Testimony on HB1575 HD2: Yes, give physician assistants more latitude

The following testimony was submitted by the Grassroot Institute of Hawaii for consideration March 14, 2022, by the Senate Committee on Health.

To: 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 HB1575 HD2, which would expand the scope of practice for physician assistants.

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, across the state, and especially in rural areas, Hawaii is facing shortages of other kinds of health professionals as well, 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 is the need to reform licensing regulations for healthcare professionals.

One-fourth of all licensed workers in the U.S. work in healthcare.[1] Those licenses can be difficult to obtain, are expensive and carry geographic or “scope of practice” limitations.

Licensing laws can also affect wages and overall medical costs. A study from the National Bureau of Economic Research[2] considered restrictions on nurse practitioners and found that fewer restrictions on nurse practitioners’ scope of practice correlated with higher wages for nurses and lower wages for physicians. Higher restrictions increased the cost of a well-child medical exam by 3% to 16%.

A similar study from the Mercatus Center examining scope of practice for nurse practitioners and physician assistants found that less restrictive regulations for physician assistants reduced the cost of outpatient claims by Medicare recipients by more than 11%.[3]

By expanding the scope of practice for physician assistants in our state, this bill would reduce the burden on medical personnel and help address the shortage of qualified healthcare personnel in Hawaii.

Thank you for the opportunity to submit our comments.


Joe Kent
Executive Vice President,
Grassroot Institute of Hawaii

[1] Ryann Nunn, “Improving Health Care Through Occupational Licensing Reform,” RealClear Markets, Aug. 28, 2018

[2] Morris Kleiner, et al., “Relaxing Occupational Licensure Requirements: Analyzing Wages and Prices for a Medical Service,” Working Paper 19906, National Bureau of Economic Research, February 2014.

[3] Edward J. Timmons, “Healthcare Licensure Turf Wars: The Effects of Expanded Nurse Practitioner and Physician Assistant Scope of Practice on Medicaid Patient Access,” Mercatus Working Paper, Mercatus Center, George Washington University, January 2016.

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