New Hampshire’s biggest problems, such as health care access and affordability, the opioid epidemic or the affordable housing shortage, are often so big because they’re bigger than our state. They’re really regional, if not national issues, so of course if we treat them as a state or local issue, they aren’t going to go away as we’d like.
At the same time, gridlock in Washington, D.C. makes the normal process for solving regional and national issues look increasingly hopeless. It doesn’t have to be that way. Lucky for us, the Founders left us a tool to reach a new “Goldilocks zone” that’s just right for solving our big problems: The interstate compact. Interstate compacts enable problem-solvers to take on thorny issues by pooling resources and know-how across state lines while at the same time bypassing dysfunction in Congress.
Interstate compacts actually predate our Constitution. Many of the first compacts were created under the Articles of Confederation and often dealt with resolving boundary disputes between states. Since then, they’ve evolved into a tool to help states coordinate but usually on mundane and uncontroversial topics like nursing licensure or port management. While not the most exciting, these examples show the potential interstate compacts have for solving bigger issues.
If an interstate compact can manage something as complicated as a port authority, why not a unified regional response to the opioid crisis and the shortage of addiction treatment capacity? Why not a multistate effort to save our struggling, rural hospitals from closure? Why not even to organize and efficiently fund universal, single-payer health insurance?
I mention single-payer because the New Hampshire House of Representatives actually considered an interstate compact bill, titled House Bill 353, to do just that. Let’s face it, New Hampshire is a small state that would have had a hard time achieving the economies of scale necessary for such a solution on its own. But imagine, instead, all of New England banding together to lead and inspire the nation by tackling uninsurance, under-insurance and spiraling health care costs all at once.
Solving big problems for small groups is expensive (especially without an income tax), but scaling solutions up to bigger groups is much less costly per person. Given the partisan control of the State House, HB 353 unfortunately didn’t get very far. But with the new year now upon us, the fact that we are more than halfway to the next election cycle is dawning.
For New Hampshire, 2024 is looking to be more exciting than most years, with Gov. Chris Sununu’s retirement putting the governor’s mansion into play. Control of the state legislature may be competitive, too. For those of us who want to see the state tackle long-standing problems more aggressively, there’s a lot to look forward to. But more importantly, there’s a lot to plan for. Successful legislative sessions, and especially successful interstate compacts, require early preparation and communication between legislators and advocates in interested states. There’s no reason that work shouldn’t start now.
Those who know their U.S. Constitution trivia may know that the Compact Clause requires congressional approval for compacts in some circumstances. This may seem daunting, but it’s not actually the issue it may appear to be. There’s not a lot of judicial precedent on interstate compacts given their low profile, but the guidance that does exist sets a rule quite favorable to problem-solvers at the state level. Congressional consent is required only if the compact would both increase state power while undermining federal power. This is a high bar, and no court appears to have ever thrown out a compact for violating this constitutional requirement.
Let’s consider the case of a hypothetical interstate compact where New England states came together to somehow support struggling, small, rural hospitals. These hospitals provide a key safety net to regions that would otherwise go without critical services like emergency rooms and maternity wards. Unfortunately, because rural communities are often lower-income, rural hospitals struggle to break even despite the essential work they do. The federal government does not lose any power if New England states were to save these hospitals from closure. If anything, this compact would complement federal power, given that there are also federal programs, albeit insufficient, targeted at the same goal. It’s frankly hard to imagine an interstate compact designed to tackle a thorny policy problem that would also materially weaken the federal government’s authority.
Given the unique opportunities they offer, it’s surprising that interstate compacts aren’t used for higher profile issues. Perhaps it’s because of an aversion to taking a states rights approach to change. Interstate compacts are, after all, a state right. But despite the charged nature of that term, it’s important to remember that state rights aren’t inherently conservative or liberal. They’re just tools that are available to those who choose to use them. Unfortunately, many past users have not had the common good at heart.
Smart policymakers will choose to use interstate compacts to make New Hampshire a better place for us all to call home, rather than let them rust away unused.
Opinion articles represent the views of their author(s), which are not necessarily those of The Dartmouth. Thomas Lane was an author of HB 353 in his capacity as a member of the steering committee at Granite State Physicians for a National Health Program. PNHP is a nationwide, nonpartisan organization that advocates for single-payer health reform.
This article was originally published by the New Hampshire Bulletin on Jan.4, 2024 at https://newhampshirebulletin.com/2024/01/04/interstate-compacts-are-new-hampshires-problem-solving-goldilocks-zone/ and is republished by The Dartmouth under a Creative Commons license.
Thomas Lane '24 is a former Opinion editor.
