We Need an Emergency Declaration for Health Care

by Tom Yamachika, President, Tax Foundation Hawaii

Last week, I ranted and raved about our COVID-19 emergency proclamations, more than 20 of them, that finally ended on March 25, 2022.  Now we see in the news that the Healthcare Association of Hawaii wants the Governor to declare a state of emergency once again.

Here’s their reasoning, as KHON2 has reported.  Health care facilities across the state are in a pinch because 1,000 workers are out on any given day.  They are out because they either were exposed to COVID, tested positive, or are experiencing symptoms.  With so many workers out, it’s not always possible to discharge patients from hospitals to care facilities like nursing homes because the care facilities are not able to care for the patient adequately.  So, patients are piling up at hospitals and are stretching them to capacity.  This problem could be solved if the hospitals and other facilities are able to bring workers in from the mainland; however, with the current licensing requirements in place the workers won’t be able to work here until they get through a bunch of bureaucratic red tape.  The state of emergency could be used to bypass the licensing requirements and get the mainland workers ready for duty here, stat.

Licensing means that you need permission from the government to work in some industries here.  All states require licensing for some occupations, such as being a doctor or a lawyer.  According to a 2012 study by the Institute for Justice called “License to Work,” Hawaii “tops the list as the most burdensome state, with an average of more than $360 in fees, 724 days—almost two years—in education and experience and two exams, as well as grade and age requirements for the 43 occupations it licenses.”  In contrast, a 2017 study by the Wisconsin Institute for Law & Liberty, entitled “Land of the Free?  50 State Study on How Professional Licensing Laws Lead to Fewer Jobs,” Hawaii was identified as the least burdensome state in the nation for occupational licensing, at least over the occupations that study covered.

Licensing laws can help the public by giving some assurance that the person or business licensed is competent to do the job.  When we are talking about bringing in health care workers from other states, however, it’s not like we are dragging in just anyone off the street.  Doctors, nurses, physician assistants, and the like presumably would be licensed in the jurisdiction they are coming from.  Assuming that these workers are in good standing with their own regulatory authority, making them go through a bunch of red tape just to do temporary work here does not seem like a particularly efficient use of everyone’s time.  Our lawmakers should see if there is a relief valve that they can add to our current laws so that the system can respond to urgent needs without excessive bureaucratic delays.

But then again, the health care system here in Hawaii is suffering from a supply shortage as well as excess demand.  The University of Hawaii System Annual Report to the 2021 Legislature on the Hawaii Physician Workforce Assessment Project shows us that the physicians we have are moving away or retiring.  As local commentator Keli’i Akina argued in a 2021 op-ed published in the Wall Street Journal entitled “Hawaii Is No Paradise if You Need Medical Care,” high taxes contribute to a shortage of doctors while certificate-of-need laws keep market entrants away.  Our laws seem to say that we don’t need or want more health care practitioners, but our reality is otherwise. 

Maybe we do need a state of emergency declared.  We need to stabilize the patient and give ourselves a time-out necessary to fix this mess.  Then we need to plan a route to recovery – the University of Hawaii report has some ideas on how to do that – and we need to execute on the plan. 

Lawmakers, you might have some thoughts about doctors and the health care industry.  Maybe you think they make too much money and should be paying heavy taxes.  If you put that vision into law, you will find health care professionals buying one-way tickets away from here, somewhat like the situation now.  Then what happens when you need them?  A state of emergency?