Sunday, September 19, 2021

States need freedom to design own health care programs

Government-run health care programs are bankrupt and broken. Medicaid, specifically, is breaking the banks of all fifty states. 

To avert bankruptcy, and to reclaim authority and responsibility for providing health care to our neediest residents, Texas must chart our own path for health care.  To do so, Texas and other states should turn to an option outlined in Article 1, Section 10 of the U.S. Constitution: an interstate compact. 

Interstate compacts are not simply theoretical exercises in constitutional law.  Compacts between states exist in a wide variety of areas, covering issues such as transportation, taxation, criminal background checks, and the supervision of former prisoners.  Specifically, there are ten approved low-level waste compacts between states to provide for the disposal of certain radioactive waste.  Texas is party to one such compact. 

With Congressional approval, a health care compact between Texas and at least one other state would allow us to run our own health and human services programs, to restore responsibility and authority for health care regulation to the member states (except for military health care, which will remain federal), and provides the funds to the states to fulfill that responsibility. It’s imperative that we try.

In Texas, health and human services spending is increasingly crowding out other priorities such as public education and transportation.  For example, in 1989, 22.2 percent of the state budget went to health and human services programs, while 12.3 percent went to transportation.  In 2010, health and human services consumed nearly 40 percent of the budget, while transportation accounted for just over six percent of the state budget (according to the Texas Comptroller’s Texas Net Expenditures by Function data). 

While these numbers are troublesome, future projections are truly cause for alarm.  In the decade after the federal Patient Protection and Affordable Care Act takes effect (assuming the Courts don’t strike it down or Congress neither repeals nor defunds it), the new law is expected to add an additional $27 billion dollars in state Medicaid costs as an average of 2 million people go onto state health care plans each year for ten years. 

Texas residents send tax dollars to Washington, but they come back with strings attached, often requiring that we spend even more money in pursuit of failed program goals.  But the radical and historic federal health care legislation not only places an unprecedented financial burden on Texas.  It also prohibits us from regulating for ourselves the most effective and efficient health care policy for our own residents.  Federal “maintenance of effort” requirements prevent Texas from making any meaningful reforms to arrest the growing Medicaid price tag.

Medicaid is just one of many examples of federal micro-management of state affairs, and the budget deficits being borne by Texas and other states is proof-positive of the harm the federal government does by intruding against states’ authority. 

Furthermore, Medicaid is a one size fits all approach to indigent health care, yet the fifty states are each varied and unique.  Why should Texas have the same health care program as Vermont when our demographics and geographies are so different?  States have different needs and different resources, and they should be free to innovate.  States, after all, are laboratories of innovation, and if freed from federal health care regulation, the states will develop solutions that provide better care for less money.

Senator Nelson, R-Flower Mound, represents Senate District 12, which includes portions of Tarrant and Denton counties.  She is Chairman of the Senate Health & Human Services Committee.

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