Testimony on HB2026: Yes to liberalizing EMS personnel licensure

The following testimony was submitted by the Grassroot Institute of Hawaii for consideration on Feb. 9, 2022, by the Senate Committee on Public Safety, Intergovernmental and Military Affairs and the Senate Committee on Health.

To: Senate Committee on Public Safety, Intergovernmental, and Military Affairs
      Senator Clarence K. Nishihara, Chair
      Senator Lynn DeCoite, Vice Chair

Senate Committee on Health
     Senator Jarrett Keohokalole, Chair
     Senator Rosalyn H. Baker, Vice Chair

From: Grassroot Institute of Hawaii
           Joe Kent, Executive Vice President


Comments Only

Dear Chair and Committee Members:

The Grassroot Institute of Hawaii would like to offer its comments on SB2026, which would enter Hawaii into the Emergency Medical Services Personnel Licensure Interstate Compact.

If this bill is enacted, the Legislature will take an important step toward addressing a significant problem that was made more evident during the COVID-19 pandemic: Hawaii’s inadequate supply of healthcare professionals.

It is well established that Hawaii is suffering from a doctor shortage. One study estimated that Hawaii is currently “short” by approximately 732 physicians, with the most severe shortages occurring in Maui and Hawaii counties. 

However, that shortage does not apply only to doctors. Across the state, and especially in rural areas, Hawaii is facing shortages of experienced health professionals, from primary care providers to nurses, specialists and staff.

Fixing the problem requires a multipronged strategy that will address everything from Hawaii’s high cost of living to the state’s regulatory scheme for healthcare facilities. Perhaps most important, however, is the need to reform licensing regulations for healthcare professionals.

One-fourth of all licensed workers in the U.S. work in healthcare. Those licenses can be difficult to obtain, are expensive and carry geographic or “scope of practice” limitations. 

In light of Hawaii’s shortages of healthcare professionals, restrictions on healthcare workers who already hold licenses in other U.S. states seem redundant and self-defeating. As the Federal Trade Commission noted in a report on occupational licensing portability:

There is little justification for the burdensome, costly, and redundant licensing processes that many states impose on qualified, licensed, out-of-state applicants. Such requirements likely inhibit multistate practice and delay or even prevent licensees from working in their occupations upon relocation to a new state. Indeed, for occupations that have not implemented any form of license portability, the harm to competition from suppressed mobility may far outweigh any plausible consumer protection benefit from the failure to provide for license portability. 

While occupational licensing is intended to protect the public, there is a point at which it can reduce the number of people in practice and increase costs without an appreciable public benefit. 

One study of licensing among medical professionals found that, “licensing is associated with restricted labor supply, an increased wage of the licensed occupation, rents, increased output prices, and no measurable effect on output quality.” 

This is where we can benefit from the lessons of the coronavirus situation. The governor’s emergency modification to state licensing laws demonstrated a need to embrace license portability, making it a simple matter for a healthcare worker licensed in another state to practice in Hawaii.

The interstate compact approach outlined in this bill would streamline licensing for EMS personnel, allowing qualified and licensed personnel from participating states to practice in Hawaii without having to overcome redundant regulatory hurdles. 

This bill would reduce barriers to practice and increase the pool of EMS workers who could work in Hawaii without raising any concerns about public health or safety.

The Legislature should be commended for considering joining the EMS compact, and we hope that this will be the first step toward lowering licensing barriers for medical personnel across the board. 

Well-established interstate licensure compacts exist for nurses, doctors, physical therapists, psychologists and speech therapists.

Joining such compacts would help attract more healthcare professionals to Hawaii, thereby improving healthcare quality and access in our state.

Thank you for the opportunity to submit our comments.


Joe Kent
Executive Vice President,
Grassroot Institute of Hawaii

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