Pushing Medicaid expansion and Obamacare may be in vogue, but just because they’re trendy doesn’t mean expanding these programs is sound policy.
Mississippi snagged headlines recently when its state House passed a Medicaid expansion bill. Members of both the Left and the Right lauded the move, while states such as Texas have drawn harsh criticism for resisting expanding the program.
In January, the Biden administration proudly touted “record” Obamacare enrollment numbers, with Centers for Medicare & Medicaid Services Administrator Chiquita Brooks-LaSure claiming, “We must do everything we can to protect and expand access to coverage for all people.”
With 92% of the public holding some sort of healthcare coverage, the Biden administration misses a fundamental point: The real problem is not a lack of coverage but a lack of access to care.
Proponents of Medicaid expansion like to emphasize how it will expand coverage for those in rural areas. It is true that people in rural communities are far more reliant on Medicaid than those in urban areas. Nearly half of children and almost 1 in 5 adults in small towns and rural areas are on Medicaid, but Medicaid coverage will only get them so far. Rural people often face worse health outcomes than their suburban and urban counterparts because they lack access to healthcare services.
The increasing rural hospital closures and physician shortages greatly undermine people’s ability to seek care. Residents in rural areas who now have to travel farther for care often face worse health outcomes. In West Texas, pediatric patients often have to drive 100 miles to get the hospital care they need. When patients have to drive that far to access care, whether or not they have an insurance card is going to matter far less, especially in an emergency situation.
States can address the physician shortage by passing laws to enact physician licensing reform if they truly want to ensure people can access the care they need when they need it.
Physician licensing reform involves removing barriers to “the free flow of health care practitioners to where patients need them,” according to Cato Institute senior fellow Jeffrey Singer. Currently, doctors who complete their residency abroad must repeat their residency in the United States, forcing doctors with years of experience to undergo costly and redundant medical training. Because of this, many foreign‐trained doctors who come to the U.S. don’t even bother starting their medical training over and seek jobs in other fields.
If states were to remove this requirement, they could attract leading talent in the medical field from around the world. International physician licensing reform would greatly benefit rural people because foreign-trained doctors are more likely to practice in medically underserved communities.
This problem isn’t limited to international physicians, either. Doctors looking to relocate to other states within the U.S. also must undergo a lengthy, burdensome process to obtain an equivalent license. During the COVID-19 pandemic, multiple states quickly granted licenses to doctors and nurses with out‐of‐state licenses, opening the door to broader occupational licensing reforms.
Some might raise concerns about the quality of doctors who are trained abroad, and certainly, other countries have different medical standards. Yet, states such as Tennessee have found ways to safeguard against these concerns by requiring internationally trained and licensed doctors to work at a hospital or licensed medical facility for two years.
Expanding government-subsidized programs such as Medicaid does nothing to help rural people if they cannot see a doctor in the first place. States should be incentivizing talented medical professionals to come practice in these underserved areas if they want to fix their physician shortages and increase healthcare access. Rural people deserve the same level of timely, quality care as people in more urban areas. Physician licensing reform is a good place to start.