Trimming Red Tape Isn’t Just For Health Emergencies
The federal public health emergency prompted by the COVID-19 pandemic is set to expire in mid-April. Some states have already let their own emergency declarations lapse.
It’s about time. COVID-19 is no longer the crisis it was back in 2020. Living in a permanent state of emergency is unsustainable.
But that doesn’t mean we should go back to the pre-pandemic status quo. Many of the reforms enacted during the state of emergency — especially those that liberalized the healthcare labor market — deserve to remain in place.
For too long, overly restrictive government requirements have exacerbated our country’s shortage of healthcare professionals.
Nearly 84 million people live in federally designated primary care health professional shortage areas. That means there aren’t enough primary care physicians to meet patient needs within a given geographic area.
The shortage is only going to get worse. The Association of American Medical Colleges projects that the country will be short as many as 48,000 primary care doctors by 2034.
Historically, it’s been difficult for doctors to go where they’re needed — or provide care in other states remotely — because every state maintains its own system for licensing doctors. Applying for a license in a different state can be costly and time-consuming.
A doctor contemplating a move to a place where he or she would be in high demand might decide that it’s not worth the expense, the wait, or the trouble.
Thirty-four states participate in the interstate medical licensure compact, which offers an expedited pathway to a medical license in each of the states that are members. But several big states — most notably California and New York — are not among them.
Many states relaxed their medical licensing rules during the pandemic. The goal was to attract physicians to serve on the frontlines of the crisis — and to make telehealth a viable option across state lines.
No longer confined to a single state, a physician in Maine could now treat a patient in New Mexico using telehealth technology. The result was an astounding 38-fold increase in telehealth utilization across the country.
This relaxation of the rules effectively increased the supply of doctors — or at least allowed supply to better meet demand. Why wouldn’t we make a freer healthcare labor market our new norm?
The same logic applies to licensing restrictions for nurses. As with physicians, a nursing shortage is already undermining access to medical care. By 2030, the nation could be short more than half a million registered nurses.
Yet as a recent investigation by NPR found, states routinely take months to issue licenses to new nurses — a period during which these qualified healthcare professionals must sit idle, even as demand for their services rises.
Many states issued emergency licensing waivers during the pandemic. But many of those waivers have now expired.
To their credit, more than half of states have joined the Nursing Licensure Compact — an interstate agreement similar to the one for physicians that allows nurses licensed in one participating state to practice in all other member states. But many states — including New York, Nevada and Oregon — have yet to sign on.
To further increase the supply of labor, government officials can also relax scope-of-practice rules that restrict which tasks well-trained healthcare practitioners — including pharmacists, nurse practitioners, and physician assistants — can perform.
For example, about half the states impose some restriction on nurse practitioners’ authority to practice. That effectively reduces the supply of primary care, as NPs aren’t allowed to handle basic healthcare needs without the oversight of a physician. It’s an inefficient use of labor.
A more liberal healthcare labor market is one of the few silver linings of the COVID-19 pandemic. Over the last two years, we’ve learned that trimming red tape can significantly boost access to care. If policymakers re-impose pre-pandemic restrictions on the healthcare labor market, we could soon find ourselves facing a different kind of public-health emergency.
Sally C. Pipes is president, CEO, and the Thomas W. Smith fellow in healthcare policy at the Pacific Research Institute. Her latest book is “False Premise, False Promise: The Disastrous Reality of Medicare for All,” (Encounter Books 2020). Follow her on Twitter @sallypipes. Read Sally Pipes’ Reports — More Here.