In this post we’re going to look at the growing right wing “Health Care Compact” movement that would transfer Medicare from a federally run program to a state-run enterprise incapable of dealing with economic shocks (which isn’t very useful for a safety-net program). We’ll also take a look at what we can expect should the “Health Care Compact” come into force by reviewing Kansas’ recent Medicaid privatization schemes and the FBI investigations that have followed. And finally, we’ll look at the origins of the Health Care Compact. Hint: it’s the kind of plan that gets hatched when someone like Ted Cruz catches nullification fever.
When “God’s Senator”, Sam Brownback, became “God’s Governor” of Kansas back in 2010 it was clear some pretty big changes were on the way for Kansas. After all, when a GOP member of Opus Dei is your new governor, some form of austerity for the masses is probably in the cards. And sure enough, following the 2012 intra-GOP “moderate” purge, austerity for Kansas has arrived in full force. As once might expect, this includes the self-inflicted austerity that comes with refusing to accept the Obamacare Medicaid expansion. Just think of it as self-flagellation for Kansas. Utterly pointless, yet still painful and damaging, self-flagellation:
Hospital officials say refusal to expand Medicaid will hurt their bottom lines
Money needed to offset other cuts coming because of Obamacare
By Jim McLean
KHI News Service
Jan. 13, 2014
PARSONS — For Jodi Schmidt and other hospital administrators across Kansas, Medicaid expansion is a critical business issue not a political one.
Schmidt is chief executive of Labette Health, a 99-bed regional medical center that serves Parsons and several surrounding communities in southeast Kansas. She said the money being lost because of the decision by Gov. Sam Brownback and legislators to not participate in the first year of expansion could mean the difference between the hospital finishing the year in the black or with a deficit.
“Whatever your politics, the reality on the ground for hospitals is that Medicaid expansion is critically important for us,” Schmidt said.
Expansion could provide coverage to an estimated 85,000 Kansans who make too much to qualify for the state’s existing Medicaid program — called KanCare — but too little to be eligible for federal tax credits to help them purchase private coverage on the Healthcare.gov exchange.
A study done last year for the Kansas Hospital Association estimated that expanding eligibility to the level called for in the Affordable Care Act would increase federal Medicaid spending in the state by $3 billion between this year and 2020. The federal government has pledged to pay the full cost of covering the expansion population for three years and no less than 90 percent thereafter.
Expansion would provide Labette Health and other hospitals in the association’s southeast district an additional $2.7 million a year to share.
The money is needed, Schmidt said, to partially offset anticipated Medicare cuts and looming reductions in federal payments that help hospitals offset the cost of caring for the uninsured.
“We could be seeing an additional $1.7 or $1.8 million in reduced reimbursement next year,” Schmidt said. “And so this lack of Medicaid expansion is just one more hit and there is only so much individual hospitals can bear.”
Forty miles up U.S. Highway 59 from Parsons the story is much the same in Chanute. There, Dennis Franks, the CEO of the 25-bed Neosho Memorial Regional Medical Center, said the hospital needs the money that would come with Medicaid expansion to offset cuts in other reimbursements.
“When you live on the margin every dollar counts,” Franks said. “So, when I’m taking $700,000 to $1 million a year out of my budget that means there are services I can no longer provide. What am I going to do to make sure that I keep my doors open and do the things for this community that I need to do?”
Via Christi Regional Medical Center in Wichita may be the Kansas hospital most affected by the state’s reluctance to participate in the Medicaid expansion. Last year, it received nearly $13 million in so-called disproportionate share payments to help offset some of the costs of caring for the uninsured. Starting next year, those payments will be steadily reduced along with Medicare reimbursement rates.
Note that Wichita also happens to be the headquarters of Koch Industries, so this is the Kochs’ backyard that’s shooting itself in the foot while refusing insurance.
That prospect has put Via Christi at the forefront of an effort being mounted by the hospital association to work out a Medicaid expansion compromise with the Brownback administration and Republican legislative leaders.
“We’ve made some progress with the public and with some legislators in making the case for Medicaid expansion,” said Bruce Witt, director of legislative affairs at Via Christi. “We’re at the point now where politics has kind of come into play and that’s where the real challenge lies.”
Put simply, the challenge is getting Brownback and legislators to decouple the expansion issue from Obamacare, which remains anathema to the Republican Party’s base and unpopular with most Kansans, assuming the polls are accurate.
The hospital association has hired former U.S. Health and Human Services Secretary Mike Leavitt, a Republican who served in the Bush administration, to try to persuade Kansas Republican leaders to move forward with expansion using a private-sector approach similar to those being developed or implemented in Arkansas, Iowa, Pennsylvania and a handful of other states.
Witt said he is hopeful progress can be made if expansion advocates with Leavitt’s help can “engage the business community.”
“The Kansas Chamber, for example, has, at least, expressed a willingness to continue discussions about Medicaid expansion, particularly if it’s taking a more Kansas-based, private-market solution,” Witt said.
Mike O’Neal, chief executive of the Kansas Chamber, confirmed the business organization is willing to participate in such talks.
“I can’t predict at the end of the day whether that discussion will bear fruit in a way that the people who want the expansion are going to be satisfied,” O’Neal said. “But the discussion of an issue this important is healthy and it should take place.”
Both O’Neal and Senate President Susan Wagle, a Wichita Republican, have said they expect the messy rollout of the ACA will make the expansion discussion more difficult. But both said they would be open to Kansas pursuing a plan like the one Pennsylvania officials are seeking federal approval to implement.
“I’m intrigued by the Pennsylvania plan because it has a work component to it,” O’Neal said. “They are actually trying to change the profile of the Medicaid population and incentivize some that are in that population to get into a work situation.”
Approximately 45 percent of uninsured Kansans in the Medicaid eligibility gap are employed, according to the Kansas Health Institute, a nonpartisan research and policy organization that includes the editorially independent KHI News Service.
Yes, the proposed Medicaid expansion plan for Pennsylvania that has the Kansas GOP and Chamber of Commerce so intrigued was to make Pennsylvania the only first state to impose of work-search requirement (even though 45% of uninsured Kansans in the “gap” are already employed). So the swelling ranks of the long-term unemployed (that rarely ever find work again in the US economy) get keep swelling but at least they might have healthcare coverage as long as they continue looking for non-existent jobs. Pennsylvania’s governor has since watered down his work-requirement proposal while he awaits for federal approval so it remains to be seen if that will come into effect. But it’s a ruling states still suffering from Obamacare Derangement Syndrome are going to be watching closely and, as such, we should all probably watch how that develops too.
So might Medicaid expansion in some form still happen in Kansas this year of Pennsylvania’} plan gets approved? Nope! Not chance. Not, after God’s Governor signed a bill that strips the governor of the power to expand Medicaid in 2014 (even if he loses reelection in November).
Death Sentence For America Health Care Compact
But that doesn’t mean no changes are on the way for Kansas and a collection of other states that also have governors suffering from Bad-Samaritanitis: A multi-state “compact” is already in the works and Kanas just joined it: Kansas, along with eight other states that have refused to expand Medicaid, wants to create a “Health Care compact” that will allow these states to completely take over the management of Medicaid AND Medicare. So the states that are refusing to take on the responsibily of ensuring their residents’ basic needs are met, want a lot more responsibilty over those basic needs:
Brownback signs controversial health care compact bill
Goal is to give member states control over Medicare and Medicaid
By Dave Ranney
KHI News Service
April 23, 2014
TOPEKA — Gov. Sam Brownback has signed into law a bill that might make it possible for Kansas to join a compact of states that want the power to run Medicare and Medicaid within their borders.
The new law also creates the possibility that the compact states could circumvent several key provisions in the Affordable Care Act, also known as Obamacare.
“The Health Care Compact will allow states to restore and protect Medicare for generations to come,” Brownback said in a prepared statement today announcing that he had signed the measure. The actual signing was Tuesday.
The compact couldn’t come into being without approval by Congress, which is considered unlikely as long as Democrats control at least one of its chambers. Democrats currently control the Senate, and Republicans are pushing hard in this year’s elections to regain the majority. The GOP already controls the U.S. House.
Kansas Insurance Commissioner Sandy Praeger and AARP Kansas had earlier urged the governor not to sign House Bill 2553, calling the initiative frivolous and misguided.
‘Really twisting things’
In a statement released today, the governor accused Obamacare of “cutting $700 billion out of Medicare,” a claim being used by Republicans across the nation as they continue to fight the law and campaign for election. Politifact, a fact-checking project of the Tampa Bay Times, has labeled the claim a half-truth.
According to Politifact, the law doesn’t actually cut Medicare spending but is expected to reduce future growth in the program’s costs mostly by reducing Medicare Advantage, “a small subset of Medicare plans that are run by private insurers.”
“The governor is really twisting things,” said Dave Wilson, a past volunteer president of AARP Kansas.
Wilson also said he doubted Brownback’s assurances that he would oppose any reduction in Medicare benefits, if the compact were enacted and state officials gained control over Medicare, which currently is administered solely by the federal government.
“That’s what he says and that’s what legislators who support this say,” Wilson said. “But the reality is they can’t do it now, but with this bill they could do it and that could have a tremendous impact on seniors, on the disabled and on veterans.”
Federal offiicals run the Medicare program, which provides health coverage for seniors. But Medicaid, which serves poor children, the frail elderly and the disabled, is a shared state-federal program with the federal government paying the majority of its cost (about 60 percent) and imposing various basic requirements on the states.
But Medicaid also gives states significant latitude in the ways they manage the program, including the determination of eligibility standards. For example, Kansas operates its KanCare program with a waiver exempting it from many of the standard Medicaid rules. And Kansas also is allowed to keep thousands of people out of Medicaid who would qualify for the program in other states.
One of nine
Kansas is one of nine states that have enacted laws expressing the desire to join the so-called “health care compact.” The others are Alabama, Georgia, Indiana, Missouri, Oklahoma, South Carolina, Texas and Utah.
“All nine states that are now in this compact are states that have turned their backs on Medicaid expansion,” Praeger said. “On the one hand you’re saying you want to bring those federal (Medicare) dollars back to Kansas, but on the other hand you’re saying we’re not going to take those (Medicaid) federal dollars.”
It’s unclear whether Kansas seniors will support the governor’s decision to sign the bill, she said.
“If it ain’t broke don’t fix it,” Praeger said. “And the Medicare program, while it needs to rein in costs, is a reliable source of health care services for our senior population, and I would not want to be putting those folks at risk.”
Americans for Prosperity, a political action group tied to the billionaire brothers Charles and David Koch, has spent millions of dollars fighting Obamacare.
“Health care decisions should be made by Kansas officials, not the federal government,” said Jeff Glendening, state director of Americans for Prosperity-Kansas. “With Congressional approval, the Health Care Compact will transfer control of federal health care funding from Washington, D.C., to Kansas. It supports the state’s ability to control its own health care system.”
Glendening said the compact wouldn’t require the states to take over Medicare or Medicaid but would allow them the option.
“Under the compact, we can set standards and reimbursement rates rather than handing those important decisions over to the federal government,” he said.
‘Path out of Obamacare’
The Libertarian Party of Kansas also endorsed the new law.
“We believe in government at its most local level,” said Al Terwelp, chairman of the state party. “So we support the compact idea in general, having the state of Kansas be in as much control over health care issues as possible.
In the Legislature, the bill’s primary sponsors were Rep. Brett Hildabrand and Sen. Mary Pilcher-Cook, both Republicans from Shawnee and opponents of Obamacare.
“By signing the health care compact, the governor has agreed Kansas needs to protect Medicare for seniors, while also providing a path for Kansas citizens and businesses out of Obamacare, giving Kansans more economic stability, freedom and choices for their health care needs,” Pilcher-Cook wrote in an email to KHI News Service.
Uh oh! Kansas’ seniors (and Alabama’s, Georgia’s, Indiana’s, Missouri’s, Oklahoma’s, South Carolina’s, Texas’s and Utah’s seniors) might be in for quite the rude awakening, because the GOP’s “solution” to Obamacare appears to be the subversion of Medicare. Well, ok, that only happens if the GOP takes control of the Senate in 2014, but since that is a very real possibility….Uh Oh!
What Might God’s Governor do to Medicare? Let’s See…
Of course, if you take Brownback at his word, Kansans shouldn’t be concerned about an erosion of Medicare because, while Brownback and these eight other states really want to take over control of Medicare, Brownback have no plans on cutting the programs. Of course, if there’s recession in the future it doesn’t sound like Kansas will have a choice in cutting back Medicare, but we should probably ignore that for Sam’s sake. No, there should be no concern that the party that has made the demonization of the poor an ideological necessity (because otherwise “the market” can’t be the answer to all of life’s problems) might have secret plans in mind for gutting programs for the poor once they have the power to do so.
Then again, if you take Brownback at his word, you’re probably somewhat naive. Or maybe you’re a loyalist lobbyist working on privatizing Medicaid:
Saturday, April 26, 2014
Sources: FBI examines lobbying by Brownback loyalists
Parallel Strategies lobbyist David Kensinger, left, and partner Riley Scott, right, huddle in the Capitol during the 2014 legislative session with clients Mary Sloan and Ben Jones, who are with the Coalition Against the Death Penalty. The FBI is looking into Parallel Strategies.
By Tim Carpenter
The Federal Bureau of Investigation is exploring whether confidantes of Gov. Sam Brownback operated influence-peddling operations in Kansas pivoting on personal access to the Republican governor and top administration officials.
The Topeka Capital-Journal learned the months-long inquiry involves Parallel Strategies, a rapidly expanding Topeka consulting and lobbying firm created in 2013 by a trio of veteran Brownback employees who left government service to work in an environment where coziness with former colleagues could pay dividends.
Of concern to the FBI were behind-the-scenes financial arrangements related to Brownback’s privatization of the state’s $3 billion Medicaid program. The governor’s branding of KanCare handed to three for-profit insurance companies exclusive contracts to provide Medicaid services to 380,000 of Kansas’ disabled and poor.
Owners of Parallel Strategies, who also maintain separate individual lobbying firms, declined requests to discuss for this story emergence of their influential joint franchise, which includes on its client list the governor himself.
Parallel Strategies was founded by David Kensinger, Brownback’s former chief of staff and campaign manager and current director of the governor’s political organization Road Map Solutions; George Stafford, a longtime fundraiser, employee and adviser to Brownback; and Riley Scott, a senior staff member to Brownback while he was in the U.S. Senate and son-in-law of Kansas Senate President Susan Wagle, R-Wichita.
“Thanks for reaching out,” Scott said, “but I’m not interested.”
The FBI also has looked into activities of individual legislators and lobbyists unaffiliated with Parallel Strategies.
KanCare, launched in January 2013 and expanded in February, is arguably the most far-reaching reform of Brownback’s first term.
Kensinger was the governor’s chief of staff during formative construction of KanCare, but quit two months before contracts were signed with AmeriGroup Kansas, United Healthcare of the Midwest and Sunflower State Health Plan, a subsidiary of Centene. These contractors now employ as lobbyists one of Kensinger’s partners at Parallel Strategies, Kensinger’s former lobbying partner and a one-time Brownback deputy Cabinet secretary.
Questions center on whether Brownback representatives pressed companies or organizations to hire specific lobbying firms or whether entities that showed inadequate deference were targeted for political or financial punishment.
Make a note of this because it’s a key element of what the FBI appears to be focusing on: Brownback’s chief of staff during the “KanCare” overhaul, David Kensinger, quit two months before the contracts where signed related to the privatization of Kansas’ Medicaid program (the one Brownback doesn’t want to expand). And the three organizations that got that contract now employ, as lobbyists, three partners from Kensinger’s firm Parallel Strategies.
So that’s what the FBI is investigating. Well that and the K-Street-style form of retribution-based politics that Brownback brought to Kansas. More on that below.
Eileen Hawley, spokeswoman for Brownback, said she was unaware of an investigation by law enforcement involving Statehouse insiders. She asserted Brownback wouldn’t engage in unethical behavior as the state’s top elected official.
“He’s really one of the most honorable and ethical people I’ve met,” Hawley said. “I have a hard time believing any of these things were occurring in the governor’s office.”
It is unclear how far the federal investigation has progressed or whether evidence will materialize to warrant proceeding to court.
Joel Sealer, special agent with the FBI in Kansas City, Mo., said the agency’s long-standing policy was to decline public comment on topics of inquiries and targets of probes.
“Can I comment? No,” Sealer said. “I can neither confirm nor deny any type of investigation.”
K Street in Kansas
The election of Brownback in 2010 triggered realignment of Topeka’s political apparatus following eight years under Democratic Govs. Kathleen Sebelius and Mark Parkinson. Election night successes by conservative Republicans, according to one former Kansas GOP official, fueled an operational philosophy best captured by the phrase “to the victor belong the spoils.”
In 2012, Brownback’s red-state overhaul entered an advanced phase when he took a prominent role in a series of contested Republican Senate primary races. In a maneuver rare by Kansas standards, Brownback embraced a slate of GOP challengers and worked against incumbent Republicans opposed to pieces of the governor’s agenda. Ten Republicans seeking re-election were ousted.
“They’re ruthless,” said Steve Morris, a former Senate president who lost re-election to a GOP candidate backed by the Brownback machinery. “I served with (Govs.) Joan Finney, Bill Graves, Kathleen Sebelius and Mark Parkinson. None of them, to my knowledge, did that.”
Within days of the August primary, high-ranking members of the Brownback administration began informing political advocates that campaign contributions to moderates or Democrats would no longer be tolerated.
This message of financial loyalty was delivered in advance of a September fundraiser in Topeka headlined by Brownback. With the House already controlled by conservatives, the objective was to raise sufficient cash to elect 14 GOP candidates capable of bringing the Senate in line with the administration’s ideals. Lobbying firms were urged to demonstrate dedication to the cause by donating $500 to $1,000 to each highlighted general election campaign.
Political evolution in Topeka has been described during interviews with more than two dozen Republican, independent or Democratic lobbyists and political figures — most conducted on condition of anonymity due to their anxiety about possible retribution from allies of Brownback — as analogous to the infamous K Street in Washington, D.C.
This road-to-riches boulevard in the U.S. capital was a hub of activity among former government employees eager to exploit revolving-door access and Republicans in government who made it known they were in charge and expected future political investment to mirror that reality.
It’s worth recalling that Brownback was pretty familiar with how K-Street operated during his time in DC, so this attempt to recreate that kind of situation in Kansas is, to some extent, a “do what you love” form of leadership.
“That is the sinister part of the Brownback folks,” said Rep. Jim Ward, a Wichita Democrat. “They punish. They can make it very cold for you. I think that’s bad for democracy. At some point, it’s going to blow up.”
As it relates to KanCare, the three Medicaid contractors reinforced their lobbying operations by hiring individuals who are no strangers to Brownback.
Scott, a partner in Parallel Strategies, was added in January by United Healthcare. Gary Haulmark, a former deputy Cabinet secretary in the Brownback administration, resigned from state government in 2013 to represent Amerigroup. Sunflower employs Hickam, who ran a lobbying firm with Kensinger from 2004 to 2010.
“I believe it is wrong for people as closely connected to the seat of power to be in a position of lobbying for pay,” said former Sen. Dick Kelsey, a Republican who represented a district south of Wichita. “I still have a problem with the pay-to-play concept.”
Kelsey said Brownback officials had a political interest in tamping down complaints about KanCare until after the November election. There is an aggressive behind-the-scene campaign to minimize public criticism about denying access to treatments, placing administrative hurdles on providers delivering care, and to delaying payment of contractors.
At the same time, Kelsey said, the managed care organizations want to please the administration by hiring Brownback associates. It is a symbiotic relationship, Kelsey said, that hasn’t best served interests of clients.
Sen. Laura Kelly, D-Topeka, said enough uncertainty about the direction of KanCare existed to warrant a significant inquiry by the Legislature. She said producing an accurate assessment would require assurances that individuals and organizations coming forward wouldn’t be subject to retaliation for speaking out.
Kelly, who serves with Crum on the KanCare oversight committee, said the model for the Legislature could be the inquiry of the Kansas Bioscience Authority led in 2011 and 2012 by Wichita Sen. Wagle, who since then was elected Senate president. The KBA, a state-financed economic development entity working to expand agriculture, animal health and human health innovation, was the subject of a legislative review and a forensic audit that cost nearly $1 million.
“If the situation at the Bioscience Authority warranted an investigation, this situation does, too,” Kelly said.
Price of dissent
Individuals who have expressed criticism about KanCare said they were targeted by Republicans representing the legislative or executive branches of state government.
Rocky Nichols, executive director of the Disability Rights Center of Kansas, a nonprofit legal advocacy organization, was publicly rebuked in March by Angela de Rocha, spokeswoman for the state’s aging and disability services agency. The Disability Rights Center has for years criticized as inadequate the funding directed at disabled Kansans.
De Rocha said the Disability Rights Center haphazardly added people to disability service waiting lists in the past “without much attention to accuracy or detail in order to provide a soapbox” useful for Nichols to “score cheap political points.”
In response, Nichols said the Disability Rights Center has no role in adding people to the waiting list. Nichols said the outburst by de Rocha indicated a willingness to attach unsavory motives to the work of an organization attempting to advance public policy under the KanCare banner. Other nonprofit groups have experienced a similar backlash for speaking out, he said.
“We have heard from several advocates and providers that if you advocate and tell the truth — if the truth is unflattering to state government — often there’s some form of blowback,” Nichols said.
Yikes! K-Street for Kansas and the privatization of Medicaid? That doesn’t sound very senior-friendly. And this all happened without the Health Care Compact.
Ted Cruz’s Principled
Death Sentence For America Health Care Compact
But what exactly is this “Health Care Compact” that appears to open the door for some rather aggressive privatizations of Medicare too. Well, it’s an idea that’s been considered by a growing number of states in recent years as part of the national outbreak of Obamacare Derangement Syndrome:
Updated: 11:14 a.m. Friday, April 11, 2014 | Posted: 7:00 a.m. Friday, April 11, 2014
Ohio considers legislation to control its health care
By Michael D. Pitman
Ohio is one of 21 states that have introduced legislation to control its health care, which includes controlling federal dollars and changes that could affect health care in the state.
Legislation would allow states to join a federally created health care compact that would transfer the authority and responsibility to make health care decisions from federal control to the member states. So far, only North Dakota has failed to pass legislation through its statehouse to join, and three states — Arizona, Minnesota and Montana — have had their governors veto legislation. There are eight states with legislation approved by their governors, and Ohio is one of eight states with legislation still pending.
Recall that those eight states that have approved the legislation now includes Kansas, so it’s nine states so far.
Republican Reps. Terry Boose, of Norwalk, and Wes Retherford, of Hamilton, introduced House Bill 227 this past June, which would allow Ohio to be a member of the health care compact. The bill passed out of the State and Local Government Committee on April 2 by way of a 10-8 vote. The vote was down party lines, though Republican Bob Hackett, of London, voted with the Democrats. Committee member Rep. Matt Lundy, D-Elyria, said this bill is not right for Ohio.
“The proposal is so extreme and has such a negative impact on the health of our citizens that even Arizona Gov. Jan Brewer vetoed (a similar bill),” said Lundy. Arizona’s state legislature passed its version of the health care compact bill in 2011, but it was vetoed by the controversial governor who became criticized in the national media for signing Arizona Senate Bill 1070, known as the “show me your papers” law. The U.S. Supreme Court in June 2012 struck down key provisions of SB 1070 but upheld a provision that allows police to check a person’s immigration status in certain circumstances.
The governors in Montana and Minnesota exercised pocket vetoes by never signing the bills that passed each of their respective state’s legislatures.
Meredith Tucker, Ohio Democratic Party communications director, called the bill a “partisan stunt.”
“It’s sad that Ohio Republicans continue these partisan stunts when there are so many important issues facing struggling Ohio families,” she said.
U.S. Rep. James Lankford, R-Oklahoma, introduced House Joint Resolution 110 in February and has garnered support from 11 Republican congressmen, including Urbana Rep. Jim Jordan, who have signed on as co-sponsors. The Oklahoma Republican said this resolution is “a breakthrough governance reform that allows states to clean up the health care mess created by the federal government.”
“Those member states are then free to implement their own health care systems without interference from federal bureaucrats, using federal health care funds already collected and spent in their state,” Lankford said.
Because of their displeasure with the Affordable Care Act, commonly referred to as Obamacare, Retherford said he and several Ohio legislators felt it necessary to work to join the health care compact efforts. And besides that, he said health care is “an issue that should be taken care at the state level.”
“Washington, D.C., often has a one-size-fits-all approach but what works for California often doesn’t work for Ohio,” said Retherford.
Ohio’s bill is likely to be presented for a vote after the May 6 primary election, Retherford said.
As the House Republicans continue efforts to repeal the Affordable Care Act, the health care compact resolution could be part of the efforts.
“The president’s health care law continues to wreak havoc on families, local small businesses and our economy,” said Speaker of the House John Boehner. “The truth is you can’t fix this law — it needs to be torn out by its roots. Republican leadership will continue our work to replace this fundamentally flawed law with patient-centered solutions focused on lowering health care costs and protecting jobs.”
Lankford, who opposes the Affordable Care Act, said the compact does not conflict with efforts by state attorneys general, state legislators or members of Congress to repeal or modify the health care law.
“While we wait for this president and Senate Democrats to move beyond their intransigent support of this unworkable law, Congress can give interested states a way to solve their state’s health-care problems themselves,” Lankford said. “States that like their Obamacare can keep their Obamacare. The health care compact simply gives a state like Oklahoma the option to create a customized system that better meets the needs of Oklahoma families.”
As we can see in Ohio, the “Health Care Compact” appears to largely be part of the broader effort to gut Obamacare. Yes, if Obamacare can’t be reversed at a federal level, the Compact will allow states to simply ignore the law and ALSO take control of Medicare and Medicaid (for a thorough gutting).
And if this strategy leaves states with substantially less revenue for those programs in the future that’s fine too according to the GOP. Yep! And it’s been fine since at least 2011 because there are principles behind the initiative that the GOP is trying to uphold. They’re Ted Cruz’s “Tenther” principles, and nullification of health care is just one element of a much larger struggle to nullify progress:
Kaiser Health News
Some States Seeking Health Care Compact
By Guy Gugliotta
Sep 18, 2011
This story was produced in collaboration with The Washington Post
State governors and legislators opposed to the federal health-care law are eyeing a novel approach to escape its provisions: joining an “interstate compact” that would replace federal programs — including Medicare and Medicaid — with block grants to the states.
To date, legislation has been drafted or introduced in 14 states and brought to the floor by lawmakers in at least nine. Three Republican governors — in Georgia, Oklahoma and Texas — have signed the compact into law, while Missouri Gov. Jay Nixon (D) let the compact become law without signing it. Supporters say they hope to get 40 states to put it on the legislative calendar in 2012.
If a significant number of states pass the compact, supporters plan to submit it to Congress for approval in the same way that the body approves interstate compacts regulating commerce, transportation, and resource conservation and development.
States have never sought a compact to shield them from a whole area of federal law, let alone been granted permission to form one. Some state officials, including Republicans such as Arizona Gov. Jan Brewer who vetoed the compact, are worried that it would usurp their authority. Many others point out that joining a compact would disqualify their states from receiving automatic federal funding increases during hard times and prevent them from getting their fair share of the available pool of money.
Still, even if its prospects are more dubious than other methods of getting rid of last year’s Patient Protection and Affordable Care Act — congressional repeal, judicial challenge or a Republican presidential victory in 2012 — the compact has become a popular way for conservatives to highlight their opposition.
And compacts might receive even more attention now that Texas Gov. Rick Perry signed his state’s law July 18, just three weeks before he announced his candidacy for the Republican presidential nomination. The primacy of states’ rights over federal powers is a tenet of tea party Republicans whose support is key for candidates during the primary season.
For the original drafters, health care is only the first compact in a longer list that would include measures giving states broad powers to control banking, education and energy. “Our view is that a good policy made under bad governance will morph into bad policy,” said Houston businessman Leo Linbeck III, a key financial backer of the compact initiative. “Progress doesn’t mean centralizing power. Progress pushes decision-making power back to the people.”
Note that Leo Linbeck III comes from a family with deep pockets and a long history of supporting far-right causes.
Supporters Look To The Tenth Amendment
The health-care compact grew out of discussions and research conducted a year ago at the Center for Tenth Amendment Studies at the Austin-based Texas Public Policy Foundation, a conservative policy group. The 10th Amendment to the Constitution leaves to the states all powers not conferred upon the federal government.
“Founding Fathers like James Madison sold the Constitution to the individual states by predicting that the accumulation of federal power would never happen because the states were too strong,” said Mario Loyola, director of the Tenth Amendment Center. “The federal government now regulates virtually all of the things the framers said it would never regulate.”
Looking around for tools to reverse this trend, Loyola, a former counsel for the U.S. Senate’s Republican Policy Committee, and former Texas Solicitor General Ted Cruz, now a candidate for the U.S. Senate, hit upon the interstate compact, which Loyola said “held the promise of reestablishing a boundary between state and federal authority through a consensual agreement with Congress.”
Again, note that Ted Cruz was one of the originators of the Compact. Ted Cruz.
The history of compacts goes back to the colonial period, and more than 200 are currently in force. Many coordinate activities between contiguous states, such as the Port Authority of New York and New Jersey. Others, such as the Driver License Compact and the Wildlife Violators Compact, offer reciprocal recognition of laws and licenses in member states.
The Health Care Compact, however, is the first one that attempts to shield states from a whole area of federal law. It is four pages long and would replace the current federal health-care system with block grants to the states. The initial grants would be pro-rated on the basis of 2010 federal funding levels. Thereafter, allocations would rise to reflect inflation and state population increases. The compact would not apply to military personnel, veterans or Native Americans.
With this template in hand, the bill’s adherents formed the Health Care Compact Alliance late last year. Eric O’Keefe, chairman and chief executive of the conservative Sam Adams Alliance, is the Compact Alliance chairman, and Linbeck serves as vice chairman. O’Keefe said the Alliance has so far spent “not much more” than $1 million.
Late in 2010, O’Keefe won support for the compact from leaders of the Tea Party Patriots, one of the main tea party groups that have emerged across the country. Linbeck said “our big push” will come in early 2012, when he and O’Keefe are hoping that 25 to 40 legislatures may take up the bill. O’Keefe said he would prefer to have at least 15 states pass the compact before it is sent to Congress.
In its early days, critics denounced the measure as a reprise of the 19th century doctrine of “nullification,” holding that any state could ignore a federal law it did not like. Linbeck pointed out, however, that the Health Care Compact is not nullification, since it requires congressional consent.
Recall that “nullification” of federal law has been one of the GOP’s primary meta-themes in recent years, so while this Health Care Compact may have sounded pretty “out there” back in 2011 when this was first proposed, times have changed (somewhat) for the GOP! Sometimes it even includes nullifying local laws. That’s how much the GOP loves nullification these days (hint: that’s because it’s mostly about nullifying opposition to the oligarchs).
Drawbacks For States
Signing on has drawbacks for states. The compact cannot be amended unless all participating states agree to the amendment and resubmit the bill to their legislatures. For elected officials who want to put their stamp on their state’s laws, this can be a hard pill to swallow.
Also, if states were underfunded in 2010 at the federal level, they would be stuck there under the compact. “We have 3 million people in Medicare and another 4 million on Medicaid and CHIP (the Children’s Health Insurance Program),” said Anne Dunkelberg, associate director of the Austin-based Center for Public Policy Priorities, a think tank focusing on low- and moderate-income Texans. “Just now [in Texas] we’re $600 below the national average per person for Medicaid.”
And, Dunkelberg added, adherence to the compact would eliminate the guarantee of a federal match to state Medicaid spending, make a state ineligible for one-time entitlements such as the 2009 stimulus and cause states to lose access to automatic increases when enrollment goes up during a recession.
Did you see that last part? The Compact would cause states “to lose access to automatic increases when enrollment goes up during a recession” (see the fixed nature of the “Funding” section of the Compact). And if it turns out that this was a horrible idea, good luck amending it since you’d need all the members to approve! That’s just part of the anti-Obamacare fun on display with this Healthcare Compact idea and with Kansas signing on as the ninth state that idea could potentially become a reality, especially if the GOP takes control of the Senate this year.
So, putting aside Governor Brownback’s recent FBI investigations into Kansas’ Medicaid privatization schemes, isn’t it somewhat fascinating that we haven’t seen more of a unified strategy from the GOP in promoting the Compact on the national campaign trail? It’s an election year and opposition to Obamacare is still a central component of the GOP’s national electoral strategy. Plus, it’s very much in keeping with the “States Rights” theme the GOP has been pushing ever since Obama first took office. So why isn’t the Compact a bigger “theme” this year? Is it just bad timing?
Or could it be that the GOP’s lacks faith in the electorate? Don’t forget, the Health Care Compact proposal that Sam Brownback just signed requires Kansans to believe that people like Brownback won’t stab them in the back while gutting their Medicare. Is that a realistic hope? After all, opposition to Obamacare is relatively easy. You just have to say “I don’t like this or that about the program”, and people you’ll find plenty of people to agree with you. But, as many have pointed out, the GOP hasn’t really put forth any alternatives to Obamacare so far and that’s where the electorate’s faith in the GOP gets tests. And yet, there IS a GOP alternative to Obamacare: The Health Care Compact! It was even the brainchild of the GOP’s id!
So why aren’t we hearing “Compact” this and “Compact” that all over the campaign trail? Could it be that even the confused Kansans and others that have been supporting the GOP all these years – even when it’s clearly not in their best interests – are starting to realize that the party that’s waging a war on Food Stamps might also be interested in slashing Medicare given the opportunity? Slashing Medicare and Medicaid expenditures is part of the Paul Ryan budget plan so why wouldn’t it be part of the Compact too even if its advocates say otherwise?
Could the GOP be losing the “don’t worry, we won’t hurt you” credibility it needs to “sell” its plans to gut Medicare without alarming seniors? Championing the Health Care Compact on the campaign trail sure would raise some alarming questions in the voting booth for seniors. Could that explain the lack of enthusiasm for making this a national party platform? For example, if politicians and the oligarchs that fund them are trying to grab green eggs and ham and healthcare from those with the least, and then these same politicians start campaigning about sending Medicare powers back to the very same states with governors that are trying to gut Medicaid, doesn’t that raise the question of what else their hearts desire? Maybe that’s a question the GOP would rather not have to answer.