JEFFERSON CITY, Mo. (Dec. 30, 2015) – A bill prefiled in the Missouri House for the 2016 legislative session would prohibit the state from denying medical licenses based on failure to participate in a health insurance plan or system, preemptively protecting health care professionals in the state from federal regulation related to Obamacare or Medicaid.

Rep. Keith Frederick (R-Dist. 121) prefiled House Bill 1682 (HB1682) on Dec. 9. The legislation, titled the Medical Practice Freedom Act, would make demonstrated skill and academic competence the only criteria used to grant state licenses to physicians, chiropractors, optometrists and dentists.

“Licensure approval…shall not be conditioned upon or related to participation in any public or private health insurance plan, public health care system, public service initiative, or emergency room coverage.”

The legislation would not only protect medical professionals’ freedom to practice in Missouri, it would also provide protection for doctors in the state if the federal government were to create licensing requirements under Obamacare or Medicaid. While the feds couldn’t directly dictate state licensing criteria, they could tie them to ACA or Medicaid funding in some way. Passage of HB1682 would preemptively draw a line in the sand, forcing state agencies to reject federal mandates. This would protect Missouri medical professionals from facing indirect federal interference in their licensing process.

As Frederick pointed out, this scenario is not outside the realm of possibility. Several states have discussed making acceptance of Medicare part of the licensing process.

“The federal government wanted to force every state to expand Medicaid, so it’s not much of a stretch that they would then want to compel the medical workforce to provide the care that they have attempted to mandate,” Frederick said. “This is surely an area where the right of the state should prevail and the 10th Amendment is our empowerment.”

Last year, the Missouri legislature passed a bill specifying that direct primary care agreements (sometimes called medical retainer agreements) do not constitute insurance, thereby freeing doctors and patients from the onerous requirements and regulations under the state insurance code – including Obamacare mandates. HB1682 represents a second step, insuring that doctors opting to structure their practices in this way won’t have to fear interference via licensing requirements.

These direct patient/doctor agreements allow a system uncontrolled by government regulations to develop. It makes doctors responsive to patients, not insurance company bureaucrats or government rule-makers. Allowing patients to contract directly with doctors via medical retainer agreements opens the market. Under such agreements, market forces will set price for services based on both demand instead of relying on central planners with a political agenda. The end-result will be better care delivered at a lower cost.

A free healthcare marketplace within a state will help spur de facto nullification the federal program by providing an affordable alternative. As patients flock to these arrangements, the old system will begin to crumble. This sets the stage for further efforts to nullify Obamacare in effect.

Legislation like HB1682 builds a firewall against federal overreach. Most nullification efforts come after the fact – a reaction to some federal act. This legislation is a preemptive strike, asserting state sovereignty as the default position instead of trying to maneuver around some unconstitutional federal overreach.

HB1682 will be referred to a committee one the 2016 legislative session gets underway in January. It will need to pass committee by a majority vote before moving on for further consideration in the full House.

Mike Maharrey

The 10th Amendment

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