Research & Commentary: Interstate Health Care Compacts

Published May 29, 2012

While the Supreme Court considers the fate of the federal health care law, some states are attempting to take more control over health care by engaging in interstate health care compacts.

An interstate health care compact involves two or more states jointly deciding they want to select the health care system that is best suited for their states by placing the power to regulate health care with the states rather than the federal government. Engaging in a health care compact requires Congressional approval, but once made law, it trumps conflicting federal laws.

Opponents of interstate health care compacts argue they put entitlement programs and their participants at risk and could abandon guaranteed coverage of preexisting conditions.

Advocates, however, claim health care is better regulated by the states. Health care is too complex and too large for the federal government to give adequate attention to state-specific circumstances. States are better aware of their residents’ needs and their economic climate, and are therefore better equipped to assess which health care systems would be most effective and efficient.

An interstate health care compact would give states authority to challenge the progression of the federal health care law. Instead of a one-size-fits-all system, states would have the opportunity to choose what suits them best.

As stated by the Health Care Compact Alliance, “Some states may choose to promulgate all of their health care regulation at the state level. Others may choose to push authority and responsibility further downstream to the county level. The point here is that the health care compact will take the authority and responsibility for health care regulation from the federal government and move it, lock, stock, and barrel, to the states.”

As of February 2011, 37 states were contemplating an interstate health care compact, and 10 states already had introduced legislation to that effect.

The following documents offer additional information on health care compacts.

The Compact
The Health Care Compact Alliance explains the different elements of an interstate health care compact and how the structure strengthens state authority.

Georgia First State to Sign Health Care Compact Into Law
A press release from TKO Communications announces Georgia as the first state to make its health care compact legislation law.

Health Care Compact Shifts Power From Federal Government to States
Arlene Wohlgemuth, director of the Center for Health Care Policy at the Texas Public Policy Foundation, discusses how health care compacts increase state authority over health care.

An Interstate Compact: Serious Option or Political Gesture?
The South Carolina Policy Council explains the health care compact, its benefits, and what level of government is best equipped to handle health care reform.

Eric O’Keefe: Health Care Compact
In a podcast for Health Care News, Eric O’Keefe discusses the benefits of engaging in a health care compact.


Nothing in this Research & Commentary is intended to influence the passage of legislation, and it does not necessarily represent the views of The Heartland Institute. For further information on this subject, visit Health Care News at, The Heartland Institute’s website at, and PolicyBot, Heartland’s free online research database at

If you have any questions about this issue or the Heartland Web site, contact Heartland Institute Legislative Specialist Kendall Antekeier at [email protected] or 312/377-4000.