Health bill shows all is not lost

Are today’s elected leaders incapable of addressing public problems in a serious, respectful, bipartisan manner? If your answer is yes, I’ll concede that you have a strong case. Congress just enacted a sweeping reconciliation bill by the narrowest of margins, with no Democrats in favor. Neither party exhibits any serious intention to close our yawning federal deficits. Current and would-be officeholders seem more interested in talking up conspiracy theories than talking down political tensions or taking on tough issues.

But are our leaders incapable of effective governance? No. The recent passage of House Bill 67 demonstrates that in our state, at least, all is not yet lost.

North Carolina fares well across a wide spectrum of rankings, from tax burdens and economic freedom to business climate, public indebtedness, and the cost-effectiveness of our highway system. Alas, the same can’t be said for the cost-effectiveness of our health care system.

Rankings by U.S. News, WalletHub, and Forbes all rate North Carolina as higher than average in health care costs. Indeed, the latter tagged us as worst in the nation by this measure. Perhaps higher costs would be worth paying if North Carolinians got better care as a result, measured either in service quality or medical outcomes, but that does not appear to be the case. Outcomes are middling at best.

There are many potential explanations for this, and no shortage of proposed reforms from left, right, and center. I have strong opinions about most of them. They are not our present subject, however.

Today, I will simply point out that Gov. Josh Stein, a Democrat, and virtually all members of the North Carolina General Assembly, led by Republicans, agree that one factor driving up the cost of health care is a shortage of providers — and that one solution is to open up the labor market for medical services.

That’s what House Bill 69 will do. A package of licensure and scope-of-practice reforms, the legislation passed both legislative chambers unanimously in June (with a few members absent). Stein signed it into law on July 1.

“To keep our people healthy, we need to reduce barriers for well-trained physicians, physician assistants, and providers from other states to practice here more quickly,” the governor said, adding that the bill “strengthens rural health by allowing qualified doctors to deliver care in North Carolina communities, and it develops a health care workforce enhancement program in community colleges.”

One provision adds North Carolina to a compact of states offering a streamlined process for physicians already licensed to practice in one state to practice in another. Another provision offers a similarly expedited way for physicians emigrating to North Carolina from another country to practice here. The bill also expands the conditions under which psychological associates and physician assistants can deliver services, thus giving North Carolinians more ways to obtain affordable care.

Christopher Norman, president of the North Carolina Academy of Physician Assistants, described the bill’s passage as historic. “As our healthcare system evolves, it is essential that our policy reflects how healthcare is delivered in 2025,” he said. “These provisions strengthen our PA workforce — and improve access and outcomes for the patients and communities we serve.”

Don’t be misled by the bill’s overwhelming support in the General Assembly this year. Proposals to open up labor markets in health care have been hotly debated for decades. Some remain controversial.

Resistance to such reforms doesn’t just reflect inertia. Some health care providers worry that broadening the scope of practice or expediting licensure for professionals trained elsewhere will harm the quality of care for patients. Others worry that change will disrupt their own revenue streams and practices. The reason House Bill 69 made it into law, anyway, is that its proponents listened to these concerns and, as much as possible, included safeguards to address them without subverting the purpose of the bill.

That’s how constructive legislating works — when it works. Perhaps the folks in Washington should be taking notes.

John Hood is a John Locke Foundation board member. His books Mountain Folk, Forest Folk, and Water Folk combine epic fantasy and American history.