The following testimony was submitted by the Grassroot Institute of Hawaii for consideration by the House Committee on Consumer Protection & Commerce on March 28, 2023.
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March 28, 2023
2 p.m.
Conference Room 329
VIA VIDEOCONFERENCE
To: House Committee on Consumer Protection & Commerce
Rep. Mark M. Nakashima, Chair
Rep. Jackson D. Sayama, Vice Chair
From: Grassroot Institute of Hawaii
Ted Kefalas, Director of Strategic Campaigns
RE: SB162 SD2 HD1 — RELATING TO DENTISTRY LICENSES
Comments Only
Dear Chair and Committee Members:
The Grassroot Institute of Hawaii would like to offer its comments on SB162 SD2 HD1, which would allow the state Board of Dentistry to issue community service licenses to practice dentistry and dental hygiene as well as temporary licenses to practice dentistry, provided the applicants meet certain specified criteria.
If enacted, this bill would be a positive step toward addressing Hawaii’s shortage of medical professionals, which has led to significant barriers to healthcare access, especially on the neighbor islands.
It is well established that Hawaii is suffering from a shortage of vital healthcare workers, including dentists. The Hawaii Department of Health has designated both Maui and Hawaii Counties — as well as a segment of the City and County of Honolulu — as Dental Health Professional Shortage Areas.[1]
Fixing the shortage in healthcare workers in Hawaii requires a multipronged strategy that will address everything from the state’s high cost of living to its 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.[2] Their licenses can be difficult to obtain, are expensive and carry geographic or “scope of practice” limitations.
As discussed in the Grassroot Institute of Hawaii’s new policy brief on medical licensing, “How changing Hawaii’s licensing laws could improve healthcare access,” 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.[3]
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.[4]
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.”[5]
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 medical professional licensed in another state to practice in Hawaii.
The expanded permissions to issue temporary and community service licenses for dentistry and dental hygiene outlined in this bill are a partial answer to the need to attract more dentists to Hawaii.
Over the long term, lawmakers should consider other ways to enhance license portability, to help end health professional shortages and improve healthcare access for all.
Thank you for the opportunity to submit our comments.
Sincerely,
Ted Kefalas
Director of Strategic Campaigns,
Grassroot Institute of Hawaii
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[1] “Hawaii Health Professional Shortage Areas,” Hawaii Department of Health, August 2020.
[2] Ryann Nunn, “Improving Health Care Through Occupational Licensing Reform,” RealClear Markets, Aug. 28, 2018
[3] Malia Hill, “How changing Hawaii’s licensing laws could improve healthcare access,” Grassroot Institute of Hawaii, February 2023, pp. 5-7.
[4] Karen Goldman, “Options to Enhance Occupational License Portability,” U.S. Federal Trade Commission, September 2018, p. 25.
[5] 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.
