New licensure law major step toward better healthcare access in Hawaii

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By Keli’i Akina

State lawmakers handed Hawaii residents a great victory this week in the effort to improve healthcare access in Hawaii.

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Gov. Josh Green signed a series of healthcare-related bills on Wednesday — and one of those was SB674, which allows Hawaii to enter the Interstate Medical Licensure Compact.

Joining the compact will make it easier for doctors from the 37 other member states to obtain a license to practice in Hawaii, which will help ease Hawaii’s longstanding doctor shortage.

Keli’i Akina

The latest estimate is that Hawaii is short nearly 800 “full-time equivalent” doctors. Primary care physicians are most in demand, but the lack of certain medical specialists is so severe that patients from some areas in the state are forced to fly to Honolulu — or even the mainland — to receive the healthcare they need.

In other words, we have long needed a series of reforms targeted at improving healthcare access in Hawaii — and now that’s starting to happen. I commend the Legislature for passing SB674, and Gov. Green for signing it.

The Grassroot Institute of Hawaii actually had a big hand in getting SB674 across the legislative finish line. At the beginning of the year, we published a policy brief titled “How changing Hawaii’s licensing laws could improve healthcare access” that discussed the ways in which licensing restrictions contribute to our shortage of medical professionals and lack of access to healthcare in general.

One solution proposed in the report is that Hawaii should join one or more of the interstate licensure compacts that allow doctors, nurses and other medical professionals to more easily practice across state lines.

That line of reasoning struck a chord with Hawaii lawmakers, and two of them — Health Committee Chairs Della Au Belatti in the House and Joy San Buenaventura in the Senate — introduced bills based on model legislation proposed by the Grassroot Institute.

Both chambers supported SB674 almost unanimously on its way to the governor’s desk, and now that Gov. Green has signed it, physicians from around the country will enjoy an expedited path to licensure in our state.

Of course, simply joining the IMLC won’t solve Hawaii’s physician shortage by itself. But it could start a wonderful trend of removing the regulatory barriers that make it unreasonably difficult for other healthcare providers to practice in our state as well.

So what should our next steps be?

I suggest that Hawaii lawmakers explore having the state join other interstate compacts for medical professionals, such as the Nurse Licensure Compact, the Physical Therapy Licensure Compact, the Psychology Interjurisdictional Compact, the EMS Compact and the Advanced Practice Registered Nurse Compact.

At a minimum, Hawaii could create its own license recognition process or establish an expedited path to state licensure for medical professionals who hold valid licenses from states.

Lawmakers also should exempt medical services from the state general excise tax. As my Grassroot Institute colleague Malia Hill explained in another policy brief we issued early this year, Hawaii is one of only two states that tax medical services and the only state to tax services for TRICARE and Medicare beneficiaries.

Hawaii doctors have been saying for years that the GET — which is often not passed on to the patient — is a substantial overhead cost that makes it more difficult and expensive to practice.

Finally, our lawmakers should take a hard look at the regulations that prevent growth and expansion of healthcare facilities in our state.

It might be hard to believe, but Hawaii’s “certificate of need” laws require state approval for everything from new hospitals to the purchase of medical equipment or construction of new rehab centers.

While many states are now repealing their CON laws — in response to research showing that they limit healthcare access and drive up costs — Hawaii continues to enforce some of the strictest “need” laws in the nation. Clearly, there is more we can do to make healthcare in Hawaii more plentiful, responsive and affordable.

But for now, let us rejoice that Hawaii has taken an important step in the journey to a better healthcare system by joining the Interstate Medical Licensure Compact. I look forward to our lawmakers removing more of the barriers that limit healthcare access for Hawaii residents.
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Keli‘i Akina is president and CEO of the Grassroot Institute of Hawaii.

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Grassroot Institute of Hawaii is a nonprofit, nonpartisan research institute dedicated to the principles of individual liberty, the free market and accountable government. Through research papers, policy briefings, commentaries and conferences, the Institute seeks to educate and inform Hawaii's policy makers, news media and general public. Committed to its independence, the Grassroot Institute of Hawaii neither seeks nor accepts government funding. The institute is a 501(c)(3) organization supported by all those who share a concern for Hawaii's future and an appreciation of the role of sound ideas and more informed choices.

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