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To Expand Access to Health Care, States Must Remove Unnecessary Regulations  

Feb 28, 2019 by AFP

For many Americans, seeking medical care requires over an hour’s drive to the nearest provider.

For some, this is a major inconvenience. For others, it can be life-threatening. Neither is acceptable.

These issues are commonplace in rural areas of the United States. While urban areas naturally attract more hospitals and more providers, there are steps states can take to ease the burden on their rural citizens.

Repeal Certificate-of-Need Laws

In 35 states and the District of Columbia, hospitals and other health care providers are saddled with onerous restrictions called certificate-of-need laws.

Suppose a hospital needed extra room to accommodate more patients and considered purchasing extra beds.

Simple, right?

Not so fast. The hospital must first ask permission from the government. What’s more, the government can deny the request if it doesn’t feel that the hospital has need of more beds.

How does it know whether a hospital needs more beds? It asks the hospital’s competitors.

Imagine applying this process to any other business. Should Samsung consult Apple before building another phone?

The result is that areas with already limited health care resources are prevented from solving problems by overzealous bureaucrats and self-interested competitors. The supply of care shrinks while costs for patients rise. And no one is protected by these laws — except, that is, for the monopolies established by them.

Repealing certificate-of-need laws would increase the supply of care available to Americans in rural areas.

Scope-of-Practice Reform

The United States has tens of thousands of health care professionals willing and able to provide care to patients. But many face barriers from administering services without the supervision of a physician.

Nurse practitioners, for example, are adequately qualified to provide a wide range of services. They are registered nurses with a masters or doctoral level of education and can provide primary and preventive care. Physician’s assistants are also licensed to diagnose illnesses and prescribe some medications.

One way for states to reduce the driving time for patients is to reform their scope-of-practice laws, allowing highly qualified providers to offer care to those in rural areas.

This solution would reduce the distance patients would need to travel for care.


For many elderly and disabled rural patients, travel can be impossible. As a result, many patients tend to neglect care, hoping their symptoms will simply go away, when they truly need a doctor.

Telemedicine is an excellent tool for fixing this problem.

Using internet teleconferencing, telemedicine brings the expertise and knowledge of health care professionals directly to the living rooms of the most remote populations. But the practice is riddled with local regulations that make it more onerous and much more expensive.

Some of these regulations prevent patients from teleconferencing with doctors they haven’t met before— which defeats the purpose of telemedicine. Some states require a nurse to be with the patient during the conference, which also defeats its purpose. This should be an option for a patient, not a requirement.

Removing these regulations would go a long way toward expanding care to remote communities.

What States Can Do

While many problems with the health care and health insurance industries can be solved at the federal level, we can’t forget how many state and local regulations exist that simply put care out of reach for many Americans, especially those in rural areas.

To increase access to care, states should consider these measures to make sure their most vulnerable populations can receive the care they need.