John McClaughry: Emergency deregulation and mutual aid
Vermont's most recent disaster occurred in September 2011, when Tropical Storm Irene roared up the west side of the state. Fourteen hundred residences were damaged and their residents displaced; 34 state highway and 90 town bridges were washed out or closed; 531 state highway miles and 175 town roads were impassable.
Gov. Peter Shumlin, in what many would conclude was the best performance of his six years in that office, moved decisively to restore and rebuild. State officials at damage scenes told contractors, the National Guard, and town governments to "git `er done" without spending their time consulting regulators.
As the recovery progressed, Shumlin said, "when you bring in the National Guard, and you don't have to hire flaggers, and you don't have to keep roads open while you're rebuilding, and you can take the gravel and the rock from the brooks and rivers that it got washed into, you drastically reduce the cost of rebuilding."
The 2012 legislature, urged on by alarmed enviro groups, responded by directing ANR to make up more rules to restrict what could be done to deal with the next natural disaster.
The present coronavirus emergency is far more pervasive than Irene, far more demanding of the health care system, and far more destructive of the state's economy. Fortunately, the legislature was in session when it arrived. To its credit, it rushed through a law that diminished a considerable number of regulatory requirements put into the laws over the years, often to protect one or another interest group.
The law relaxes occupational licensing for health care providers, and rules governing hospitals, nursing homes, child care, public assistance and foster care. It extends driver's license expirations and tax filing deadlines. It relaxes the onerous Certificate of Need (CON) procedure and provider budget review requirements for facilities needed to cope with emergencies. It suspends the health care provider tax, a too-slick idea from 1992 that was first adopted to extract more Medicaid funds from Washington, and after a decade became just a scheme for financing Medicaid through hidden taxes on health insurers, customers, and patients.
Perhaps most significantly, the new law knocked down barriers to out of state physicians practicing in Vermont. It authorizes temporary licenses and expanded scope of practice rules for physician's assistants and nurse practitioners. It allows doctors to examine and assist patients via telemedicine and emails.
At least 11 other states are considering repealing CON laws altogether (14 of 49 repealed them previously). Probably all of them are increasing telemedicine, which the federal government has already done for Medicare. Many are allowing out of state physicians to practice, and Arizona is considering letting pharmacists test and treat lower-level conditions, above and beyond providing flu shots.
An important question is whether these salutary provisions will continue after the Vermont act's termination date, which is six months after the Coronavirus emergency is revoked. Let's hope so.
One exceptional consequence of this emergency is the efflorescence of voluntary service and mutual aid among caring Vermonters. Gov. Scott has launched a website, vermont.gov/volunteer, for people to volunteer to support the state's response to the emergency. The website directs those with medical and healthcare skills to the Medical Reserve Corps, and enrolls those with other needed skills like child care, home care, grocery work, and drivers to a quick registration process to sign up to help. Many thousands of Vermonters are self-organizing to help friends and neighbors across the state.
We are all immensely grateful for the courageous service of our medical personnel. Let me add a tribute to the men and women who keep America running. That includes grocery and pharmacy workers, fire, police and public works departments, postal and delivery workers, the news media (especially community newspapers), and the vital electricity and fuel industries.
I'm especially grateful for an indispensable but often overlooked group: truck drivers. James Williams, a tank platoon commander in Iraq, is now operations manager of a large trucking company. He writes in the Wall Street Journal: "These truckers and workers are away from family for long periods. They work grueling hours and risk exposure to Covid-19. But they're willing to put their health at risk so that millions of people can have a semblance of normalcy in their lives. Thanks to these sacrifices, grocery and pharmacy shelves will be stocked even amid a pandemic. That consistency and reliability will give confidence to American consumers as the economy starts to rebound. As I learned in Iraq, the supply chain and the truckers who hold it together are vital to the health of a nation." Here's a big 10-4 to that.
John McClaughry is vice president of the Ethan Allen Institute, ethanallen.org.
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