would vote for it as well.
The compact strategy grew out of talks last summer among a handful of conservatives worried about the growth in federal power, particularly under Obama. They chose health care, given its unpopularity, as the issue on which to draw a new line between federal and state authority.
In October, Eric O’Keefe of the Sam Adams Alliance broached the compact strategy with the leaders of the Tea Party Patriots, Mark Meckler and Jenny Beth Martin. And in November, they, in turn, took the idea to their national council, which gathered in Washington to conduct an orientation session for newly elected members of Congress (only Republicans showed up).
When O’Keefe and a panel explained the strategy, they received a standing ovation from the 180 members of the council. At least 37 of them signed up as state coordinators for winning legislative approval of the health care compact. An experienced political consultant, Mike Barnhart, was hired as the national coordinator.
The campaign for the compact begins early next month when many state legislatures convene. Texas and Nebraska are among the target states. “There are a lot of good opportunities,” said Texas attorney Ted Cruz, a former state solicitor general.
Like the other efforts to snuff out Obamacare, the compact drive is likely to aid Republicans and conservatives by keeping the health care issue alive. That will not help Obama in his re-election campaign. But it could be an effective tool for Republicans in recruiting volunteers and appealing to voters. But what attracted conservative organizers such as O’Keefe and tea party activists is how broadly the compact strategy can be used to shrink the power of the federal government. It is an “unused lever point” with enormous potential, O’Keefe said.
“We picked one of the tougher issues,” health care, he said, and ratification by Congress and the president is “a big hurdle. But we want the fight. We want the clarity. We want to define the lines of the fight” between Washington and the people.
Achieving that will not be easy — but not impossible.
Fred Barnes is the executive editor of The Weekly Standard, where this article appeared.