State Policy Network
Spotlight on legislative sessions: States adopt reforms to improve access to healthcare for millions of American families

It’s March 17, 2020, and you turn on the news. The same headline flashes across every channel: America’s healthcare system may be ill-equipped to handle the growing surge of coronavirus patients.

As the days and weeks pass, you hear more about hospitals reaching capacity. They lacked ventilators, masks, beds—and even doctors. America’s medical system was overwhelmed.

That’s why states across the country passed policies that enabled our healthcare system to respond and fight the coronavirus head-on. These reforms removed certificate-of-need laws that restricted access to much-needed medical equipment, enabled nurse practitioners to treat patients, allowed Americans to use telemedicine, and removed licensing restrictions so doctors could practice across state lines.

More than a year later, several states—with encouragement from a Network of state policy organizations—are making these temporary reforms permanent. After all, a policy that’s a good idea during an emergency is probably a good policy outside an emergency too.

Below is an overview of the healthcare reforms passed during the state legislative sessions. These policy reforms will improve access to healthcare and lower costs for millions of Americans.


The Arizona Governor signed into law a first-in-the-nation telehealth reform developed by the Goldwater Institute that allows people to get help from their healthcare providers directly on their smartphones, computers, and landline phones. 


The Montana Governor signed a bill that allows medical providers to dispense prescribed meds directly to patients. The Frontier Institute played a role in this win and noted that prior to this bill, Montana was one of only five other states that prohibited doctors from dispensing the medicine they prescribe in most instances, requiring patients to make an additional trip to the pharmacy. The Wall Street Journal Editorial Board described this win as a victory for competition and commonsense.

In another big win for Montana patients, the Montana Governor signed legislation that protects medical entrepreneurs from being regulated simply for offering low cost memberships directly to their patients. The measure permanently authorizes Direct Patient Care (DPC) and sends a message to medical innovators everywhere that Montana is open for business. Frontierchampioned the bill from the beginning, promoting DPC as an innovative healthcare model where patients bypass insurance to pay doctors directly.

Montana also passed a law that repeals telehealth regulations permanently. The bill draws from recommendations in theFrontier Institute’s Montana Recovery Agenda to permanently eliminate regulations waived during the coronavirus outbreak which increased telehealth access and helped lower costs. Frontier noted thousands of Montana patients can continue benefiting from telehealth thanks to this bipartisan effort to remove unnecessary regulations.

Finally, Montana passed a law that repeals protectionist certificate-of-need laws. Frontiernoted this will boost market competition and help drive down healthcare costs in the state.


Mississippi passed a law that expands scope-of-practice for optometrists. Empower Mississippi noted the law will allow optometrists to examine, diagnose, manage, and treat conditions and diseases of the eye, something they are currently prohibited from doing.


The Nebraska Legislature unanimously passed a bill that makes pandemic emergency changes to telehealth regulations permanent. The legislation allows patients to receive telehealth services from the location of their choosing instead of being required to go to a hospital or clinic. The Platte Institute supported the bill and noted the Legislature should be proud to be one of the early states to reduce barriers to healthcare access.


House Bill 6 was signed into law, reducing unnecessary regulatory restrictions on pharmacists and allowing them to test for COVID-19 and administer COVID-19 vaccines. The Buckeye Institute recommended this reform as part of its Policy Solutions for the Pandemic series.


South Carolina expanded scope-of-practice for advanced practice registered nurses and podiatrists. This was a reform recommended by the Palmetto Promise Institute in their 2020 report, “The Palmetto Playbook.”


Tennessee passed certificate-of-need reform, which means hospitals in the state will no longer need permission from a state board before adding a bed or new service. For years, the Beacon Center of Tennessee has been encouraging lawmakers to repeal these burdensome laws. Beacon noted this reform will expand access to quality care for Tennesseans in need.

Tennessee also passed legislation authorizing unlicensed graduates of certain medical training programs to provide telehealth services as long as they adhere to the same standards for telehealth services that licensed medical professionals must meet.


The Texas Legislature passed a bill that allows the Texas Farm Bureau (TFB) to use its statewide infrastructure to provide health plans to members. The legislation will allow TFB to provide members with the option to purchase an affordable non-insurance health plan with extensive health coverage as a member benefit. The Texas Public Policy Foundation noted this program is an alternative to the Affordable Care Act, which has resulted in skyrocketing insurance premiums and high deductibles.


Utah passed a law that would no longer require nurse practitioners to be supervised to make prescriptions. Before this law passed, nurse practitioners could only make a prescription under the supervision of a physician or another experienced nurse. The Libertas Institute noted this legislation would expand the scope of who can prescribe medication, thus alleviating the struggle to obtain prescriptions. Utah also took an important step to expand scope-of-practice for physician assistants. The legislation will remove the requirement for a physician assistant to “maintain a relationship” with a physician. Libertas explained this will increase the ability to provide effective healthcare to underserved populations in Utah.

In addition, Utah passed a law that says if an individual needs mental health treatment, they can do it through telehealth so long as their current plan provides coverage for those kinds of services and the service being provided can meet the appropriate standard of care. Libertas noted this ensures that Utahns have multiple options available to access the medical services they need.


In February, Washington lawmakers introduced a bill to allow doctors and qualified healthcare providers in other states to treat Washington state patients online or by phone. Lawmakers also introduced legislation to ensure that insurance policies cover telehealth services provided by telephone or the internet, to serve people living in rural areas and small towns. In April, the Washington Legislature passed both bills and the governor signed them into law in early May. Increasing access to telemedicine was one of the Washington Policy Center’s 2020 Policy Guide recommendations


The West Virginia Governor signed expansion of telemedicine access for all West Virginians. The new law allows providers from other states to use telehealth to treat residents in the state and redefines telehealth to include audio-only phone services. The legislation also provides Medicaid payment parity.

Policy Issues: Healthcare
Organization: State Policy Network