1Authorizing the Commonwealth of Pennsylvania to join the Health
2Care Compact; providing for the form of the compact; imposing
3additional powers and duties on the Governor and the
4Secretary of the Commonwealth; and establishing the
5Interstate Advisory Health Care Commission.

6The General Assembly of the Commonwealth of Pennsylvania
7hereby enacts as follows:

8Section 1. Short title.

9This act shall be known and may be cited as the Health Care
10Compact.

11Section 2. Authority to execute compact.

12The Governor of Pennsylvania, on behalf of the Commonwealth,
13is hereby authorized to execute a compact in substantially the
14following form with any one or more of the states of the United
15States and the General Assembly hereby signifies in advance its
16approval and ratification of such compact:

17HEALTH CARE COMPACT

18PREAMBLE

19WHEREAS, The separation of powers, both between the branches

1of the Federal Government and between Federal and state
2authority, is essential to the preservation of individual
3liberty; and

4WHEREAS, The Constitution of the United States creates a
5Federal Government of limited and enumerated powers and reserves
6to the states or to the people those powers not granted to the
7Federal Government; and

8WHEREAS, The Federal Government has enacted many laws that
9have preempted state laws with respect to health care and placed
10increasing strain on state budgets, impairing other
11responsibilities such as education, infrastructure and public
12safety; and

13WHEREAS, The member states seek to protect individual liberty
14and personal control over health care decisions, and believe the
15best method to achieve these ends is by vesting regulatory
16authority over health care in the states; and

17WHEREAS, By acting in concert, the member states may express
18and inspire confidence in the ability of each member state to
19govern health care effectively; and

20WHEREAS, The member states recognize that consent of Congress
21may be more easily secured if the member states collectively
22seek consent through an interstate compact.

23ARTICLE I

24DEFINITIONS

25As used in this compact, unless the context clearly indicates
26otherwise:

27(a) "Commission" means the Interstate Advisory Health Care
28Commission.

29(b) "Effective date" means the date upon which this compact
30shall become effective for purposes of the operation of Federal

1and state law in a member state, which shall be the later of:

2(1) The date upon which this compact shall be adopted under
3the laws of the member state; and

4(2) the date upon which this compact receives the consent of
5Congress pursuant to section 10 of Article I of the Constitution
6of the United States, after at least two member states adopt
7this compact.

8(c) "Health care" means care, services, supplies or plans
9related to the health of an individual and includes, but is not
10limited to:

11(1) Preventive, diagnostic, therapeutic, rehabilitative,
12maintenance, or palliative care and counseling, service,
13assessment or procedure with respect to the physical or mental
14condition or functional status of an individual or that affects
15the structure or function of the body.

16(2) Sale or dispensing of a drug, device, equipment or other
17item in accordance with a prescription.

18(3) An individual or group plan that provides, or pays the
19cost of, care, services or supplies related to the health of an
20individual.

21The term does not include any care, services, supplies or
22plans provided by the United States Department of Defense and
23United States Department of Veterans Affairs or provided to
24Native Americans.

25(d) "Member state" means a state that is signatory to this
26compact and has adopted it under the laws of that state.

27(e) "Member state base funding level" means a number equal
28to the total Federal spending on health care in the member state
29during Federal fiscal year 2010. On or before the effective
30date, each member state shall determine the member state base

1funding level for its state, and that number shall be binding
2upon that member state. The preliminary estimate of member state
3base funding level for the Commonwealth of Pennsylvania is
4$47,448,000,000.

5(f) "Member state current year funding level" means the
6member state base funding level multiplied by the member state
7current year population adjustment factor multiplied by the
8current year inflation adjustment factor.

9(g) "Member state current year population adjustment factor"
10means the average population of the member state in the current
11year less the average population of the member state in Federal
12fiscal year 2010, divided by the average population of the
13member state in Federal fiscal year 2010, plus 1. Average
14population in a member state shall be determined by the United
15States Census Bureau.

16(h) "Current year inflation adjustment factor" means the
17total gross domestic product deflator in the current year
18divided by the total gross domestic product deflator in Federal
19fiscal year 2010. Total gross domestic product deflator shall be
20determined by the Bureau of Economic Analysis of the United
21States Department of Commerce.

22ARTICLE II

23PLEDGE

24The member states shall take joint and separate action to
25secure the consent of Congress to this compact in order to
26return the authority to regulate health care to the member
27states consistent with the goals and principles articulated in
28this compact. The member states shall improve health care policy
29within their respective jurisdictions and according to the
30judgment and discretion of each member state.

1ARTICLE III

2LEGISLATIVE POWER

3The legislatures of the member states have the primary
4responsibility to regulate health care in their respective
5states.

6ARTICLE IV

7STATE CONTROL

8Each member state, within its state, may suspend by
9legislation the operation of all Federal laws, rules,
10regulations and orders regarding health care that are
11inconsistent with the laws and regulations adopted by the member
12state pursuant to this compact. Federal and state laws, rules,
13regulations and orders regarding health care will remain in
14effect unless a member state expressly suspends them pursuant to
15its authority under this compact. For any Federal law, rule,
16regulation or order that remains in effect in a member state
17after the effective date, that member state shall be responsible
18for the associated funding obligations in its state.

19ARTICLE V

20FUNDING

21(a) Each Federal fiscal year, each member state shall have
22the right to Federal monies up to an amount equal to its member
23state current year funding level for that Federal fiscal year,
24funded by Congress as mandatory spending and not subject to
25annual appropriation, to support the exercise of member state
26authority under this compact. This funding shall not be
27conditional on any action of or regulation, policy, law or rule
28being adopted by the member state.

29(b) By the start of each Federal fiscal year, Congress shall
30establish an initial member state current year funding level for

1each member state, based upon reasonable estimates. The final
2member state current year funding level shall be calculated, and
3funding shall be reconciled by Congress, based upon information
4provided by each member state and audited by the United States
5Government Accountability Office.

6ARTICLE VI

7INTERSTATE ADVISORY HEALTH CARE COMMISSION

8(a) The Interstate Advisory Health Care Commission is
9established. The commission consists of members appointed by
10each member state through a process to be determined by each
11member state. A member state may not appoint more than two
12members to the commission and may withdraw membership from the
13commission at any time. Each commission member is entitled to
14one vote. The commission shall not act unless a majority of the
15members are present, and no action shall be binding unless
16approved by a majority of the commission's total membership.

17(b) The commission may elect from among its membership a
18chairperson. The commission may adopt and publish bylaws and
19policies that are not inconsistent with this compact. The
20commission shall meet at least once a year and may meet more
21frequently.

22(c) The commission may study issues of health care
23regulation that are of particular concern to the member states.
24The commission may make non-binding recommendations to the
25member states. The legislatures of the member states may
26consider these recommendations in determining the appropriate
27health care policies in their respective states.

28(d) The commission shall collect information and data to
29assist the member states in their regulation of health care,
30including assessing the performance of various state health care

1programs and compiling information on the prices of health care.
2The commission shall make this information and data available to
3the legislatures of the member states.

4Notwithstanding any other provision in this compact, no
5member state shall disclose to the commission the health
6information of any individual, nor shall the commission disclose
7the health information of any individual.

8(e) The commission shall be funded by the member states as
9agreed to by the member states. The commission shall have the
10responsibilities and duties as may be conferred upon it by
11subsequent action of the respective legislatures of the member
12states in accordance with the terms of this compact.

13(f) The commission shall not take any action within a member
14state that contravenes any state law of that member state.

15ARTICLE VII

16CONGRESSIONAL CONSENT

17This compact shall be effective on its adoption by at least
18two member states and consent of Congress. This compact shall be
19effective unless Congress, in consenting to this compact, alters
20the fundamental purposes of this compact, which are:

21(1) To secure the right of the member states to regulate
22health care in their respective states pursuant to this compact
23and to suspend the operation of any conflicting Federal laws,
24rules, regulations and orders within their states.

25(2) To secure Federal funding for member states that choose
26to invoke their authority under this compact, as prescribed by
27Article V.

28ARTICLE VIII

29AMENDMENTS

30The member states, by unanimous agreement, may amend this

1compact from time to time without the prior consent or approval
2of Congress and any amendment shall be effective unless, within
3one year, Congress disapproves that amendment. Any state may
4join this compact after the date on which Congress consents to
5the compact by adoption into law under its state constitution.

6ARTICLE IX

7WITHDRAWAL; DISSOLUTION

8Any member state may withdraw from this compact by adopting a
9law to that effect, but no such withdrawal shall take effect
10until six months after the governor of the withdrawing member
11state has given notice of the withdrawal to the other member
12states. A withdrawing state shall be liable for any obligations
13that it may have incurred prior to the date on which its
14withdrawal becomes effective. This compact shall be dissolved
15upon the withdrawal of all but one of the member states.

16Section 3. The Governor is authorized to apply, on behalf of
17the Commonwealth, to Congress for its consent and approval to
18the compact set forth in section 2.

19Section 4. The Governor shall not enter into any compact
20with a member state under this act until that state shall have
21passed a substantially similar act embodying the agreement
22between the two states as set forth in section 2.

23Section 5. The Governor shall publish the date of approval
24by the Congress of the United States as prescribed by section 10
25of Article I of the Constitution of the United States of the
26compact authorized by this act as a notice in the Pennsylvania
27Bulletin.

28Section 6. The compact authorized by this act shall become
29operative and effective upon publication of the notice provided
30for under section 5.

1Section 7. This act shall take effect immediately.