Emergency orders our newest emergency

by Keli'i Akina, Ph.D., President / CEO, Grassroot Institute of Hawaii

Hawaii desperately needs to fix some of the problems that have been bedeviling us for so long, such as the housing crisis and shortage of healthcare personnel. 

But there is a right way to do so and a wrong way.

The wrong way is for the governor to declare an emergency and unilaterally cut through all the regulations and legislative foot-dragging that sometimes make it seem virtually impossible to resolve a particular issue. That approach might be efficient in the short run, but it circumvents the legislative process, excludes public input and, because emergency orders are not permanent, is only a temporary fix. 

The right way requires the involvement of the Legislature. It might be slower, but it is constitutional, democratic and results in real, lasting change.

Nevertheless, various candidates for governor have said they would invoke a state of emergency to fix the state’s housing crisis. And earlier this week, the Healthcare Association of Hawaii asked Gov. David Ige to declare an emergency so he could waive the state's licensing requirements for certified health professionals.

HAH President Hilton Raethel told Hawaii News Now that the association requested the emergency proclamation “because our hospitals and other healthcare facilities are getting very stressed in terms of staffing.” This has been exacerbated by the fact that many people delayed care during the pandemic and are now having difficulty getting appointments, according to Community First Hawaii, an alliance of local healthcare providers.

It seems extreme, but the idea of using an emergency proclamation to change licensing requirements for doctors, nurses and healthcare staff isn’t unheard of. In fact, during the COVID-19 emergency, the governor allowed medical professionals such as physicians, osteopaths, nurses and physician assistants to work in Hawaii without a state license if they had been hired by a local medical facility. 

Under that order, all the facility had to do was verify that the medical professional in question had no pending disciplinary actions, lawsuits or insurance claims against them, indemnify the state and register with the state Department of Commerce and Consumer Affairs.

Of all the governor’s emergency actions during the pandemic, his order on healthcare licensing was among the most logical and least controversial. The mystery is why the Legislature failed to follow his example and reform or ease the licensing burden during the two uninterrupted sessions since the pandemic began.

It’s not as though we have just become aware of the the lack of sufficient healthcare professionals. For years, experts have warned about the state’s critical doctor shortage. Just this month, the Hawaii Physician Workforce Assessment Project estimated that Hawaii currently has a shortage of 1,008 full-time physicians, up from 820 in 2021.

Addressing that shortage requires a multipronged approach that involves everything from taxation of medical services to regulation and the cost of living. At the very least, the Legislature could have acted promptly to adopt the streamlined licensing approach of the governor’s COVID-19 emergency orders and made it permanent.

How? There are a couple of ways. Either create a pathway to expedite recognition of those who hold licenses in good standing from other states, or by join the interstate compacts that make it easier for nurses, doctors and other healthcare professionals to practice across state lines.

Unfortunately, too many lawmakers still believe that the key to solving Hawaii’s healthcare problems is to have more government involvement, not less. That’s why frustrated health advocates are now beseeching the governor to use his emergency powers.

I certainly appreciate their concerns. We need to make it easier for people to work in Hawaii, in the healthcare field as well as many other industries. The fact that Gov. Ige’s order on healthcare licensing proved to be safe and effective should be enough to allay concerns about the health and safety rationales behind licensing laws.

What we should not do is shortcut the legislative process and encourage the governor to abuse his emergency powers. Even when we agree with his aims, the governor is not — and should not be — a super-legislator. 

Not only are emergency orders a temporary solution, but encouraging further expansion of the executive’s power comes with worrisome consequences for our state Constitution and traditional balance of powers.

By all means, strip back regulations on healthcare, housing and any other activities where they have become a critical roadblock to improving our lives. 

But do it the right way, through the Legislature, with debate and public participation. 

E hana kākou! (Let’s work together!)