Missouri Becomes Latest State to Join Health Care Compact

On Thursday, Missouri became the latest state to join the Health Care Compact after the legislation became law without signature after Missouri Governor Jay Nixon allowed the bill to exceed the signing deadline.

The bill has been either introduced or drafted in 12 other states.  Oklahoma and Georgia have signed the compact into law.

The major hurdle state legislatures will have to overcome is in obtaining congressional consent.  To overcome this hurdle, the Health Care Compact may have to wait until there is a Republican majority Congress in order for the compact to become federal law.

In a recent Capitol Research brief, I wrote about the process of congressional consent and specifically about when consent by Congress is appropriate:  “Under the U.S. Supreme Court case of Virginia v. Tennessee, Congress must approve only two types of compacts: those compacts that alter the balance of political power between the state and federal government, or those compacts that intrude on a power reserved to Congress.  Thus, when a compact does not touch on either of those two items, the courts have ruled the federal government does not have a direct interest in the compact and congressional consent is not technically required. Essentially, if federal supremacy is threatened, then congressional consent is required for the compact to be valid. On the other hand, if federal supremacy is not threatened, then an absence of congressional consent will not render the compact invalid.”

Here, the compact will require congressional consent since the compact would potentially alter the balance of political power between the state and federal government and the fact that the compact is directly aimed at affecting current federal law, the Patient Protection and Affordable Care Act, the compact would seem to clearly warrant consent by Congress in order to be considered enforceable as federal law.