The following testimony was submitted by the Grassroot Institute of Hawaii on Feb. 17, 2026, for consideration by the Senate Committees on Health and Human Services and Commerce and Consumer Protection.
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Feb. 17, 2026, 9:45 a.m.
Hawaii State Capitol
Conference Room 229 and Videoconference
To: Senate Committee on Health and Human Services
Sen. Joy A. San Buenaventura, Chair
Sen. Angus L.K. McKelvey, Vice Chair
Senate Committee on Commerce and Consumer Protection
Sen. Jarrett Keohokalole, Chair
Sen. Carol Fukunaga, Vice Chair
From: Grassroot Institute of Hawaii
Ted Kefalas, Director of Strategic Campaigns
RE: TESTIMONY IN SUPPORT OF SB3105 — RELATING TO THE PHYSICIAN ASSISTANT LICENSURE COMPACT
Aloha Chairs, Vice Chairs and other members of the Committees,
The Grassroot Institute of Hawaii supports SB3105, which would allow Hawaii to join the Physician Assistant Licensure Compact.
The interstate compact approach outlined in this bill would make it easier for licensed physician assistants to practice in Hawaii. This would help alleviate one of the major challenges for healthcare access in Hawaii: the ongoing shortages in physicians and medical staff.
According to the Physician Workforce 2026 annual report, Hawaii has a shortage of 833 full-time equivalent doctors statewide, with the greatest deficit being in primary care, where the shortage is 178 FTEs across all islands.[1]
Addressing the problem requires a multipronged strategy aimed at alleviating burdens such as 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.[2] 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[3] 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 made by Medicare recipients by more than 11%.[4]
Physician assistants can help alleviate the problems caused by the physician shortage, but only if we make it easier for PAs to work in Hawaii. This is where the PA Compact can help.
At present, the PA Licensure Compact comprises 21 states, and more than a dozen states have introduced legislation to join. The growing popularity of medical compacts testifies to the safety and effectiveness of this approach to license reciprocity.
Joining the PA Compact would be an important step toward addressing the medical staff and healthcare shortages in our state.
Thank you for the opportunity to testify.
Ted Kefalas
Director of Strategic Campaigns
Grassroot Institute of Hawaii
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[1] “Annual Report on Findings from the Hawai‘i Physician Workforce Assessment Project,” University of Hawaii System, Dec. 2025, p. 1.
[2] Ryann Nunn, “Improving Health Care Through Occupational Licensing Reform,” RealClear Markets, Aug. 28, 2018
[3] 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.
[4] 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.
