Agreeing to disagree
Interstate compacts, which were discussed as a possible alternative to Obamacare at the Belmont Club some years ago, may enjoy a new vogue as progressive America rediscovers the advantages of autonomy in the age of Trump. Interstate compacts you will remember are an agreement between two or more states entered into with the consent of Congress to do something together. In 2011 Mother Jones ridiculed Health Care Compacts as "the Tea Party's latest scheme to kill health care reform".
The vehicle for this reform end run is called the health care compact, an interstate compact not very different in theory from the ones states use to create regional transit authorities, for instance. Recently, the nation’s largest tea party group, the Tea Party Patriots, has thrown its weight behind the concept, seeing it as another way of downsizing the federal government. But the group may have other motivations, too. TPP has received a significant amount of money from the measure’s backer, the Health Care Compact Alliance, an organization bankrolled by the right-wing heir to a Texas construction company fortune.
But now that the Left wants its own America it may find Interstate Compacts appealing. Sasha Issenberg of New York Magazine notes it is the obvious path to policies a Blue State may want to adopt but which a Red State may resist; single-payer health care system for instance. He describes a hypothetical future.
The year is 2019. California’s new governor, Gavin Newsom, recently elected on a platform that included support for the creation of a single-payer health-care system, now must figure out how to enact it. A prior nonpartisan analysis priced it at $400 billion per year — twice the state’s current budget. There appears to be no way to finance such a plan without staggering new taxes, making California a magnet for those with chronic illnesses just as its tax rates send younger, healthier Californians house-hunting in Nevada and big tech employers consider leaving the state.
But Newsom is not alone. Other governors have made similar promises, and Newsom calls together the executives of the most ideologically like-minded states — Oregon, Washington, New York, Massachusetts, Connecticut, Maryland. What if they banded to create a sole unified single-payer health-care system, spreading risk around a much larger pool of potential patients while creating uniformity across some of the country’s wealthiest states?
Fifteen end up forming an interstate compact, a well-established mechanism for working together, explicitly introduced in the Constitution.
There are now dozens of policy areas in which the Left wants to chart its own course from immigration to climate. "Some states have attempted to enforce their own citizenship policies ... After Trump withdrew from the Paris climate agreement, Governor Jerry Brown — he has said 'we are a separate nation in our own minds'". Rather than force other states to accept their policies it may be easier to attempt a separate endeavor. Issenberg concludes "even if they don’t use the term, states’ rights has become a cause for those on the left hoping to do more than the federal government will."