WPC Report: “Making COVID-19 health care reforms permanent in Washington state”

To prepare for a potential surge in cases, the COVID-19 pandemic quickly ushered in changes to Washington State’s health care delivery system. A new policy note from the Washington Policy Center (WPC) looks to make the case that many of the temporary health care reforms adopted during the public health emergency should be made permanent.



The report, titled “Making COVID-19 health care reforms permanent in Washington state,” was authored by WPC health care policy analyst Roger Stark, MD, FACS. In it, he highlights 5 health reforms he believes should remain in place into the future:

1. Repeal Certificate of Need (CON) Laws: On March 30, state officials suspended Certificate of Need Laws for long-term care facilities. This, says Stark, allowed the state to set up non-hospital facilities, such as the Century Link Field Event Center, to prepare for patient surges at traditional hospitals. Stark argues that the state should permanently repeal CON laws, stating that they do little to reduce health care costs and instead reduce access to care.

“As more patients use high-deductible health insurance plans and thereby use more of their own money, they should have more choices and better access to health care. Expanded access, increased price competition and greater medical choice would serve the public interest by allowing new health care services to be provided in communities where they are needed,” writes Stark.

“For these reasons, the bureaucratically restrictive and long-outdated CON law in Washington state should be repealed. CON laws were not necessary during the COVID-19 crisis and should be repealed on a permanent basis.”

2. Allow more telemedicine: In an effort to preserve personal protective equipment (PPE) and ensure capacity in hospitals, the COVID crisis forced the rapid adoption of telemedicine. At the end of March, state officials ordered telemedicine visits to be reimbursed at the same rate as in-office visits.

To continue the utilization of telemedicine, Stark reasons that state officials should streamline licensing for out-of-state providers and reduce barriers between patient-doctor interactions through telemedicine.

“Extending the use of telemedicine is a practical solution to ever-increasing health care costs and to limited health care access for millions of Americans in rural areas. Government officials should offer guidelines and protect patient rights, but they should otherwise let people in the voluntary free market decide the most efficient use of this expanding technology,” he writes.

3. Expand provider licensing and scope-of-practice: Gov. Inslee issued an executive order on February 29 allowing volunteers who were not fully licensed in Washington State to provide emergency services during the COVID-19 crisis. Stark argues that removing barriers to practicing medicine in the state should continue beyond the public health emergency. This includes relaxing scope-of-practice laws, utilizing out of state providers for telemedicine, and making it easier for those who have graduated from foreign medical and nursing schools to work in the state.

4. Enact health insurance reform: During the pandemic, the state has mandated changes in the health insurance industry.

 Because of the COVID-19 crisis, Washington state officials have unilaterally forced changes on the health insurance industry. They have mandated that insurance companies waive co-pays, deductibles, and co-insurance payments for virus testing. They have banned surprise bills for virus treatments in facilities that are out-of-network for patients. They have forced insurance companies to pay for telemedicine services,” writes Stark.

This, says Stark, proves that insurance reforms can be made expeditiously. He advocates for adopting permanent reforms like price transparency and the elimination of most benefit mandates to “introduce more free market ideas” into the health insurance market.

5. Enact tort reform: Stark notes that many states have limits placed on the cost of medical lawsuits in order to keep costs down for physicians. On April 24, Inslee denied a request from the Washington State Hospital Association, Medical Association, and Nurses Association to extend the Emergency Volunteer Protection Act. “His reasoning was that the majority of the COVID-19 crisis had passed and tort reform was not necessary,” writes Stark.

“From the experience in other states, a meaningful legal cap on non-economic damages is the most effective element of successful lawsuit reform legislation. To a lesser extent, a statute of limitations on lawsuits and pre-trial screening are often effective in reducing the cost of specific medical malpractice lawsuits.”

Stark notes that lawmakers would need to amend Washington’s constitution in order to enact caps on non-economic damages, but says the action would make the state a more attractive place for physicians to practice.

WPC’s full report is available here.