Health Care
Free-Market Healthcare Reform
THE PROBLEM
Regulations needlessly limit healthcare supply, often by protecting incumbent providers at the expense of patients.
THE SOLUTION
Enact free-market reforms to increase the availability of care across the state and lower healthcare prices.
Remove Unnecessary Barriers
More treatment options mean more competition among providers, which is good for consumers in terms of service and price, especially in rural areas where doctors may not always be nearby. Missouri continues to restrict the scope of practice of advanced practice registered nurses. Our state’s nurse practitioners, for example, must practice under collaborative arrangements with physicians, while 28 states—including Kansas and Illinois—grant them full practice authority. Those collaborative agreements typically require nurse practitioners to pay a supervising physician for oversight, adding a real cost with little corresponding benefit to patients.
Missouri has made progress in removing other barriers. The state has expanded its telemedicine laws to include audio-only technologies, and in 2026 lawmakers expanded opportunities for physicians licensed in other states to treat Missouri patients remotely. In 2025, lawmakers also eliminated an exception that had prevented the state’s general licensure-reciprocity law from applying to professions overseen by boards participating in interstate compacts.
But licensure can still be a barrier to entry for qualified healthcare providers from other states. Unnecessary delays and requirements can discourage qualified providers from practicing in Missouri. Under Missouri’s general reciprocity law, an applicant ordinarily must have held an out-of-state license for at least one year before qualifying for reciprocity. After an application is submitted, a Missouri licensing body has up to six months to decide whether to waive duplicative examination, education, and experience requirements. These statutory delays can discourage otherwise qualified providers from practicing in Missouri.
The laws and regulations governing what healthcare providers can do and where they can practice also affect Missouri’s ability to recruit healthcare workers. Greater freedom for providers can make Missouri a more attractive place to practice and help the state compete for healthcare professionals.
Repeal Certificate of Need
Missouri’s Certificate of Need law restricts healthcare competition by requiring many healthcare providers to get state approval before entering new markets or expanding services offered in existing facilities. This restriction hampers market newcomers and puts upward pressure on healthcare prices by restricting supply. It can also give existing providers a voice in whether potential competitors are allowed to enter the market. Decisions about whether a new healthcare facility or service is needed should be driven by patient demand and the willingness of new providers to meet that demand, not a state approval process.
POLICY RECOMMENDATIONS
- Expand the scope of practice for advanced-practice registered nurses, including granting nurse practitioners full practice authority.
- Eliminate the one-year prior licensure requirement, require licensing bodies to approve or deny completed reciprocity applications within 45 days, and create additional pathways for licensed healthcare providers in other states to treat patients in Missouri.
- Repeal Missouri’s Certificate of Need laws.
