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.

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.