Rep. Paul Ryan (WI-1) released the GOP's budget for fiscal year 2012 this week, calling it the "Path to Prosperity." The budget's major components include:

• Reducing spending
• Welfare reform
• Health and retirement security
• Budget enforcement
• Tax reform

One of the key - and controversial - reforms that Ryan proposes falls within the welfare reform category. Ryan wants to convert the federal share of Medicaid spending into block grants, allowing states to free themselves of federal mandates and offer a variety of options, giving Medicaid patients more access to better care. The current system allows the federal government, mostly through unelected and unaccountable agency bureaucrats, to write the regulations and impose mandates on state governments that the people of the state simply cannot afford. That also means that the people in each state have little to no say in regulations that affect their health and their lives.

A superior approach that returns all federal funds to the states is being proposed in the Health Care Compact. A fundamental reform to governance, the Health Care Compact asks the question, "Who decides?" Moving the power to decide from the federal government to the state governments ensures that the answer is: you.

Interstate compacts have existed since before the Constitution was written, and the Founders believed compacts were vital to balance power between state governments and the federal government. Therefore, they included this concept in the Constitution itself. The Compact Clause is found in Article 1, Section 10 of the Constitution, and there are currently more than two hundred compacts operating today. In a nutshell, interstate compacts are contracts between states, and in some cases they impose on federal authority. In those cases, the compact must obtain approval from Congress, but Congress is not allowed to amend the compact. Rather, they must give it an up-or-down vote. There are around ninety compacts operating today that have received Congressional approval.

The Health Care Compact seeks to use the formal authority granted to the states by the Constitution to band together and demand that the federal government relinquish its hold over health care regulations. The federal government has proven that it cannot humanely or efficiently manage a complex health care system involving over three hundred million people with diverse needs. The Health Care Compact would allow each state legislature - a governmental body that is far closer and more accessible to the people - to utilize health care dollars in a manner that best suits the needs of the citizens of each state.

The major elements of the Health Care Compact are as follows:

• Pledge: Member states agree to work together to pass this Compact, and to improve the health care in their respective states.

• Legislative Power: Member states have primary responsibility for regulation of all non-military health care goods and services in their state.

• State Control: In member states, states can suspend federal health care regulations. Federal and state health care laws remain in force in a state until states enact superseding regulations.

• Funding: Member states get an amount of money from the federal government each year to pay for health care. The funding is mandatory spending, and not subject to annual appropriations. Each state's funding is based on the federal funds spent in their state on health care in 2010. Each state will confirm their funding before joining this Compact. This funding level will be adjusted annually for changes in population and inflation.

• Commission: An advisory commission is created to gather and publish health care cost data, study various health care issues, and make non-binding recommendations to member states.

• Amendments: Member states can amend this Compact with approval of the members, and no further Congressional consent is needed.

• Withdrawal: Any member state can withdraw from this Compact at any time.

Rep. Ryan recognizes that block granting Medicaid funds will permit state governments to manage Medicaid programs much more efficiently, keeping the program within the budgetary boundaries that every state faces. States cannot print money and most states have balanced budget amendments, so states cannot run deficits without employing some very well documented "gimmicks." This sort of change would beneficially alter the status quo, but Americans need more changes beyond block granting. Substantial governance reform is needed to make any real progress.

The Patient Protection and Affordable Care Act, signed into law last year, cemented into place an unsustainable and unworkable system, removing the last vestiges of power that people had over their own health care decisions. However, the Health Care Compact can turn that around, putting power back in the hands of the people, and allowing states to control their own budgets.