Straight talk on health care reform: HOPE Act an empty promise for Colorado

The latest shot in the national debate over health care has landed in Colorado. It's called the HOPE Act, or the "Health Care Opportunity and Patient Empowerment Act."

Proponents say it is a better, practical alternative to the Affordable Care Act passed by Congress last year. But evidence suggests otherwise. The proposal has little or nothing to do with improving health care and instead is part of a national campaign to derail health care reform for partisan and ideological purposes. At least nine other states are weighing similar proposals. Colorado should have nothing to do with it.

In November, Colorado voters soundly defeated Amendment 63, the previous attempt to sidetrack implementation of national health care reform. This current legislation, House Bill 1273, simply represents another attempt to override that election result.

HB 1273 would be the first step in implementing a "health care compact," a dubious legal framework for exempting Colorado and other member states from participating in the Affordable Care Act. In reality, such a compact would face a gantlet of political, legal and practical obstacles, making implementation highly unlikely.

And even without these obstacles, an interstate health care compact would be hard-pressed to match the benefits already enshrined in recent national reforms. Those reforms will bring health care coverage to as many as 500,000 Coloradans who currently have none, and they are likely to reduce the growth in health care costs and insurance premiums while increasing economic output and creating more jobs, according to a recent study by the Colorado Trust.(1) Any alternative should be measured against this standard. The HOPE Act falls far short.

Chief among political obstacles is the constitutional requirement that interstate compacts be approved by both houses of Congress, which is unlikely without a filibuster-proof majority in the Senate. Beyond that are major legal challenges. According to Pietro Nivola of the Brookings Institute, "Usually (interstate compacts) are used for proactive efforts to advance a policy, not to block it. ... All these types of maneuvers are going to be challenged in the courts one way or the other."(2)

Multi-state compacts are not a new invention, and more than 200 have been created under Article I, Section 10 of the U.S. Constitution. They are used to establish multi-state agencies and partnerships and to manage waterways and deal with issues ranging from environmental protection to waste disposal.(3)

However, this is where a proposed health care compact diverges from past practice. HB 1273 and similar bills across the nation do nothing to foster interstate cooperation. Rather, they would establish a mechanism for states to go their own separate ways.

Under a "health care compact," states would be allowed to:

• Design and operate unique and individualized health care systems untouched by any external accountability or authority.
• Use federal money to fund health care systems in the form of block grants, without external oversight or regulation.
• Negotiate with other states to implement the purchase of insurance across state lines. This likely would drive purchasers to states with the least amount of regulation, which would deprive Coloradans of hard-won consumer protections.
• Followed to its logical conclusion, a health care compact could create as many different health care systems as there are states.

So if the political, legal and practical hurdles are all but insurmountable, and the benefits are not likely to match those in the Affordable Care Act, why are the proponents pushing this legislation?

As it turns out, HB 1273 is about much more than a national campaign to derail health care reform. According to Fred Barnes, writing in the conservative publication The Weekly Standard, "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 won't help Obama in his re-election campaign. But it could be an effective tool for Republicans in recruiting volunteers and appealing to voters."(4) And health care, according to Barnes, 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, education, to name three possibilities – to the states or even local governments."(5)

An organization called the Health Care Compact Alliance was recently established to help promote health care compacts nationwide. Colorado's HOPE Act embraces the alliance's direction and even some of its suggested language. That pedigree and the compact mission outlined by Barnes suggest that the Hope Act is less about improving health care for Colorado citizens and more about falling in line with a larger national political strategy.

– Bob Semro

End notes
(1) Colorado Trust Issue Brief, The Economic Impact of Health Reform in Colorado, February 2011.
(2) Virginia Statehouse News, Conservatives may use interstate compacts to fight health care law, Dec. 3, 2010.
(3) Adam Winkler, professor of law, University of California at Los Angeles, Republicans' Latest Effort to Circumvent the Constitution: Interstate Compacts, March 10, 2011.
(4) Barnes, Fred, Nullifying Obamacare; Here's one more weapon, The Weekly Standard, Jan. 10, 2011, Vol. 16, No. 16.
(5) Barnes, Fred, Nullifying Obamacare; Here's one more weapon, The Weekly Standard, Jan. 10, 2011, Vol. 16, No. 16.