The discovery and spread of COVID-19 shined a new light on many old problems — in particular, the laws and regulations standing in the way of treating and caring for patients.
Early in the pandemic, the Mackinac Center recommended fully suspending several of the laws as a way to increase access to qualified providers, increase hospital bed capacity, and bring the emergency under control. Gov. Gretchen Whitmer adopted many of our suggestions. Unfortunately, all of them have been reinstituted, despite Gov. Whitmer acknowledging the suspension helped “save countless lives and ensured our hospitals were fully staffed to care for COVID-19 patients.”
If these laws can be suspended to improve patient outcomes and save lives during an emergency, they should be permanently suspended.
Increasing the number of providers to treat patients and using their competencies to the greatest extent are a must during a pandemic. To do so, Gov. Whitmer suspended scope-of-practice restrictions on nurse practitioners, physician assistants, pharmacists and others that prevented them from fully using their education, experience and training. These restrictions, such as the requirement for nurse practitioners to have written collaborative practice agreements with physicians, contribute to primary care shortages by limiting access to essential providers. They also increase costs, wait times, and driving distances for patients.
Patients benefit when providers have full practice authority. Research has found no significant health differences and comparable patient outcomes between patients randomly assigned to either nurse practitioners or physicians, when NPs had the same authority and responsibilities as physicians. Research has also found that patients were more satisfied with NP consultations.
Another method to address shortages and increase access to providers is to recognize the licenses of highly trained health professionals from other states. In response to the increased need of providers during the initial surge of COVID-19, Gov. Whitmer suspended licensing restrictions that prevented professionals from other states with licenses in good standing from treating Michiganders without first paying for a Michigan license.
Those concerned about quality issues can rest assured, as the requirements for obtaining a state license in most health care professions are largely the same from state to state. Additionally, if this temporary reform were made permanent, health professionals would still be required to follow all Michigan laws, practice only within their scope, and register with the state. The federal Department of Veterans Affairs sets an example; it accepts individuals with a license in good standing to practice in any of its facilities, regardless of where they are licensed.
Adequate bed capacity is another requirement during a health emergency. Since Michigan health facilities are currently required to obtain a certificate of need, or CON, to add additional beds, Gov. Whitmer issued several executive orders that expedited the process to add bed capacity to treat COVID-19 patients. The state approved over 100 emergency CONs for facilities.
CON laws were initially enacted to control health care costs, but decades of research has found the opposite result. Because of how they are constructed, CON laws protect current providers from competition and are associated with reduced access to care, decreased health care quality and higher costs. George Mason University’s Mercatus Center found that eliminating our state’s CON laws would increase the number of health care facilities here and reduce total health care spending. For comparison, 12 states have no CON laws, and more than 20 states have fewer CON regulations than Michigan, including all surrounding Midwestern states.
For decades, these laws and regulations have stood in the way of putting patients first and have acted as buffers to adding natural competitive forces (and their benefits) into the health care market. The governor has maintained she would welcome “ideas on science-based solutions to protect public health.” In that spirit, we recommend making these temporary responses permanent, which will help our state respond to future emergencies and provide more access to affordable care under normal circumstances.