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A self-governance perspective on health care

Friday, December 09, 2011

Yesterday on IndyStar.com, Indiana State Representative Tim Neese published an op-ed about the importance of returning control of health care matters to the state level.  Rep. Neese notes the considerable costs to the state of Indiana of abiding by the federal government's regulations.  By allowing states to retain the decision-making authority in the area of health care, Rep. Neese believes the state will be able to produce significant cost reductions.

From the article:

Health-care spending is one of the largest contributing factors to excessive budgets and deficits in the United States and it is expected to accelerate due to the new Patient Protection and Affordable Care Act. Disappointingly, the congressional joint committee, also known as the supercommittee, which was created to identify deficit reductions, was unable to agree on a proposal to reduce the nation's budget deficit. That's one reason why governors and state legislatures have been looking for solutions to their state's health-care problems, including the Health Care Compact initiative.

Read the full article here.

ALEC Adopts HCC as Model Language

Thursday, December 01, 2011

This past week, ALEC adopted the Health Care Compact as model legislations.

Below is the press release from the Health Care Compact's website.

Alexandria, Va. (Nov. 30, 2011) – The Health Care Compact Alliance today announced the American Legislative Exchange Council (ALEC), the nation’s largest nonpartisan individual membership association of state legislators,has adopted the Health Care Compact as model legislation. This move will make the Health Care Compact vision and language widely available to nearly 2,000 state legislators across the country, and marks ALEC’s support of the initiative to bring the power over health care to the state level.     

The Health Care Compactis an initiative of the Health Care Compact Alliance, a nonpartisan organization dedicated to providing Americans more influence over decisions that govern their health care. The Health Care Compact is an agreement between participating states that restores authority and responsibility for health care regulation to member states. The Health Care Compact does not make suggestions on what policies individual states should pursue, but advocates that health care policy should be decided at the state level.

“States, not the federal government, are in the best position to implement market-driven and patient-centered health care reform,” said Christie Herrera, director of the Health and Human Services Task Force of ALEC. “The Health Care Compact Act adds to ALEC's powerful list of tools legislators can use to push back against the unprecedented federal health care law.”  

ALEC adopts model legislation that is consistent with their mission and reflects their policy. The Health Care Compact bill was first submitted to and approved by members of ALEC’s Health and Human Services Task Force. After the Task Force approval, the bill was sent to ALEC's Board of Directors for final approval. Upon final approval by the board, the bill became official ALEC model legislation. 

“ALEC is such a highly regarded and trusted organization among state legislators, and we are excited to have its support for the Health Care Compact,” said Leo Linbeck III, Vice Chairman of the Health Care Compact Alliance. “We hope that legislators across the United States will utilize this model legislation to address the pressing health care issues in their states.”

The concept of using interstate compacts to return sovereignty to the states was originally developed by the Texas Public Policy Foundation(TPPF),a non-profit, free-market research institute. TPPF was integral in shepherding the Health Care Compact through the ALEC model legislation process.

“Interstate compacts are highly effective in shielding against federal overreach,” said Arlene Wohlgemuth, executive director of the TPPF. “The Health Care Compact is a strong solution to many of our country’s health care problems, particularly managing Medicaid on a state level.”

The Health Care Compact has been introduced in 13 states since February 2011 and has already been adopted in Texas, Georgia, Oklahoma and Missouri. In addition, citizen groups and state legislators in more than 20 states are actively considering the Health Care Compact.

Under the Health Care Compact, each state receives annual funding from the federal government for health care. The funding is mandatory spending for the federal government and is not subject to annual appropriations. Funding for each state is calculated from a baseline of 2010 health care spending, adjusted for changes in population and inflation.

For the Health Care Compact to become law, it must be passed by both houses of a general assembly or legislature, signed by the governor and approved by Congress. Health care policy in a member state is not prescribed in the compact. Policy is determined by each individual state after the compact is ratified.

Interstate compacts have been used throughout U.S. history to allow states to coordinate in important policy areas. Authority for compacts was established in the Constitution (Article I, Section 10), and more than 200 such agreements are currently in effect. They are voluntary agreements between states that, when consented to by Congress, have the force of federal law.

About the Health Care Compact Alliance

The Health Care Compact Alliance is a nonpartisan [501(c)4] organization providing tools that enable citizens to exert greater control over their government. The Health Care Compact was developed to offer Americans more influence over decisions that govern health care. For more information, please visit www.healthcarecompact.org.

About the American Legislative Exchange Council

The American Legislative Exchange Council (ALEC) is the nation’s largest nonpartisan individual membership association of state legislators, with nearly 2,000 state legislators across the nation and more than 100 alumni members in Congress. ALEC’s mission is to promote free markets, individual liberty and federalism in the states.For more information, visit www.alec.org


Health Care Compact Would Generate $3 Trillion in Federal Savings

Tuesday, September 13, 2011

SUMMARY

The Self-Governance Institute recently developed a thorough analysis of the Health Care Compact's fiscal impact on the federal budget. If the HCC were adopted by all 50 states, the ten-year deficit reduction would be nearly $3 trillion.

The Health Care Compact is an interstate compact that allows member states to assume the decision-making authority for health care matters in their own states. States that participate in the Health Care Compact will have more flexibility to create programs that uniquely meet the needs of their residents, rather than implementing the federal government's one-size-fits-all programs.

The Health Care Compact, unlike the federal government's confusing calculations, relies on a consistent and straight-forward funding mechanism. The Health Care Compact is based on 2010 Health Care spending, and adjusts annually for population and GDP fluctuations. But by harnessing the funding formula to a constant number and eliminating much of the uncertainty with federal spending, the Health Care Compact is able to significantly cut the projected deficit.

DETAILS

The Self-Governance Institute recently analyzed the fiscal impact of the Health Care Compact (HCC), an interstate compact to return decision-making and funding for health care to the states, on the federal deficit.  The conclusion:  This single governance reform can significantly alleviate the federal government’s budget problems.  In fact, implementation of the HCC in all 50 states cuts the deficit by nearly $3 trillion by 2021.

The Budget Control Act of 2011 (BCA) creates a Congressional joint committee charged with identifying deficit reductions of $1.5 trillion between 2012 and 2021.  As part of its mandate, the so-called “super-committee” will consider spending cuts, entitlement reform, and tax reform.

All eyes are on the super-committee, which has only until November 23, 2011 to make its recommendations.  According to a September 11, 2011 Politico article, the super-committee has met just once and doesn’t seem to be pushing the envelope with fresh ideas. 

When the commission meets next, health care spending must be high on the agenda for reform.  Federal health care spending is already one of the largest contributing factors to spiraling budgets and deficits.  And spending is projected to actually accelerate   because of the new healthcare law.

As Washington’s new super-committee prepares for protracted policy and budget wrangling with no real reform in sight, the HCC offers real reform, shifting who decides about health care to the states and reducing the deficit by nearly $3 trillion over the next ten years. 

How Funding Works under the HCC

Under the HCC, each state receives annual funding from the federal government for health care.  The funding is mandatory spending for the federal government and is not subject to annual appropriations.  Funding for each state is calculated from a baseline of 2010 health care spending, adjusted for changes in population and inflation.  The increase of spending is controlled in a more fiscally responsible manner. 

Assuming the HCC is implemented in all 50 states in 2012, following is an example that illustrates how total health care spending would be computed under the HCC (in billions). 

Year

2012

Population Adjustment Factor

(the increase from 2010)

     1.0171

GDP Adjustment Factor

(the increase from 2010)

     1.0341

Health Care Compact Spending

$852.0

The baseline spending for health care was $810 billion in 2010.  The 2012 spending is the baseline adjusted using a growth factor defined in the HCC itself:

2010 Healthcare spending x GDP Inflation Factor x Population Growth Factor = New Spending

Under the HCC, total health care spending would be $852 billion in 2012.  Following is an examination of total health care spending in 2012 under the existing health care law (in billions).

2012

Projected Current Spending

$857.0

Health Care Compact Spending

$852.0

Savings

$5.0

Data from the Congressional Budget Office, July 2011

In 2012, the HCC saves $5 billion by converting federal health care spending from a “defined benefit” approach to a “defined contribution” one. Note that this does not limit health care spending directly; states are free to spend more if they choose. But it caps the amount of federal funding, and indexes it for inflation and population changes.  Now let’s examine the impact through 2021.

The table below employs the same method to project savings each year from 2012 through 2021 (in billions).

YEAR

Projected Federal Spending

Health Care Compact Spending

Annual Savings

Total Savings

2012

$857.0

$852.0

$5.0

2013

$906.0

$878.6

$27.4

2014

$1,026.0

$907.7

$118.3

2015

$1,128.0

$937.3

$190.7

2016

$1,255.0

$967.9

$287.1

2017

$1,336.0

$998.9

$337.1

2018

$1,406.0

$1,031.0

$375.0

2019

$1,530.0

$1,064.2

$465.8

2020

$1,637.0

$1,097.8

$539.2

2021

$1,763.0

$1,132.3

$630.7

$2,976.3

Data from the Congressional Budget Office, July 2011

So, if all 50 states were to pass the Health Care Compact and regain control of health care regulation and funding, the federal government would no longer be responsible for administering Medicare, Medicaid, S-CHIP, and other health programs.  Funding for these programs would be calculated under the HCC’s simple funding formula, rather than the complex funding mechanisms that the federal government uses, and each state would be responsible for administering its own programs.   Most important, if all 50 states were to adopt the Health Care Compact, the federal government would save nearly $3 trillion over 10 years.

The Health Care Compact has been introduced in 13 states since February and is already adopted four states and is gaining significant additional momentum moving into 2012.

More information is available on the Health Care Compact Alliance’s website here.


Did You Know

How long is the new health care law (PPACA)?

2,700 pages.
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