By Greg George
Mackinac Center for Public Policy
Americans are good at breaking down seemingly insurmountable barriers. We’ve broken down barriers to travel with airplanes, self-driving cars and space exploration. We’ve eliminated barriers to communication with the smartphone and the internet. Where we struggle is with eliminating bureaucratic barriers — which we create ourselves.
These self-created barriers are typically considered necessary to protect public health and safety. More often, however, they serve as a way to protect existing organizations, infrastructure and personnel from competition. Dismantling bureaucratic barriers has significant value, though, and we shouldn’t be afraid to eliminate barriers that do more to prevent competition than protect public health.
COVID-19 has revealed many bureaucratic barriers we’ve accepted as normal but shouldn’t, and some of those are in our nation’s health care system, making it harder for people to get the care they need.
Traditionally, conversations about health care access focus on insurance. Increasing access, however, is a twofold problem. One side of the coin is certainly insurance reform, which is challenging and often divisive. On the other side is improving patient access to various primary care and behavioral health providers.
As an early response to addressing the COVID-19 emergency, nearly all states, in some way, temporarily suspended bureaucratic barriers to telehealth, as well
as state licensure requirements. Suspending these obstacles increased both in-person and remote access to much-needed medical professionals.
Since it is safe to suspend licensing and telehealth barriers during an emergency, states should codify the practice and make it permanent. Patients would benefit from increased access to new providers and virtual visits.
The education, training, scope of practice and licensing requirements for health professionals across the country are largely standardized, making it safe for states to recognize professional licenses issued elsewhere. Acknowledging the licenses in good standing of out-of-state professionals would help states address shortages within professional specialties and in regions, giving patients new options for care.
States have taken steps to expand access, but the strategies have been varied. Some states have signed onto various licensing compacts that create a guided process for granting a license to providers, such as physicians and nurses, from other states in the compact. Some states have state-specific reciprocity agreements. These tactics haven’t been uniform, however, creating a complicated and costly patchwork for providers to navigate.
Reforms to telehealth laws, which can improve access to providers, vary by state, too. In fact, no two states are exactly alike. According to the Center for Connected Health Policy, 16 states limit where a person must physically be when receiving virtual services, and only 18 states provide reimbursement for secured electronic communications of medical information, such as pre-recorded videos, documents and images. Only eight states, the group reports, issue licenses related to telehealth that allow an out-of-state licensed provider to deliver services via telehealth.
Further limiting access, many states restrict the scope of practice allowed to nurse practitioners, physician assistants, behavioral health providers and pharmacists, thus restricting access to primary caregivers. Several states suspended some of these requirements in response to the COVID-19 pandemic. In my home state of Michigan, Gov. Gretchen Whitmer, through an executive order, suspended any regulations preventing nurses, nurse practitioners, nurse anesthetists and pharmacists from providing care within their education, training and experience. The governor acknowledged that this “saved lives.” But once the early surges of the pandemic subsided, she suspended her order, and business went back to normal.
All of these bureaucratic restrictions reduce access by limiting options for patients. They increase costs, wait times and driving distances to see a provider. Americans shouldn’t have to wait for a pandemic to see them removed. The loosened regulatory environment, which existed early last year, should govern the health care system every day.
Americans are ready to break down these barriers. Lawmakers just need to act.
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Greg George is the director of legislative affairs at the Mackinac Center for Public Policy.
