SB317: Join compact allowing more hearing, speech specialists

The following testimony was presented February 10, 2023, by the Grassroot Institute of Hawaii to the Senate Committee on Health and Human Services.

February 10, 2023
1 p.m.
Conference Room 225

To: Senate Committee on Health and Human Services.
      Sen. Joy A. San Buenaventura, Chair
      Sen. Henry J.C. Aquino, Vice Chair

From: Grassroot Institute of Hawaii
           Ted Kefalas, Director of Strategic Campaigns


Comments Only

Dear Chair and Committee Members:

The Grassroot Institute of Hawaii would like to offer its comments on SB317, which would allow Hawaii to enter into the Audiology and Speech-Language Pathology Interstate Compact.

If this bill is enacted, the Legislature will take an important step toward addressing Hawaii’s shortage of medical practitioners and specialists, a problem that has existed for years and has become a serious obstacle to healthcare access in our state.

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 is the need to reform licensing regulations for healthcare professionals.

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

As discussed in an upcoming policy brief on medical licensing by the Grassroot Institute of Hawaii, the state’s shortage of healthcare professionals makes its 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.[2]

In other words, though medical licensing is intended to protect the public, there is a point at which the level of regulation reduces the number of people in practice 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.”[3]

This is where we can benefit from the lessons learned during 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 doctor licensed in another state to practice in Hawaii.

The interstate compact approach outlined in this bill would allow licensed audiologists and speech-language pathologists from other participating compact states to apply for the privilege of practicing in Hawaii.

This legislation would increase the pool of audiologists and speech-language pathologists able to practice in Hawaii and shorten the time it would take for them to begin working here.

With one bill, the Legislature will be able to improve access to and choice of audiology and speech-language pathology providers for all Hawaii residents.

At present, the ASLP Compact includes 23 states. Nine additional states have introduced legislation to join as well. The Compact’s successful implementation speaks to the safety and effectiveness of this approach to license reciprocity.

Joining the ASLP Compact would be an important step toward attracting more medical providers to our state, thereby improving healthcare access for all.

Thank you for the opportunity to submit our comments.


Ted Kefalas
Director of Strategic Campaigns,
Grassroot Institute of Hawaii

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

[2] Karen Goldman, “Options to Enhance Occupational License Portability,” U.S. Federal Trade Commission, September 2018, p. 25.

[3] Sean Nicholson and Carol Propper, Chapter Fourteen — Medical Workforce,” in “Handbook of Health Economics, Vol. 2,” Elsevier, B.V., 2012, p. 885, cited also in the previously mentioned FTC study, footnote #9, p3.

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