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Opinion: More work needed to expand access to health care
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Opinion: More work needed to expand access to health care

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While COVID-related news dominated coverage of the 2021 legislative session, Gov. Greg Gianforte and Montana’s legislature have quietly ushered in one of the most dramatic expansions of health care access in recent memory. Montana’s leadership should be commended for tackling our state’s chronic health care shortage head-on. Now the focus should be keeping the momentum going.

The legislature passed a Frontier Institute proposal this spring to repeal protectionist Certificate of Need (CON) regulations, which will help open more options for inpatient addiction care, home health care, outpatient surgery centers and more.

A Billings nursing home testified that repealing CON regulations would allow them to remodel their facility to provide residents with more focused care in private rooms, without having to wait for government permission. Previously, any expenditure over $1.5 million would trigger a CON review, a costly process that could last six months and require working through a long list of red tape. The nursing home said the regulations hadn’t been adjusted for over 30 years, since the first CON laws were passed.

By repealing CON regulations, Gianforte and the legislature are allowing health care providers the freedom to better serve their patients and broadly expand health care access without requiring government permission — all without spending a dime of taxpayer money. 

The legislature also followed this model with telehealth, voting unanimously to repeal numerous regulations that held back access, such as a law that prevented doctors from using old-fashioned, audio-only telephones to connect with patients. This regulation had been temporarily waived under emergency orders during COVID and as a result thousands of Montanans have since connected with their doctors using their telephones.

Reducing the red tape and burdensome regulations imposed on the health care system has proven an effective and cost-conscious way to expand access in Montana, but more needs to be done.

During COVID, Montana made the “the rapid licensure, renewal of licensure, or reactivation of licensure” a top priority. Emergency regulatory flexibilities allowed a streamlined process for medical professionals to remotely practice across state lines as long as they had a license in good standing in another state. Other flexibilities allowed doctors who had retired in the last five years to quickly reactivate their licenses. These reforms have helped Montana’s health care system overcome our longstanding health care shortages and rapidly add capacity when needed most during COVID.

Without action from policymakers, Montanans could lose access to health care when emergency orders officially expire. Once again red tape and paperwork will creep back into the picture, requiring out-of-state providers to become formally licensed in Montana to deliver telehealth and retired physicians to apply for a new license to practice after just two years.

To address this, Montana could consider following Arizona’s lead by making universal licensure recognition permanent, boosting access to telehealth across state lines for years to come. Another consideration may be to lock in flexibilities for doctors who retire here to continue practicing. Given Montana’s rising status as a destination for young people, it would also make sense to lower barriers for medical students to become licensed and practice in Montana. Numerous other states have done this during COVID by allowing a pathway for competent medical students in the end stages of their training to begin practicing early.

A health care provider from Whitefish I spoke with recently wistfully imagined Montana becoming an “oasis for health care” —  a destination for medical professionals and patients alike. By continuing to eliminate government barriers to accessing health care, that vision could become a reality.

Kendall Cotton is president and CEO of the Helena-based Frontier Institute. His column appears in print every other Monday on the Missoulian's Opinion page. 

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