Patrick B. McGuigan
Stephanie Simmons is a Texan, a black Democrat, and a supporter of the health care compact as an explicit alternative to the controversial health care law Congress passed, and President Barack Obama signed into law, in 2010.
She is spokeswoman for a group called “Democrats for the Health Care Compact.” In an interview this week with CapitolBeatOK, Simmons applauded the Sooner State for becoming an ally of those advancing the compact approach to health care policy governance.
Only two states have enacted a health care compact, so far. Asked to sketch states where the issue is under serious consideration, Simmons said, “As you have reported, the health care compact has been signed into law in Georgia and Oklahoma. It has also passed the state House of Representatives in Montana, Missouri, Colorado, and Arizona. It has passed the Senate in Arizona and Missouri. Soon it will be introduced in Florida, Michigan, Ohio and Pennsylvania.”
CapitolBeatOK asked Simmons whether or not, with only two states engaged in the compact process, the mechanism could still be effective. She commented, “An interstate compact is a contractual agreement between two or more states where the member states can adopt standards or work in agreement on a policy issue that impacts them. It is arguably the single most powerful instrument for the collaboration and creation of cooperatives among states. So, there exists an actual healthcare compact now, but we certainly are working to increase the number of member states because there is power in numbers. There are currently over 200 interstate compacts in existence today.”
A native Texan, Simmons is an attorney, activist, and former political candidate (state Senate, 2008) who runs her own consulting firm in Houston.
Asked why she supports the compact, and how fellow Democrats have responded to her involvement in a policy initiative intended to provide a clear alternative to the federal health care law passed in 2010, she reflected, “The healthcare system is in a period of profound change. As healthcare reform tries to focus on the goals of rationalizing costs, improving quality, and enhancing access to care, it is also acting as the stimulus for fundamental changes in the structure of the American healthcare system.
“There needs to be a rapid development of new ideas and knowledge and the ability to move that information quickly to develop new organizational systems and concepts. It is recognition of this impending need that has garnered my support for the Compact. It is the most viable inroad to actively gain the attention of Congress and make our concerns known within our resident state. It is a nonpartisan effort to aid the country in overhauling this problem by looking at a root cause – governance.
“When you ask about responses from fellow Democrats, I can tell you that it has varied at the inception of the conversation, but has always garnered a healthy dialogue about what is happening with healthcare in this country. People, not just Democrats, are thirsty for honesty as it relates to this issue. They know that something is amiss within our healthcare system, and they are uncomfortable about what might happen; but, when we speak of the need to do more than just sit at home and wait to see if the President can hold on to the 2010 Patient Protection and Affordable Care Act, they understand that more changes are coming and more citizens must engage in the discussion.
“While some people might banter back and forth at home about what should or should not happen, if they are not engaged in the effort to make things better, then the gains of complacency will be few.”
As for how a compact would work in terms of process and impact on the health care system, Simmons – who has practiced insurance law for 13 years -- said:
“Let me begin by stating that we will seek Congressional approval of the Compact. Here’s why. Because this interstate compact will move control from the federal government to the states, such action will require the approval of Congress. While all compacts do not require such approval (largely because they do not affect federal authority), the Health Care Compact will.”
Supporters of the compact, she said, “desire to utilize the framework of the Constitution to gain the authority to regulate healthcare.”
She continued, “Here’s how it works. Those states that become member states will now have the opportunity to suspend the existing Patient Protection and Affordable Care Act once they have designed and enacted legislation for their own system. Member states in essence have a shield from the federal regulations (still applicable to non-member states) that allows them to have primary responsibility for healthcare regulation and create laws that will supersede the federal healthcare law.
“It is important to recognize that because this is a reform of governance, not policy, the Compact is silent on the design of a healthcare program to be adopted state by state. This is where citizens of a particular state have a huge advantage with the health care compact. By moving the responsibility to the states, a more accountable program can be designed based on the needs of the residents of the state, not the nation as a whole.
“Additionally, the state’s role may vary based on the needs, population, or design of their plan. Some states may implement a single-payer system, while others seek a hybrid, maintaining aspects of the federal plan. Whatever the policy solution is that a particular state chooses, the Compact will serve as the governing authority placing authority and responsibility for the regulation of healthcare with the member states.”
Advocates of the health care compact, including those in Oklahoma, point out that compacts have existed throughout American history. Simmons offered CapitolBeatOK several examples of compacts touching other areas of U.S. policy in which state compacts are operating constitutionally at the present time.
She noted, “The Interstate Agreement on Detainers is an interstate compact among all 50 states that provides a procedure for the transfer of a prisoner currently incarcerated in one state to be transferred to another state that will dispose of outstanding criminal charges in an effort to encourage expeditious disposition of charges where the length of a sentence is uncertain.”
She then pointed to a second example: “The Non-Resident Violator Compact requires member states (around 44) to suspend the driver’s license of those who get traffic tickets for moving violations in other states and fail to pay them. The compact is not supposed to include non-moving violations such as expired inspection stickers, equipment violations such as window tinting or parking violations. A member state may choose to voluntarily suspend a license of a person who does not pay an out-of-state ticket for an equipment violation such as a broken tail light.”
Perhaps the best-known existing compact is the famous (or infamous) tobacco litigation settlement. As Simmons explained, “One of the most prominent compacts to have gone into effect in the last decade is the Master Settlement Agreement (‘MSA’), under which forty-six states agreed to end their litigation against the four largest tobacco companies in 1998.”
Finally, “The Regional Greenhouse Gas Initiative (“RGGI”), which came into effect in September of 2008, originated as a response to federal inaction in the face of rising greenhouse gas levels. The RGGI obliges signatory states to implement a cap and trade arrangement for carbon dioxide emissions from power plants.”
Asked to give her reasons for joining advocacy for the health care compact, Simmons said, “The country is in need of a fundamental change in the way we as citizens respond to the urgency of today’s social issues. The world we live in today is not that of our parents or those before them. The connectivity between people (or lack thereof) has given rise to challenges to the intent of what was and the use of what is.”
Simmons continued, “Generations now have a diminished regard for historical meaning. As such, we need to be critical thinkers in how we move forward with the nation’s future. We need to see beyond the next ten years and act with regard to sustainability. This is a challenge. Healthcare is but one arena where attention to the future is approaching critical mass. I’m speaking out for generations I will never know, but will certainly be impacted by the times I live in.”
Despite the breadth of the exchange with Simmons, she was asked if CapitolBeatOK had left anything out of the “get acquainted” interview. The Texan replied:
“The President deserves credit for recognizing the urgency of healthcare reform and aggressively doing something. Unfortunately, politics will continue to undermine the greater good that should be served. I commend the President on getting the ball rolling, but bureaucracy will not serve the people of this country well. The HCC represents a way to provide sustainable healthcare for seniors, persons with disabilities, and the uninsured. It puts states in a position to create reform that is more responsive and more customized for its constituents.”
State Sen. Clark Jolley of Edmond and state Rep. Glen Mulready of Tulsa, both Republicans, were the leading advocates of Senate Bill 722, the legislation through which Oklahoma created the framework for a compact.
When she signed the legislation last month, Oklahoma Governor Mary Fallin told CapitolBeatOK, “The federal government should give states more flexibility to design and implement health care programs to fit the specific needs of their citizens.”
Fallin, who rejected state involvement with the federal health care exchange mandated in the federal law, said, “Oklahoma is joining the Health Care Compact Alliance with the goal of gaining the flexibility to implement a program that meets our state’s specific health care needs without onerous unfunded mandates from Washington.”
At the national level, the Health Care Compact Alliance describes itself as “a nonpartisan organization dedicated to providing Americans more influence over decisions that govern their health care.” Eric O’Keefe, a leader of the compact (www.healthcarecompact.org) drive, emphasizes the systems intended to be created within a compact are not prescribed. Rather, “Who and what is covered as well as the level of regulation are determined by each state after the compact is ratified.”
Reinforcing Simmons’ overview, O’Keefe’s alliance reports, “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.”