State Policy Network
“People’s minds are more open today than they were six months ago, and I think there’s an opportunity for every state think tank in this country to make ground on healthcare policy.”

Q&A: Russ Walker

The unprecedented coronavirus pandemic has radically transformed the healthcare industry and the way Americans receive care. It also moved the focus of conversation from health insurance to healthcare supply. We sat down with State Policy Network senior policy advisor Russ Walker to get his thoughts on how the coronavirus has shifted the focus of the healthcare debate, expanded opportunities for state think tanks, and what’s next for SPN’s Healthcare Working Group.

Russ is a senior policy advisor at State Policy Network, where he heads up SPN’s Healthcare Working Group (HCWG). The HCWG provides a platform where state think tanks collaborate on ideas for state-level healthcare reforms, share best practices, and serve as a voice for states in DC and across the 50-state Network.

Russ Walker

SPN: From a policy standpoint, what went through your mind when the coronavirus started to spread?

Russ: The United States was looking at, initially, potentially millions of deaths and an overwhelmed hospital system. This question drove our discussions in the HCWG: What policies will alleviate the current crisis and provide the best healthcare possible to Americans? It just so happens that those policies are the same free-market solutions we’ve been promoting for decades.

The pandemic gave us this great opportunity to reevaluate what we refer to as legacy programs. Legacy programs are healthcare policies that have been in place for a long time. Take certificate-of-need (CON) laws, for example. These laws require healthcare providers to get permission from a regulatory body and prove the community needs the planned services. CON laws limit the amount of hospital beds available. Several governors issued executive orders that suspended these laws to make sure beds were available to the patients that needed them. Many of these legacy programs were temporarily repealed during the crisis to expand access to care.

SPN: Why did it take a crisis to repeal these legacy programs?

Russ: I think special interests are a problem across the board in America. We have entrenched special interests that are good at influencing politicians to maintain the status quo—for good or ill.

Scope-of-practice reform was one of the policy changes we encouraged and several states passed. We encouraged policymakers to allow healthcare professionals to practice at the top of their licensing, instead of the bottom. That can cut costs for consumers and alleviate physician shortages. If there’s a medical service a nurse practitioner can provide that’s well within her scope, but she’s not allowed to do so because of some law—that doesn’t make any sense. Special interests keep those laws in place.

Another example is telehealth. In many states that allowed telemedicine, there was a law that would require a patient to meet with a doctor in person before they could use telehealth. It’s an unnecessary regulation that creates additional costs for the patient. It’s often a special interest that wanted that regulation in place.

SPN: Why has the conversation always focused on insurance, rather than supply?

Russ: I’m not sure when the conversation started to focus solely on insurance, but it’s been about insurance for a long time. The discussion has centered on making sure people are insured, when really what people want and need is access to affordable healthcare. Insurance doesn’t guarantee access. If there are not enough doctors, you can have the best insurance in the world, but you won’t be able to get into the doctor’s office.

In the early stages of the crisis, we were looking at significant shortages of doctors, especially in places like New York. Licensing reciprocity was something New York granted by waiver just so they could get physicians in. There’s that famous picture that went viral of the nurses and doctors on a plane to New York. That wouldn’t have been possible under the laws that existed in most states just six months ago. They had to provide waivers to make that possible. The whole discussion shifted naturally to a conversation about the supply side of healthcare. Those kinds of discussions lead to innovation. If we just talk about insurance, that doesn’t lead to any kind of innovation at all. Insurance reform isn’t going to improve healthcare.

In a time of a nationwide and global pandemic, more people were going to need access to doctors and medical professionals. How could states make that happen? SPN’s Healthcare Working Group offered five reforms states could pursue, including telehealth, scope-of-practice, and licensing reform. Many states adopted these reforms to improve healthcare supply and access in the pandemic’s early days.

SPN: Why are state think tanks so important in the healthcare debate?

Russ: If you represent nurses or physicians, your interest is whatever is in the interest of those nurses or those physicians. It’s not necessarily in the interests of the patients or improving access and costs.

State think tanks, especially when it comes to healthcare, occupy a different space. They are a third party disconnected from the financial incentives that drive some of these discussions. It’s why, for instance, state think tanks have always championed telehealth as a good solution. It improves access, it lowers costs, it’s more cost-efficient, and it improves access for consumers.

SPN: Why is a state-based approach so important to healthcare reform?

Russ: A one-size-fits approach to healthcare is never going to work. This has been a big problem, even in states. Some states impose regulations on rural areas that are built for an urban environment. You have these legacy laws that have been put in place over time, and they are not helpful in providing innovative healthcare delivery in rural areas. A great example is the rural hospitals that have been closing. They are closing because the regulatory model doesn’t work for rural areas. You have to change the regulatory structure to allow for the development of innovative models.

When you move further away from this top-down approach, you end up with more innovation. Healthcare functions better at the state level because it’s closer to the people and the healthcare professionals who deliver care.

SPN: What should state think tanks be doing to make sure these reforms stay?

Russ: It’s best that state think tanks make that case while there’s still this concern about a coronavirus resurgence. In responding to the pandemic, states advanced valuable reforms that allow all Americans to have access to affordable healthcare. Policymakers have realized that our healthcare regulations and approach to healthcare need to be reformed. People’s minds are more open today than they were six months ago, and I think there’s an opportunity for every state think tank in this country to make ground on healthcare policy.

Telehealth is a great example. The discussion about telehealth is so different now than it is was a year ago. Before the coronavirus, most Americans had never used telemedicine, and several states had laws in place that restricted access to the technology. The debate has completely shifted and so has public perception. Many people used telemedicine in the first few months of this outbreak because it allowed them to see a doctor remotely without fearing they would spread or contract the virus. My daughter-in-law was in my backyard on the phone with a doctor because she couldn’t get to the doctor in a traditional way. There are millions of Americans who had that same experience—and it was a positive one that allowed their needs to be met.

SPN: What’s next for SPN’s Healthcare Working Group or any states looking to make even more progress on healthcare reform?

Russ: Many of the pandemic-related reforms were tied to executive orders or waivers, many of which have expiration dates. For states, making these reforms permanent is the next goal in implementing long-term, beneficial changes to our healthcare system. The coronavirus has opened up several opportunities, but there are some challenges as well. The economic downturn is going to increase the Medicaid rolls, so there’s going to be a greater call for Medicaid expansion and “Medicare for All.”

Further, there are opportunities to re-envision the way hospitals function. Hospitals were hurt during the coronavirus. They didn’t see as many patients. Maintaining hospitals in rural America with the financial downturn is going to be tough, and there’s a lot of discussion in Washington about a hospital bailout. How do we make sure that, during this bailout discussion, we don’t reinforce old models that don’t work? We need to find new, innovative ways to provide hospital care in rural America. I think telehealth is a big part of this evolution. Much of healthcare policy is interrelated. You can’t have good telehealth unless you also have good licensing and scope-of-practice laws. You can’t have hospital reform unless you look at certificate-of-need laws.

As this crisis continues, SPN’s HCWG will continue to look for opportunities like these to strengthen our healthcare system and improve access for all Americans.

Categories: Interviews
Organization: State Policy Network