As COVID-19 cases soar across the country, the federal government has lost control of the situation. Amid the Trump Administration’s happy talk and outright dismissal of the crisis, the U.S. is experiencing a forest fire of contagion and hospitalizations, and an upsurge in COVID-related deaths has already begun.
Many other advanced countries have controlled their outbreaks, which is why their COVID-19 infections and deaths have been minimal or trending downward in recent months. To replicate those nations’ strategies of testing, contact tracing and quarantining, the U.S. Congress would have to appropriate about $43.5 billion, according to one estimate. But as we know, Senate Republicans won’t pass such a bill without Donald Trump’s prior approval—and that’s unlikely as long as his main focus is on reopening the economy.
We can hope that electoral victory by the Democrats in November will change this equation, but Joe Biden won’t take office until January if he wins. Meanwhile, the coronavirus is chewing up America. We can’t afford to wait six months to blunt the impact of this horrible disease. However, there is a solution that doesn’t depend on federal leadership: states can form compacts that would form the basis for collective action to get us out of the trap we’re in.
Interstate compacts are very common in the U.S. Various pacts cover everything from clean water and clean air to medical licensure, mental health and interstate transportation. For example, under the Middle-Atlantic Forest FireProtection Compact, which includes Ohio, West Virginia, Virginia, Pennsylvania, New Jersey, Delaware, and Maryland, member states assist one another in fire prevention and suppression and firefighter training.
Altogether, there are more than 200 active interstate compacts. Twenty-two of them are national in scope and more than 30 are regional.
Article 1 of the U.S. Constitution specifically allows states to enter into multistate agreements for their common benefit. Congress doesn’t have to approve interstate compacts unless they would increase the states’ political power in a manner that would encroach upon the federal government’s power.
Such is not the case with the coronavirus crisis. If states joined together to fight the pandemic, they’d be fulfilling their mandate to protect the public health. While it might be argued that the federal government should be coordinating these efforts, collective state action would not trespass on that authority if Washington shirked its duty, as it is doing today.
New York Governor Andrew Cuomo pointed to the need for this collective action after New York’s COVID-19 crisis had passed its peak. Acknowledging that his state didn’t require as many ventilators as initially projected, Cuomo in mid-Aprilsaid he was sending 100 of the machines in the New York stockpile to Michigan, 100 to New Jersey and 50 to Maryland.
Now some other states are in crisis. Hospitals in Texas, Arizona, Florida and California are running out of ICU capacity as their COVID case counts continue to rise. Across the country, desperate measures are being considered or carried out, including triaging patients by their likelihood of survival. In the richest nation on earth, with one of the most extensive healthcare infrastructures, the idea of having to leaving some patients out in the cold is beyond crazy.
There are workarounds, of course. Some hospital wards can be repurposed as ICUs. Field hospitals can be set up in convention centers and parks, as they were in New York City. But all of this takes time. In the short term, neighboring states could enter compacts that obligate their hospitals to take some of the overflow of COVID patients if other states run out of ICU space. They could share ventilators and PPE, instead of bidding against each other for the equipment. States with lower rates of COVID infection could encourage some of their health workers to travel to more hard-hit states, as some clinicians did when New York was in need.
Beyond fighting the pandemic in hospitals, compact member states could also form learning collaboratives to find out which approaches to mask-wearing, social distancing, contact tracing and quarantining work the best. Moreover, they could pool their resources to scale up the requisite number of tests, as suggested in a recent New York Times op-ed.
If compact members wanted to go further, they could agree to require the wearing of masks in public places and/or follow the guidelines of the White House Coronavirus Task Force on reopening their economies. States that refused would be excluded from compacts that might help them cope with the pandemic.
All state governors are facing a common challenge—which is why they should cooperate with each other, regardless of their political philosophy. Those that reopened their economies too early have learned a painful lesson. Some of these states have had to pause their reopening schedules or are on the verge of new lockdowns. Whether or not their governors have recognized their earlier mistakes is open to question. Still, it’s clear that the only way to reopen successfully is to contain COVID-19 and maintain social distancing until a vaccine is available.
Interstate compacts are not a panacea. For one thing, the Senate still has not taken up the House-passed Heroes Act,which includes emergency funding of state and local governments. Without this money, the states would be unable to meet their obligations under compacts. Also, the compacts would be only a partial substitute for a rational, comprehensive national policy to combat COVID-19. For starters, the federal government’s help is still needed to provide adequate supplies of equipment for testing and treatment of patients and protection of providers.
For now, however, collective state action is desperately needed so that the states most badly hit by this pandemic can receive timely aid from the other United States.
Ken Terry is a journalist and author who has covered health care for more than 25 years. His latest book, Physician-Led Health Care Reform: A New Approach to Medicare for All, was recently published by the American Association for Physician Leadership.