WASHINGTON D.C.: With the start of the new year, Fred Barnes, columnist and executive editor for The Weekly Standard, penned an article touting the concept of an interstate compact as one of the more effective and efficient ways in which states could oversee health care, rather than the federal government. Supporters of the Health Care Compact concept believe that it would create a better foundation for health care than the federal government can. Not only would the use of an interstate compact “reduce the scope of Washington’s power,” Barnes states, more importantly it would allow the states to “set the rules for health care from top to bottom,” rather the federal bureaucrats. 
An interstate compact is a contractual arrangement made between two or more states in which the assigned parties agree on a specific policy issue and either adopt a set of standards or cooperate with one another on a particular regional or national matter. Interstate Compacts are considered to be the “the most powerful, durable, and adaptive tools for ensuring cooperative action among the states.”  The reasoning for this belief is that, unlike federally imposed mandates, interstate compacts are neither bogged down with stringent bureaucratic requirements nor are they backed by empty funds from a centralized source. Although there are a variety of reasons for an interstate compact to be enacted, the cause for their popularity is two-fold – they afford states the ability to act jointly outside the constraints of the federal government while at the same time respecting the concept of appropriate joint action imposed by Congress.
Article I, § 10, Clause 3 of the United States Constitution, which states, “No State shall, without the Consent of Congress, lay any duty of Tonnage, keep Troops, or Ships of War in time of Peace, enter into any Agreement or Compact with another State, or with a foreign Power, or engage in War, unless actually invaded, or in such imminent Danger as will not admit of delay,” authorizes states to create interstate compacts. Thus far, no interstate compact has been struck down by the United States Supreme Court. The Political Consent Compact Clause Theory is the set standard by which the Supreme Court today bases its decisions regarding interstate compacts on. The crux of this argument is that determining “whether the compact contains a political subject affecting federal interests or the interests of non-compacting sister states, in which case congressional consent is required,” is the sole basis on which the constitutionality of such agreements lies. 
A far more important reason to back the use of an interstate compact in challenging federal health care reform, Barnes argues, is the level of clout it will create for states in staring down Washington D.C. Supporters of the proposal figure that at least twenty states will be needed in order for the compact to move forward. Given that at least that many states have joined in filing suit against the federal government over the “individual mandate”, which requires every citizen to purchase health insurance, this should not be a difficult hurdle to overcome.
Eric O’Keefe of the Sam Adams Alliance first broached the subject of utilizing the interstate compact in fighting back against the newly enacted health care measure with leaders of the Tea Party Patriots in October 2010. He then laid out his strategy before the national council of tea party activists in November, where the proposal received a standing ovation and resulted in at least 37 out of the 180 members in attendance registering as “state coordinators for winning legislative approval of the health care compact.”  Proponents of the Health Care Compact argue that the purpose of the interstate agreement is to return “responsibility and authority for the healthcare system to the states. It gets Congress and lobbyists out of the business of controlling the healthcare industry, and empowers states to create their own healthcare system. It keeps the tax money currently collected by the Federal Government and used to pay for healthcare in the state, creating greater accountability and more flexibility for each state government.”
The campaign for states to take up the idea of forming this multi-state agreement begins this month as a number of state legislative bodies convene for the first time this year. Large states such as Nebraska and Texas are among the first targets for the group.