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29 Health Matrix 293 (2019)
Unlocking Access to Health Care: A Federalist Approach to Reforming Occupational Licensing

handle is hein.journals/hmax29 and id is 299 raw text is: HEALTH MATRIX 29 - ISSUE 1 - 2019 UNLOCKING ACCESS TO HEALTH CARE: A FEDERALIST APPROACH TO REFORMING OCCUPATIONAL LICENSING Gabriel Scheffler' ABSTRACT Several features of the existing occupational licensing system impede access to health care without providing appreciable protections for patients. Licensing restrictions prevent health care providers from offering services to the full extent of their competency, obstruct the adoption of telehealth, and deter foreign-trained providers from practicing in the United States. Scholars and policymakers have proposed a number of reforms to this system over the years, but these proposals have had a limited impact for political and institutional reasons. Still, there are grounds for optimism. In recent years, the federal government has taken a range of initial steps to reform licensing requirements for health care providers, and these steps have the potential to improve access to health care. Together, they illustrate a federalist approach to licensing reform, in which the federal government encourages the states to reform their licensing regimes, while largely preserving states' control over the system. These steps include: (1) easing federal licensing restrictions for health care providers in certain areas where the federal government possesses regulatory authority; (2) creating incentives for states and professional bodies to experiment with reforms; (3) intensifying the Federal Trade Commission's focus on licensing boards' anti-competitive conduct; and (4) generating additional pressure for state-level reforms through expanding health insurance and promoting delivery system reforms under the Affordable Care Act. This article argues that a federalist approach represents the most promising path toward reforming occupational licensing in health care. Federal intervention in licensing is necessary, due to states' lack of 1. Regulation Fellow, Penn Program on Regulation, University of Pennsylvania Law School; Research Fellow, Solomon Center for Health Law and Policy, Yale Law School. I wish to thank Cary Coglianese, Bridget Fahey, Laura Giuliano, Allison Hoffman, Jesse Kaplan, Ryan Nunn, Shayak Sarkar, Samuel Scheffler, and Daniel Walters for providing helpful feedback on earlier drafts. Many thanks also to Laurent Abergel, Evan Silverstein, and Timothy Von Dulm for excellent research support. Finally, thanks to the editors of Health Matrix, especially Amanda Mahoney, for very helpful editorial assistance. Any mistakes are my own. 293

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