A second chance to
get America's health care right: Give authority to our states
Health care reform
has dominated our nation’s political and social conversations for the past six
years. After the implementation of ObamaCare, it is clear the law brought
radical change and real pain to our nation’s families, economy, and health care
system. The promised "affordable health care fix" made things worse.
The pending King
v. Burwell case reveals another interesting legal problem with the policy
and text of the Affordable Care Act. As written, the federally controlled
subsidies and employer mandates are not allowed, unless a state chooses them.
Now the Supreme Court debates, behind closed doors, the question of state
responsibility and textual intent to determine the direction of health care in
America. The resulting Supreme Court opinion could dismantle the structure of
ObamaCare and give America a second chance to get health care reform right.
Ironically, the issue
of state responsibility could take ObamaCare down and lift individual citizens
up.
States are generally
more effective regulators than the federal government. Allowing states to
assume responsibility and maintain authority moves people from numbers on a
spreadsheet to neighbors down the street.
The Constitution
gives states the power to regulate health care within their state and
voluntarily compact with other states, but the federal government has attempted
to preempt state action by assuming centralized control. What is needed is
clear legislation that affirms the right of states to compact with one another
to return authority for health care regulation to states that choose to
participate.
Interstate compacts
have been used on more than 200 occasions to establish agreements between and
among states. Mentioned in Article 1, Section 10 of the Constitution, state
compacts provide authority and flexibility to administer government programs
without federal interference. In the Compact structure, federal health
care tax money and responsibility is returned to a state when they expand their
existing Healthcare Authority structure. Congressional consent is
extended when states enter into a legally binding compact. It is similar to a
multitude of other grants made by the federal government to states and local
entities.
Complexity empowers
big government, simplicity empowers families and local leaders. Giving
health care authority to states is simple and beneficial because they are able
to enact accountability, efficiencies and tailor their system to fit the exact
needs of their population. One size does not fit all – ObamaCare proves that.
The health challenges and population needs of Vermont or California are not the
same as Texas or Oklahoma.
Why should
bureaucrats in Washington, D.C. manage all health care systems the same way?
Health care is large,
complex, and challenging to manage at the federal level. With a federal system
that impacts over 300 million people, $2.3 trillion spent annually and almost
3,000 pages of regulations for Medicare and Medicaid, federal management of our
health care system is inefficient and virtually occluded from individualized
input. The Medicare fraud rate has hovered around 10 percent for decades,
with over $50 billion in annual lost tax money. Big systems allow massive
financial loss and make individual citizens small.
States are generally
more effective regulators than the federal government. Allowing states to
assume responsibility and maintain authority moves people from numbers on a
spreadsheet to neighbors down the street. Rural health care struggles to get
the attention of federal agencies, but they would have the consistent ear of
state agencies.
Some people assume
only people in Washington, D.C. care about the health needs of people across
the nation, but we can assure you that state leaders and state agencies deeply
care for their neighbors and want to find ways to help them. In fact,
before the Affordable Care Act passed, our states had already initiated systems
to care for those without health care. Unfortunately, the state solutions were
forced out when ObamaCare took over.
The Compact is an
option that ensures the people of each state will have a choice. States can opt
in to the Compact – or not. To date, the Health Care Compact has been
formally requested by 9 states – Alabama, Georgia, Indiana, Kansas, Missouri,
Oklahoma, South Carolina, Texas, Utah – and several other states are
considering it.
As Congress works
towards solutions to the problems created by the top-down approach of
ObamaCare, we want to let states innovate to serve their citizens’ health care
needs. When the Supreme Court rules on King v. Burwell in favor
of state responsibility, we want to let states innovate ways to serve their
citizens’ health care.
Republican John
Cornyn represents Texas in the United States Senate where he serves on the
Judiciary Committee. He is a former state attorney general.
Republican James
Lankford represents Oklahoma in the United States Senate.
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