Publisher's note: This post appears here courtesy of the Carolina Journal, and written by Kari Travis.
First of two parts
Unprecedented times call for unprecedented measures.
So North Carolina's leaders and lawmakers say of the fight against coronavirus. That's true, say a group of researchers from North Carolina's John Locke Foundation. But those unprecedented measures should involve less bureaucracy, regulation, and government red tape.
On March 10, Gov. Roy Cooper declared a state of emergency. In the days after, he outlawed gatherings of more than 100 people - then shrank the number to 50 within a week. Races and concerts were canceled. Schools shut down. Dining rooms in restaurants and private clubs closed under executive order.
North Carolina's path forward is paved with sensible policies, JLF experts say. As the state is overwhelmed with almost 200,000 claims for unemployment insurance and hundreds of residents test positive for COVID-19, boosting free-market solutions is the best way to ensure both public and economic health.
"What makes a free society so formidable is that it lets more people in on the fight," said Jon Sanders
, JLF's director of regulatory studies. "It doesn't wait for the central government to move, and it certainly doesn't lock the private sector out.
Jobs and the economy
- Recommendation: Lift ABC rules against to-go containers to help restaurants and bars hurt by Cooper's edict and allow breweries, distilleries, and wineries to deliver bottles
- Why: To provide additional sales revenue to embattled restaurants and bars under a carry-out/drive-through/delivery order
Getting a burger for carryout from your local sports bar? You can't order a cocktail to go with it.
Not right now
Restaurants are still allowed to provide takeout under Cooper's executive order, and that's great, Sanders said. But thanks to North Carolina's Alcoholic Beverage Control laws, a bartender or restaurant server can't pour spirits into a to-go container.
Restaurants should be allowed to serve up alcoholic drinks for takeout or delivery, the N.C. Restaurant and Lodging Association said in a recent package of policy recommendations. As restaurants and bars struggle to keep even minimal staff working curbside food options, hospitality workers need all the breaks they can get.
It's a good idea to let restaurants sell all types of alcohol to go in closed containers, Sanders said.
"People are going to miss a good mixed drink, and some establishments have their own signature drinks,"
Sanders said. "Others may serve local beers on tap that aren't available in manufacturers' take-home containers. Plus, if you'd care to support your favorite local establishment right now, getting a drink with your meal can't hurt."
The prohibitions don't make sense under the circumstances, he said, and lifting them could help struggling restaurants and private clubs raise profits and maintain staff. Cocktails are now available for takeout and delivery in California and New York.
The waiver could also apply to tap rooms at wineries, distilleries, and breweries that profit from slinging drinks in-house, he said.
- Recommendation: Suspend occupational licensing and rethink licensing going forward
- Why: Licensure keeps out needed health professionals and other workers and raises prices on people
If you're a nurse in Virginia, you don't suddenly lose those skills by crossing into North Carolina. The same goes for other licensed workers
, such as plumbers, electricians, hair stylists, and all other occupations that require licensing.
Cooper's emergency order waives North Carolina's licensure requirements for health care and behavioral health workers. That means doctors and nurses licensed in other states can get to work in North Carolina, helping test patients for COVID-19.
It's a start, Sanders said. But such deregulation should be more than just a back-up plan.
"Last year, Arizona became the first state with universal license recognition,"
Sanders said. "It directs the state's occupational licensing boards to recognize licenses from other states rather than require duplicative training and other requirements from already qualified individuals."
North Carolina should look beyond medical professions to all other types of licensing, he said.
"Disruptions from the coronavirus are going to cause people a lot of economic pain,"
he said. "A recession seems inescapable. In general, but especially now, there's no need for the state to impose regulations causing a whole slate of services to be harder to get, harder to find work in, and more costly to people than they should. But that's what occupational licensing does."
- Recommendation: Give extensions for expiring driver's licenses, expiring vehicle registrations, and other nonessential services that require in-person visits and standing in lines at government offices
- Why: To encourage social distancing
Social distancing is supposed to mitigate contagion, and people should only go to the grocery store or to work if absolutely necessary, Cooper and state health leaders have repeatedly said.
It's time to consider waiving other non-essential trips to government buildings, Sanders said, and waiting in long lines at the Division of Motor Vehicles and other government offices is a risk worth reconsidering.
"Services and payments can be made online, but people should be given the benefit of the doubt if they cannot."
On March 20, Cooper issued an executive order
postponing DMV hearings that can be "reasonably delayed." The order also waived some commercial driver's license requirements to make sure school buses could be used to respond to the crisis and called for limited appointments and some closures at smaller DMV offices.
The order doesn't go far enough, Sanders said.
"Suspending license and registration expirations for a certain period, such as six months, would help reduce the volume of people visiting the remaining offices still open. It just makes sense."
- Recommendation: Repeal Certificate of Need (CON) laws
- Why: Other states have, and health regulations that stand in the way of providing services in a health emergency aren't worth keeping
In the face of coronavirus, needs are straightforward. Sick people need care. Some may even require hospitalization.
But hospitals may need more beds.
That's not an easy fix in North Carolina, where Certificate of Need laws dictate how much medical equipment a facility is allowed to buy. In March, the state temporarily lifted restrictions on hospital beds due to the threat of coronavirus. The measure helps hospitals meet community needs without the permission of a Raleigh-based government board, said Jordan Roberts, JLF health care policy analyst.
"This regulation should remain lifted indefinitely,"
- Recommendation: Waive requirements for out-of-state telemedicine providers and give pharmacists the ability to test and prescribe medication for non-chronic conditions, such as strep or the flu. Grant nurse practitioners full practice authority.
- Why: Increasing access to telemedicine could help coordinate patient care and keep unnecessary visits to a minimum; freeing up primary care doctors and other point-of-contact providers will help with testing and treatment for COVID-19.
If you're sick, a quick video chat with your doctor could help maintain social distance while providing treatment. But North Carolina needs to make that option less tricky for patients, Roberts said.
On March 20, the state temporarily modified telemedicine rules
to provide remote care for Medicaid patients. The waiver loosens rules about payment, technology, and patient location. It also allows providers, such as clinical pharmacists and mental health providers, to provide video and phone sessions for patients.
These changes are a good example of how the state can provide better access to care going forward.
The General Assembly should allow out-of-state doctors to provide care via video calls and other electronic means, Roberts said. Now, a doctor in Virginia would also need to be licensed in North Carolina to practice telemedicine.
That's redundant, Roberts said.
If that rule were lifted, patients could go to a CVS pharmacy website and video chat with a doctor for just $59
. But today, that's not an option
Legislators should find ways to empower medical providers in multiple roles, Roberts said. One example is a recently enacted Florida law allowing pharmacists to test patients and prescribe medications for some illnesses.
"This could free up primary care doctors and other point-of-contact providers who will need to conduct testing and treatment for COVID-19-related illnesses,"
Nurse practitioners should also be granted full practice authority, he said, since COVID-19 is an all-hands-on-deck situation.