Dating back to the Obama administration, conservatives have criticized the impulse to “never let a crisis go to waste.” In truth, the impulse is not always wrong.
Sometimes a crisis is a good time to address policy issues precisely because those issues would help alleviate the crisis at hand. This is certainly the case in the COVID-19 pandemic.
Health care workers are on the frontlines serving their fellow citizens, and these workers, and the resources on which they depend, are stretched very thin.
To help with this, governors around the nation are making some radical changes to their state’s medical regulations. As of April 2, Governor Kay Ivey issued an emergency order dramatically curtailing much for the red tape within the medical profession, namely allowing for licensed professionals from across the US and Canada to practice in Alabama, and freeing up both nurse practitioners and nurse anesthetists to work under less strenuous regulations in order to meet the demands of this crisis.
Writing in al.com in late March, state house Minority Leader Anthony Daniels also made a handful of proposals, many of which are among those taken up by Gov. Ivey in her executive order. When the dust settles on this crisis, one can hope that Rep. Daniels will lead his caucus in the fight to permanently eliminate the red tape that hampers medical professionals and creates a restrictive guild that upholds numerous barriers to entry for aspiring medical professionals and drives up health care costs for everyone involved.
Rep. Daniels unfortunately resorts back to a conventional policy preference when he calls for the expansion of Medicaid.
He is right to be concerned by the lack of health care access for rural Alabamians, especially as there remains the possibility that COVID-19 could severely impact these communities. Yet even if Medicaid expansion would provide the improvements to health care infrastructure that its proponents claim, those improvements would take a considerable amount of time to develop, and there remains the persistent question of how funding such a system might strangle the state’s already troubled finances. Moreover, while Medicaid can provide some immediate relief to those it serves, it creates a structure of perverse support that ultimately creates dependents instead of temporary relief for those in the most extreme need.
Instead of propping up such a system with a countless amount of tax dollars, Rep. Daniels and his colleagues should look to additional pieces of the governor’s order for guidance.
Beyond relaxing regulations on health care professionals, Gov. Ivey also ordered the Certificate of Need (CON) Review Board to provide temporary waivers in order to permit “new services, facilities, and other services” needed to fight COVID-19. This is a welcome development and one that should be a stepping stone towards the eventual elimination of the CON board. Unfortunately, nothing in Rep. Daniels’s list of recommendations takes this necessary step.
Ostensibly designed to make sure all areas of the state have adequate health care, the board holds the power to determine where any medical institution may be established. Any practice that would like to open its doors – any clinic, outpatient facility, or hospital – must have the approval of the CON board.
It’s hard to look at the dearth of health care options in the state’s rural regions without wondering if medical institutions are deterred by such a difficult approval process.
The ultimate problem with the CON process is the assumption that the board has the knowledge to properly judge the health care needs of any given community. Alabama is a relatively small state, and it’s true that much research can be done, but the people best suited to make this determination are the residents of a community, and the medical professionals who would serve them. Oversight from the CON Board only creates more complications which in turn drives up costs and limits access to care.
A recent study from the free market Mercatus Center indicates that Alabama would save on health care costs with the elimination of the CON: patients would save as much as $203 per capita, while physicians could save as much as $80 per capita. The elimination of the board would be one less barrier for providers who would then have an additional incentive to practice medicine in areas suffering from a shortage of care.
Doing away with, or at least curtailing, the CON board is an easy fix.
The increased need for care in the midst of a pandemic should remind all Alabamians that the ability to provide care should be as streamlined as possible. Bureaucratic institutions like the Certificate of Need Board not only limit access to care and drive up costs, they stifle innovation and slowly but surely contribute to the hollowing out of rural communities.
Sometimes politicians use one crisis to take on unrelated matters. Other times a crisis reveals the need for reform in order to better allow for society’s flourishing.
Governor Ivey was wise to loosen these restrictions, and the order for the CON board to issue waivers is an invaluable measure.
Unfortunately, the governor’s order is only a temporary measure. As this crisis fades and Alabama’s leaders return to the State House, they should make these changes permanent in order to provide unrestricted access to the medical care our rural communities desperately need.
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