Interstate health care compact bills in limbo as 60-day session enters homestretch

SANTA FE — Amid a chronic health care worker shortage, New Mexico lawmakers are weighing proposals to make it easier for licensed out-of-state practitioners to work in the state.

A package of bills would, if passed, allow New Mexico to join various interstate medical licensing compacts and streamline the licensing process for physicians.

New Mexico is a member of a 40-state nursing compact, but has not joined similar compacts for doctors, physical therapists, dentists, mental health counselors and audiologists.

With just five days left in the 60-day legislative session, some medical compact bills have already passed one chamber, but none have as of yet crossed the finish line.

Though similar piecemeal bills have stalled in past years, this is the first time advocates are pushing for a comprehensive package to make it through the Legislature.

One of the compact bills, House Bill 243, aimed at allowing physicians to apply for an expedited license in member states, was discussed in the Senate Judiciary Committee on Monday but not voted on.

Sen. Joseph Cervantes, D-Las Cruces, the committee’s chairman, expressed concern about New Mexico physicians being subject to subpoenas issued in another state.

He also referred to as interstate compacts as business ventures, adding, “It looks like a pretty creative way to make a buck.”

But Cervantes also said he’s willing to work with advocates to try to address concerns.

“We want to have more doctors in New Mexico and we want to work with you to make that happen,” Cervantes said during Monday’s meeting.

Rep. Marian Matthews, D-Albuquerque, the bill’s sponsor, said the hearing broke the ice for the bill and hinted at possible compromise amendments to come.

“The committee’s identified what’s important ... and now we’re going to go take a moment and look at it and see if there’s a way to move forward,” she told the Journal.

Another member of the committee, Sen. Katy Duhigg, D-Albuquerque, said in a Monday interview the compact bills often feature problematic language that advocates don’t want to change.

Duhigg, an attorney, said a proposed social work compact bill came in cleaner than other compact legislation and the amended version that passed through the Senate Judiciary Committee cleaned it up even more.

“That is the example of how they should do it. They were reasonable in removing language that was not right for New Mexico, and we passed the compact,” she said.

She also said it could be very dangerous to let a private commission make laws about what New Mexico does in medical care, pointing to issues like reproductive health care or gender-affirming health care. Dozens of other states joining compacts doesn’t unequivocally mean New Mexico should, she said.

“If other states think it’s cool to let some private organization make their laws for them, OK, but that is no reason for us to do so,” Duhigg said.

A way to ease chronic worker shortage?

The interstate compacts are aimed at alleviating a longstanding health care provider shortage, especially in rural New Mexico.

Despite recent efforts to boost funding for health care training programs at New Mexico colleges and universities, the state had an average shortage of 5,000 health care workers between 2018 and 2013, according to legislative data.

Most of New Mexico’s neighboring states are already members of five or more of the interstate compacts, according to Think New Mexico, a Santa Fe-based think tank that has advocated for the legislation.

Founder and Executive Director Fred Nathan described the health care compacts as the most impactful short-term fix to New Mexico’s doctor shortage crisis.

“These are bills that the overwhelming number of states have already approved, and we have a dire shortage of health care workers. So it makes sense that these bills should all be passed this session,” Nathan said.

In a legislative analysis, the state Department of Health concluded that passage of the medical licensure compact would reduce the administrative burden and the time required to become licensed in New Mexico, which could increase available physicians.

The DOH analysis also said an increase in primary care providers could reduce the number of emergency department visits in New Mexico by making it easier for patients to access routine care.

But while legislation may be advancing through the legislative process, some advocates aren’t entirely happy with changes made along the way.

Matt Shafer, deputy policy director of the National Center for Interstate Compacts, emailed Cervantes on Monday with concerns that the committee changes to Senate Bill 105, concerning social work licensure compacts, would “prohibit New Mexico from being seated on the compact commission,” according to an email shared with the Journal.

Kristina Fisher, associate director of Think New Mexico, explained that the national commission can bar states from joining the compacts under the reasoning that, “you can pass what you want, but we can’t accept it unless it’s substantively the same as what every other state agreed to.”

She said if the Legislature passes the compact bills, the national commission could vote to add New Mexico to the compacts before the end of the year.

Nathan said trial lawyers are often against the compacts because they don’t want to expand immunity in lawsuits — language in some of the bills states that officers and employees of the interstate commission are immune from suit and liability. Nathan described trial lawyers’ interests as self-serving, not wanting to grant lawsuit immunity, “even if the probability of suing these people is beyond remote.”

But Duhigg later denied that, saying, “This is not a trial lawyer thing” and some advocates aren’t willing to compromise to fix bad language.

Nathan said the need for interstate compacts pairs with a need to reform the state’s medical malpractice statutes. A bill to limit attorney fees in medical malpractice cases died in its first committee last week.

“The issue is not going away, and we’re not going away,” Nathan said.

Fisher added, “And unfortunately, the doctors are going away — and that’s what we need to address.”

Hospital mergers also on lawmakers’ minds

The House voted Monday to approve a bill, House Bill 586, giving the secretary of the state Health Care Authority the ability to decide whether to approve proposed mergers and acquisitions of hospitals and other health care facilities.

“The focus of this is hospitals, and making sure the quality of care and the way we treat our workforce is the same — or better — after this transaction,” said House Majority Leader Reena Szczepanski, D-Santa Fe, during Monday’s debate

New Mexico has the nation’s highest percentage of hospitals owned by private equity firms, as 17 of the state’s 45 private hospitals are owned by such firms, according to a legislative analysis.