All across the country, the Democrats have promised to fight various efforts from the White House and congressional Republicans to repeal the Affordable Care Act, and this task has been growing more complicated by the day. However, even if the law is repealed, with or without a certain replacement, progressives could still have recourse at the level of the state.
A widely used type of treaty between different states can permit them to come together and come up with their multistate health care programs to take care of the gaps that have been created by the federal government. During the age of retreating federal programs, tools in the form of interstate compacts can be used to enact a nationwide or a regional agenda.
Large states will have very little trouble replacing the Affordable Care Act, also known as Obamacare.
They can replace it with a state-run program made by their own. California has its population and resources to run its state healthcare exchange program, Covered California, from the region of Sacramento and can even get hold of the Medicaid expansion it has implemented under the ACA. In the north, states with a lower population like Washington and Oregon would try to do the same but with more struggle due to the absence of comparably sized economies.
However, if they join with California through an interstate compact, they can reap the benefits of the economy that is on the scale. In that way, they can save on costs with the help of the major size of bargaining power and enrollment pool.
The interstate compacts also allow individual states to maintain consistency in their established laws through coordination on a multistate level. They might not rival the power possessed by the federal government, but compacts could be the next best option for states which are facing the sudden cutbacks due to support from Washington.
The DC states can use them for the preservation of ACA-initiated programs or build new systems right from scratch. Presently, there are more than 200 active interstate compacts, and many of them are regional. In scope, 22 agreements are national, and each one of them addresses different issues facing the states. For instance, The Interstate Compact for Adult Offender Supervision oversees parole transfers along with probation between various states.
Meanwhile, the Gulf States Marine Fisheries Commission is roughly one of the two dozen compacts which are water-related, and they govern everything from fish stocks to the fair use of river basin in the adjoining areas.
President Trump has vowed that he will repeal the Affordable Care Act, but Sarah Kliff of Vox.com said that it is an overreach to say that the Republicans have a plan for what will come next. Kliff covered health policy for The Washington Post and also for POLITICO and Newsweek. She also co-hosts a policy-oriented podcast for Vox known as The Weeds.
According to Kliff, the ACA was a major win for the Democrats. They had this big thing on which they could cover millions of Americans with insurance. Meanwhile, the Republican side has always been rather unified in repealing the entire concept.
She thinks that it is a part of politics and that it isn’t good for the other side to have the program which covers 20 million people. There are actual policy concerns associated with the law. There are worries about premiums going up and also too few insurance plans available in the market.
According to Kliff, there is a philosophical disagreement regarding the role government will play in health care.