Patrick Ishmael
Licensing laws are typically seen as a way to ensure that members of a profession are well-trained and, thus, their customers well-served and protected. But could overly restrictive licensing rules actually be bad for customers' health? There is reason to believe so; restrictive and ambiguous Missouri licensing requirements in health care have kept, and are keeping, at least one charitable medical group that provides free medical care to the needy from operating freely in the state. That group: Remote Area Medical (RAM).

The brainchild of British transplant Stan Brock, RAM started as a relief service abroad. But for many years it also has turned its services inward to help America's neediest, providing medical care to those who otherwise would not have received it. Brock told 60 Minutes in a 2008 report (featured above) that his organization “operate[s] entirely on the generosity of the American people.” Like so many families, stretching those sometimes “little checks” is how RAM makes ends meet. In addition, thousands of highly-trained and medically-licensed volunteers have traveled the country assisting Brock's work for decades by providing their professional services free of charge.

Yet a recurring stumbling block as RAM visits states is artificial barriers to entry – that is, state laws that prevent out-of-state volunteers from easily donating their medical expertise because of burdensome, and sometimes expensive, licensing requirements. During a phone call last week, Mr. Brock told me that RAM wanted to do more in Missouri, but onerous state requirements — such as requiring licensed in-state medical personnel to participate in a clinic before RAM could provide its services — had stifled his organization on several occasions. Most recently, he said, Missouri regulations prevented RAM from providing free eyeglasses to the southwest corner of the state.

But Missouri could make it easier for groups like RAM to help the state's neediest if officials relax licensing rules and explicitly allow medical professionals licensed in other states to provide their services for these charitable endeavors. Tennessee has led the way on this policy front.

In 1995, Tennessee enacted the “Volunteer Health Care Services Act,” a reform of its medical licensing law which allowed relief organizations like RAM to bring out-of-state medical professionals to help Tennessee’s poor without putting professionals licensed in their home states through an arduous and unnecessary process of re-licensing. If a doctor is licensed to practice in her home state, RAM can bring that doctor to provide her services free of charge to Tennessee’s medically-underserved. It is, in short, a clear and unambiguous law that ensures the state’s neediest are served ably and safely.

The good news? The reform movement appears to be spreading, with a handful of states following Tennessee's lead in whole or in part. Oklahoma has reformed its laws to accommodate organizations like RAM, and more recently, Connecticut and Illinois passed legislation that allows organizations like RAM greater access to its neediest citizens. Arizona currently is taking up a reform of its own laws.

Tennessee's law is a model for the country – and a model that Missouri, one of Tennessee’s neighbors, would do well to emulate. Allowing organizations like RAM to freely enter Missouri would go a long way towards improving care to Missouri’s underserved. When burdensome licensing laws and medical regulation interfere with the delivery of skilled, safe, and desperately needed services to America’s poor, the system is in need of reform. For Missouri, relaxing licensing laws for charitable groups like RAM would be a step in the right direction.

About the Author

Patrick Ishmael
Director of Government Accountability

Patrick Ishmael is the director of government accountability at the Show-Me Institute.