Let’s just acknowledge that providing health care, health care insurance, or retirement income are not parts of the federal government’s list of responsibilities. To get there you need to treat certain clauses extremely expansively, assigning them meanings far different from the way in which they were originally construed. Nonetheless, I have reservations about the argument being made by Texan Drew White at RealClearPolicy urging that the Children’s Health Insurance Program (CHIP) be abandoned to the states:
It’s true that CHIP may be slightly better than other federal programs such as Medicaid since it provides states with far more flexibility to administer the program. Moreover, households receiving CHIP benefits are routinely expected to share in some of the costs, and are typically better consumers of care than those enrolled in Medicaid. But CHIP is far from perfect. And with its reauthorization up for debate, Congress has the opportunity to go one step further and truly empower states and improve CHIP in the process.
First and foremost, CHIP should be a fully state-administered program, not a federal responsibility. The federal regulation of health insurance only drives up premiums, hinders market forces that reduce the cost of care, and perpetuates a cartel-like system between insurers and government that leaves patients with few options. If, instead, states had full control over this program with no federal strings attached — similar to a block grant of Medicaid — they would have the ability to tailor it to the needs of their own residents. This would improve health outcomes for the children enrolled in the program and lower total costs as well. States could use the resulting savings for any number of policy reforms, such as health savings accounts for lower income households or funding for state-based high-risk pools serving those with preexisting conditions.
The problem occurs when the states don’t fulfill their responsibilities. Without federal intervention Southern states would still have segregated schools if not segregated restrooms.
What’s the line of demarcation for federal action? I think there needs to be one but I’m uncertain about where it should be drawn or how it should be effected.
Reads to me that he wants the federal money but does not want to be told what to do with it. So, for example, Texas could take the money and tackle the public health emergency of poor marksmanship while another state decides the money is best used for preschool gender affirmation testing. In the meantime, Tommy’s compound fracture is being treated at a high cost to his family while little sister’s is withering away from undiagnosed Type `1 Diabetes.
The line of demarcation should be the 14th amendment followed by who signed the check. States are free to finance out of their budgets, their own indigent care plans.
I dunno. In 1792, Congress mandated healthcare be provided to sailors of US vessels above a certain tonnage or with a crew numbering greater than 10 at no cost to the sailors (cast accruing to to owners). (See https://memory.loc.gov/cgi-bin/ampage?collId=llsl&fileName=001/llsl001.db&recNum=257). Granted, the government wasn’t to foot the bill, but evidently the members of that Congress believed that the language of the Constitution, as they understood it, allowed for the federal government to have a roll in the provision of healthcare. Surely if anyone knew what the “original meaning” was, it was those guys. There were 20 framers in that Congress, and George Washington signed the bill into law. Later on, in 1798, the Congress imposed a duty on the master or owner of any ship entering a US port (20 cents per crew member) to go to a fund to provide healthcare for sailors. (See, https://memory.loc.gov/cgi-bin/ampage?collId=llsl&fileName=001/llsl001.db&recNum=728)
“The problem occurs when the states don’t fulfill their responsibilities.” It shouldn’t require an excess of imagination to guess which states wouldn’t under his proposal.
Dave, can you spring my comment from moderation?
I think that case fell within interstate commerce.
My personal view is that states need to heed whatever restrictions are written into the law that provides the money – otherwise, states can do what they want with the money, consistent with the usual constitutional guarantees. So, if the feds only want CHIP money spent in a certain way, then that restriction needs to be written into the law and/or appropriations bills.
In short, I see no reason why federal money should not come with strings attached. That is, after all, how the feds bully the states into compliance with policy that the feds have no actual authority on (for example, the now-defunct national highway speed restrictions and the 21 drinking age). But the feds need to clearly put those conditions into law.
Unfortunately, it seems that most laws these days give some broad guidelines or goals but leave it to the implementing agency to create rules that define any restrictions. This is another example of Congress shirking its duty and passing the buck. The rule-making process in this country is highly contentious, highly bureaucratic, highly politicized yet is invisible to most of the public.
I will acknowledge that we have an expansive reading of the interstate commerce clause, rather than a narrow one, but I will acknowledge no further.
However, I don’t see the point of states in modern life. Do we really benefit from a patchwork of laws and regulations? Do we see ourselves as South Dakotans or Americans? Do people in Eastern Washington have more in common with Seattle or rural Idaho?
As a rule of thumb, I would say we should weaken states wherever possible, pushing power either to the federal or local governments.
Gus,
States, IMO, suffer from benign neglect. They do, however, retain their sovereignty even if they choose not to exercise it. It’s easier for state governments to defer to the feds on contentious issues or, as I noted above, acquiesce to federal rules in exchange for money. States could choose to stop that if they wanted.
I think, for these reasons, states have been weakened in the mind of the American public, but there is a limit since the state remains the central political unit in our form of government. That can’t be changed without rewriting the Constitution.
Which specific powers and authority you would want to see ceded from state to federal/local control?
IMO the federal government is barely able to function as it is. Additionally, centralizing authority in the federal system makes all the things we hate about national politics worse….What benefit exactly, would centralization of political authority give us in exchange?
Finally, I do not want to give Congress, President Trump (and future Presidents) the authority to enact by fiat their flawed vision of what’s best for everyone. Frankly, there are already too many people in powerful positions who think they know what’s best for everyone and are all too happy to use what power they have to force their ideas down everyone else’s throat. No thanks.
Secondly, local governments only exist as the offspring of state government. IOW, states have complete sovereignty over local governments. States can disband local governments whenever they choose to do so – local governments have no authority except what is given to them by the state. So there is no mechanism to weaken states in favor of local government. At best states can grant local governments more autonomy, but that grant could be revoked at anytime.
Finally, most people will continue to consider themselves as Americans first as long as we are a united country with agreement on broad principles. But I suspect that South Dakotans will begin to see themselves as South Dakotans should their state prerogatives be seriously threatened.
There are no restrictions on the power of the federal government. De facto repeal of the 1st Amendment should make that abundantly clear for us. We do not have rights, we have privileges.
We do not have rights, we have privileges.
Try to convince the up-and-coming college students who seem to think otherwise.