State Policy Network
States ease healthcare licensing barriers to help Americans during the pandemic

Think back to March 2020. America’s healthcare system was overwhelmed. A record number of coronavirus patients pushed the nation’s hospitals and medical professionals to the brink.

Prior to the onset of the pandemic, the United State was already feeling the strain of a shortage of healthcare professionals. As hospitals across the country began to experience an influx of patients suffering from COVID-19, it became clear there weren’t enough medical professionals to treat them. As physicians and nurses were exposed to the virus, many were themselves sidelined with illness, further exacerbating shortages. Healthcare providers, especially in coronavirus hotspots such as New York and Washington, needed help—and fast.

Photo Credit: Southwest Airlines

You may remember a photo that went viral at this time. Southwest Airlines took a picture of a group of healthcare workers on a flight to New York to help with the coronavirus. What the picture doesn’t show, however, is that prior to the pandemic these doctors would not have so easily been able to go to New York for the purpose of offering additional medical care.

Why is that? Most states do not accept the out-of-state qualifications of professionals from other states, including those of experienced healthcare workers. Instead, many states require workers, including doctors and nurses, to go through a lengthy application process in order to re-license. During the early stages of the pandemic, as patients languished and hospitals were overwhelmed, it became clear that regulatory hurdles really were a matter of life and death.

In hotspots such as New York, hospitals didn’t have time to wait—they needed doctors and nurses right away. There wasn’t time to wait for doctors to go through the normal, slow, and burdensome licensing process. That’s why New York and numerous other states acted quickly to lift burdensome licensing rules in order to streamline the process.

States act quickly to ease licensing requirements, help our healthcare system respond to COVID-19

These actions at the state level allowed healthcare professionals, like those on the Southwest flight to New York, to practice in the state that needed their help. But states didn’t stop there. Several governors took other actions regarding licensing to make it easier for the healthcare system to respond to COVID-19.

The Texas Governor gave temporary licenses to nurses who were almost finished completing their certification requirements. This policy allowed more nurses to enter the healthcare workforce and treat coronavirus patients.

The New York Governor issued an executive order to allow retired doctors and nurses to reenter the workforce more easily. In one day, 1,000 retired healthcare workers signed up to help treat their fellow New Yorkers.

Other states expanded scope-of-practice so healthcare professionals could practice at the top of their profession. Scope-of-practice is a term for the types of services a qualified healthcare professional is allowed to perform. Nurse practitioners, for example, are trained and qualified to perform certain healthcare services, such as evaluate and diagnose patients, but sometimes aren’t allowed to do so without the supervision of a physician. Several states eased these scope-of-practice rules so nurse practitioners could use their training to help patients more quickly and efficiently. In addition to actions undertaken by governors, legislative models to expand scope-of-practice have also been introduced across the country.

As the Goldwater Institute pointed out, expanding scope-of-practice also helped with the vaccination efforts underway. Before the coronavirus, many states had laws in place that prohibited pharmacists from administering immunizations not yet approved by the FDA. The three COVID-19 vaccines, however, are approved for emergency use, but not fully FDA-approved. This means pharmacists were not allowed to administer vaccines, even though they are more than qualified to do so. Goldwater and other state policy organizations encouraged policymakers to ease this regulation and consider the critical role pharmacists will play in the vaccine rollout.

Naomi Lopez, director of healthcare policy at the Goldwater Institute, added: “These reforms, whether responding to the current crisis or as a matter of permanent policy, are helping to increase the availability of educated and trained healthcare professionals where they are needed most.”

Case Study: Arizona’s universal licensure brings more healthcare providers to the state

As more Americans are vaccinated and the strain on our healthcare system eases, there is an opportunity to reflect upon lessons learned from the rapidly-moving pandemic. In addition to the states that acted quickly to reduce burdens specifically on healthcare workers during the crisis, Arizona offers a unique case study of a state which took a more holistic approach to reform, benefiting medical professionals and workers of all kinds.

In 2019, Arizona passed a landmark law to recognize the out-of-state occupational licenses of skilled professionals from across the country. Designed by Goldwater and the Institute for Justice, this first-of-its-kind universal recognition legislation, allows professionals to apply for and be quickly granted a license to work based on their out-of-state qualifications. While the law makes recognition available to numerous occupations, its ability to streamline licensing processes for physicians and other healthcare professionals has proven essential during this time of national crisis. Since the law went into effect, more than 3,100 licenses have been granted. Among these were 200 physicians, more than 100 physician assistants, and more than 400 behavioral health specialists. At a time where more Americans than ever are facing risk to their physical and mental well-being, the ability of Arizona to quickly, safely, and efficiently approve the licenses of skilled professionals has proved invaluable in responding to the pandemic.

With help from the Goldwater Institute, states from coast-to-coast are working to ensure that healthcare professionals as well as workers of all kinds are able to more easily relocate across state lines. Sixteen states have now adopted a version of universal recognition to benefit military families and a broad range of professionals. Still more states are currently considering the reform, with more than two dozen states introducing a version this session alone. Most recently, Kansas and Mississippi passed universal recognition into law. Oklahoma quickly followed suit, enacting a version that offers a strong starting place for future reform.

The success of Arizona in easing licensing hurdles for all workers, including healthcare professionals, offers a case study for policymakers seeking to cut the kind of red tape that so often stands between workers and their right to earn a living. This is sound policy both in times of crisis and in normal times.

The coronavirus was a significant test for our healthcare system. The quick action by states to ease licensing barriers was essential to providing access to care and undoubtedly saved lives. Now, policymakers have the opportunity to make many of these reforms permanent, ensuring that states are well-prepared for the future, whatever it may bring.  

Additional Reading:

Spotlight on state legislative sessions: State think tanks work to improve job opportunities for American families
State Policy Network

Revitalizing America: A Legislative Guide to Recovering from Coronavirus
Goldwater Institute

The Goldwater Institute’s Guide to Universal Recognition
Goldwater Institute

Categories: Policy Solutions
Policy Issues: Healthcare
Organization: State Policy Network