COMMENTARY: Health care shouldn’t stop at state lines

COMMENTARY: Health care shouldn’t stop at state lines By Justin Leventhal InsideSources.com July 21, 2026 - 9:00 pm America faces a shortage of wellness‑attraction workers, and patients are bearing the cost. Many communities—especially thriving agrarian regions—lack sufficient doctors, registered nurses, and advanced‑practice nurses to meet basic health‑care needs. Providers concentrate in urban markets, leaving rural areas with far too few options. Interstate licensure compacts can bridge that gap. By simplifying the process for qualified clinicians to practice across state lines—particularly through telemedicine—these compacts bring care to patients instead of assuming thousands of providers will suddenly relocate. Interstate medical‑licensure compacts are a cost‑reducing, competition‑enhancing improvement that can expand supply and improve access without additional payer spending. Health‑care licensing remains structured as if patients never move, never travel, and never use remote care. A provider licensed and in good standing in one state still faces duplicative requirements merely to treat a patient in another, even when the service could be delivered safely and efficiently. Those rules protect incumbents more than patients, restricting choice, suppressing competition, and artificially limiting provider supply. Rural and underserved areas pay the highest price because they already have fewer physicians overall and fewer specialists in particular. Interstate compacts lower the cost of practicing in multiple states, making it easier for providers to reach patients wherever they are. This means more remote care from clinicians based in cities and more options for patients in places lacking local providers. It also increases competition: providers in crowded urban markets must compete harder on responsiveness, quality, and price, while patients in rural areas no longer have to settle for the limited options that happen to be nearby. Compacts also eliminate redundant applications, fees, and administrative hurdles. This matters greatly for independent providers and smaller practices, which lack the capacity of large health systems to absorb unnecessary regulatory costs. By removing artificial limits on who can deliver care, compacts allow the health‑care system to use its existing workforce more effectively, instantly expanding supply by letting clinicians serve patients where they are needed most. Health care should operate like an open national market, not a collection of protected state fiefdoms. The rule should be straightforward: if a provider is licensed and in good standing in one state, that should normally be sufficient to serve patients in another. Interstate compacts respect state authority over internal rules while trimming the duplicative barriers that block care for no good reason. Providers must still follow the rules of the state where the patient resides. If state legislatures seek a fast, low‑cost way to expand access, boost quality, and ease pressure on health‑care costs, interstate licensure compacts are an obvious place to start. Physician and registered‑nurse compacts have already been adopted by most states, showing the reform is workable and politically attainable. Yet no progressive compact exists for advanced‑practice registered nurses, even though nurse practitioners and other advanced‑practice nurses play a critical role in primary and specialty care. States that have not joined physician and registered‑nurse compacts should do so. They should also collaborate to adopt a nurse compact with minimal burdens for licensed practitioners so patients can benefit from a larger pool of caregivers. Consumers gain when policy places their needs above provider geography. Patients need access to a broader pool of clinicians, especially in rural communities. People who move, travel, reside out of state, or live near a border often wish to continue seeing the same doctor or nurse practitioner. They should be able to do so. Interstate compacts are among the simplest deregulatory reforms available; they expand access, strengthen competition, and make it easier for patients to obtain and retain the care they want. Justin Leventhal is a senior policy expert for the American Consumer Institute. He wrote this for InsideSources.com.