It’s an early morning in March, and Americans are waking up and getting ready for the day. After brewing some coffee, many head to the office, and some drop their children off at school on the way. As the day progresses, people pack into restaurants for lunch. St. Patrick’s Day is around the corner, and many are making plans to celebrate.
On March 7, 2020, a death is reported in Washington state. The cause: a new virus that had reached the states from Wuhan, China. From that day on, normal life in America was upended. The president declared a national emergency, the stock market crashed, and the shutdown orders began.
Worried and panicked, Americans looked towards their elected officials for guidance and leadership. But many policymakers were unsure how to respond. Initial reports predicted 2.2 million US deaths from COVID-19. Our healthcare system would not be able to handle the influx of patients. There weren’t enough doctors, beds, or ventilators. Policymakers needed answers right away. With millions of American lives on the line, how could they make sure our country had enough healthcare providers, supplies, and facilities available?
Thankfully, state policymakers could look to a coalition of healthcare experts: State Policy Network’s Healthcare Working Group (HCWG). For more than seven years, the HCWG has championed innovative, state-level solutions that increase healthcare supply and reduce costs for Americans. The HCWG provides a platform where state think tanks collaborate on ideas for state-level healthcare reforms, share best practices, and serve as trustworthy advisors to policymakers across the states and in DC.
The HCWG hastened to get policymakers the answers they needed. The healthcare reforms that would give hospitals and doctors the tools they needed to care for patients were the same reforms the HCWG had been advocating for years.
The HCWG offered five solutions that states could pursue immediately to improve healthcare access for all Americans, including removing barriers that restrict the use of healthcare beds and medical equipment; fortifying and expanding the number of healthcare responders; and allowing more telemedicine options to keep patients safe from the disease. Since the pandemic began, 40 states have adopted at least one of the five recommendations. This success would not have been possible without the years of work the HCWG put into advocating for supply-side reforms and building relationships with local policymakers.
At SPN’s 28th Annual Meeting, SPN recognized the leadership and success of this Network coalition by presenting the 2020 Network Award to eight state think tanks from the HCWG. These organizations ensured our healthcare system was ready for the challenges brought on by the coronavirus:
In Ohio, The Buckeye Institute created a report outlining immediate actions Ohio policymakers could take to address the healthcare crisis. Buckeye shared its policy suggestions with key leaders in the state.
Ohio has since adopted eight of Buckeye’s significant policy recommendations, including: Increasing telehealth access and monitoring, extending universal occupational licensing reciprocity to doctors and physician assistants, and enlisting medical and nursing students to support doctors and nurses fighting COVID-19. Read more about Buckeye’s policy solutions for the pandemic here.
The Foundation for Government Accountability worked closely with many state think tanks across the country to help governors and legislatures navigate the uncertainty and assist states to make wise decisions on healthcare.
FGA Senior Fellow Josh Archambault noted: “In just two days, we developed a COVID-19 rapid response policy menu with 40 actionable solutions designed to tackle the new challenges facing our nation. By May, along with our partners, we achieved 71 COVID-19 policy victories through 44 executive orders that helped millions of Americans navigate the earliest stages of the pandemic.” See FGA’s full list of COVID-19 policy solutions here.
When the coronavirus started to spread, the Goldwater Institute released several policy reforms and a comprehensive state lawmaker toolkit to address the COVID-19 crisis. The toolkit included model legislation for several supply-side healthcare reforms.
Goldwater’s Director of Healthcare Policy, Naomi Lopez, observed: “Goldwater’s work is reflected in a number of the Arizona Governor’s executive orders and waiver authority. This includes waiving a scope-of-practice limitation on Certified Registered Nurse Anesthetists (CRNAs) in the Medicare program, allowing pharmacists to do emergency refills of maintenance medications for up to 180 days, allowing pharmacists to make hand sanitizer, expanding the use of telemedicine in the state’s Arizona Health Care Cost Containment System, allowing facilities to expand patient capacity, and the addition of liability protections for healthcare workers coming into the state to assist with the healthcare crisis.” See Goldwater’s insight and analysis on the coronavirus here.
Florida was an “early adopter” state that passed market-based healthcare reforms just before the crisis struck. Based on recommendations from the James Madison Institute (JMI), Florida policymakers repealed their certificate-of-need (CON) laws, expanded telemedicine, and reformed ambulatory surgical facility regulations to better reflect market needs. The state became a model for other states trying to figure out how to respond to COVID-19.
Sal Nuzzo, vice president of policy at JMI, added: “In 2020, just before the pandemic spread across the country, Florida showed the rest of the country that real policy reform is possible. The Legislature expanded the scope-of-practice for qualified nurse practitioners, allowed pharmacists to test and treat for routine conditions like flu and strep, and authorized automated pharmaceutical dispensing machines statewide.” Read JMI’s road map for the future of Florida here.
The Mackinac Center played a key role in advising the Michigan Governor’s office on healthcare policies to include in their executive orders and regulatory guidance. Even with a Democratic administration, the governor was receptive to their ideas.
The reforms included an expansion of telemedicine, scope-of-practice reform to increase the types of care certain medical professionals could provide, and a repeal CON laws to free up medical resources. “For the governor to take our recommendation and suspend all CON laws is extremely significant, not just because of the immediate impact it has for patients, but it sends a strong signal that this was bad policy to begin with,” said Lindsay Killen, vice president for strategic outreach and communications at the Mackinac Center. “We do know that prior to COVID-19, if Michigan had lifted its CON laws, we would have had approximately 4,000 more hospital beds in the state.” See Mackinac’s COVID-19 resources and solutions here.
When the coronavirus crisis began, the Mississippi Center for Public Policy (MCPP) used the expertise and experience provided by the HCWG to stand up against a very powerful medical lobby opposed to allowing out-of-state doctors practice telemedicine. MCPP able to force the Board of Medical Licensure to rescind monopolistic policies that were limiting access to care for Mississippi patients.
Jameson Taylor, vice president for policy at the Mississippi Center for Public Policy, added: “The HCWG has been a game-changing resource for me and MCPP. The group is a perfect marriage of ideas and action. In dialoguing about healthcare challenges and trends, we are able to imagine alternative innovative policies. As we implement these policies in our own states, we can identify what ideas actually work and improve upon them. Everyone in the group has something to contribute.
The Oklahoma Council of Public Affairs (OCPA) fought to reform Oklahoma’s healthcare system by increasing the supply of healthcare and expanding access, by promoting innovative deliveries of care including telemedicine and direct primary care practices, as well as encouraging price transparency.
OCPA Policy Research Fellow Kaitlyn Finley added: “As healthcare prices continue to increase in these uncertain times, Oklahoma families are often left worrying about how much their visit or surgery will cost them. It should not be a near impossible task to secure an estimate from providers. That is why OCPA will continue to encourage medical providers to provide a good faith estimate for their patients by supporting Oklahoma Senate Bill 1646. With this legislation if providers do not provide a good-faith estimate, they may not collect payment from services rendered.
OCPA believes patients should have the ability to see prices beforehand and find the best value for their care. Ensuring price transparency will lead to increased competition among providers and lower overall healthcare costs for all.” See OCPA’s coronavirus policy solutions here.
The Show-Me Institute is proud of its record of research that finds at its core a simple objective: to help people, not from the top down but from the bottom up. It’s why the Institute pushed hard in Missouri for the Volunteer Health Services Act in 2013, which tore down licensing barriers for volunteer medical professionals from other states, and why they concluded in their 2016 paper on license reciprocity expansion that “states do not have to wait for [an interstate compact] to emerge and should be willing to accept, unilaterally, the licenses of qualified medical professionals from other states.”
Patrick Ishmael, Director of Government Accountability at the Show-Me Institute, observed: “It was gratifying that to meet the 2020 coronavirus challenge, state officials adopted many of the supply side reforms that we’d advocated for years—including not only licensing reform and unilateral license reciprocity, but also the expansion of telemedicine and relaxation of scope-of-practice limitations. We’re excited for this progress and look forward to even greater health care policy gains in the months and years ahead.” Read the Show-Me Institute’s healthcare policies to fight COVID-19 here.
Congratulations to these organizations for advancing reforms that ensured America’s healthcare system was ready to respond to this devastating virus. Americans now have peace of mind that hospitals and doctors have the resources to care for coronavirus patients. Through the power of SPN and the states coming together, state policymakers were able to implement sound policies that expanded access to healthcare for millions of Americans.