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REVITALIZING AMERICA

A Legislative Guide to Recovering from Coronavirus

How to Revitalize America in the Face of Coronavirus

America is facing a crisis unlike any other—one that tests our healthcare, education, and economic infrastructure like never before. But as extraordinary as these challenges may be, there is no reason Americans cannot surmount them, if they remain true to the principles of liberty that have seen us through so many crises in the past.

Revitalizing our nation following the COVID-19 pandemic requires bold and innovative policy solutions that ensure Americans have the freedom they need to recover. That’s why the Goldwater Institute has put together a legislative toolkit—our roadmap for recovery—which sets out practical policy recommendations in the following three areas to shape and hasten the nation’s recovery from the coronavirus crisis:

  • Economy
  • Education
  • Healthcare

While the coronavirus outbreak poses many trials for Americans, we have the tools necessary to overcome them. For years, the Goldwater Institute has developed and enacted policies to expand individual liberty and ensure that people can live freer, happier lives. Our Right to Try Act—today the law of the land—helps bring the right treatment to the right patient at the right time. Our Breaking Down Barriers to Work Act enables licensed workers to get to work more quickly when they move across state lines. In our legislative toolkit, you can read more about many other innovative policy solutions that can empower Americans to revive our economy, create new jobs, protect our health, educate our children, and revitalize our nation in the wake of this crisis.

You can download the Goldwater Institute’s legislative toolkit “Revitalizing America: A Legislative Guide to Recovering from Coronavirus,” here. If you have any questions about how to transform these recommendations into realities in your state, please contact Heather Curry, Goldwater’s Director of Strategic Engagement, at hcurry@goldwaterinstitute.org.

Victor Riches is the President and CEO of the Goldwater Institute.

Break Down Barriers to work

Issue overview

Today, about a third of Americans—more than ever before—are required to get a government permission slip before they may work in the field of their choice. This isn’t just a significant burden on their right to earn a living, but it also prevents them from earning a paycheck when they move from one state to another, because they are typically forced to go through the government permitting process all over again—a costly, time-consuming, and irrational barrier to work. 

At the onset of the coronavirus pandemic, many states moved swiftly to waive licensing requirements for out-of-state healthcare workers and other occupations, recognizing that regulatory obstacles could truly mean the difference between life and death. The removal of these requirements ensured that out-of-state nurses and physicians were able to cross state lines quickly and provide quality care at a critical time. These waivers showed that many licensing restrictions hurt more than they help.

As we recover from the coronavirus crisis, eliminating duplicative licensing requirements will be crucial in providing needed healthcare services and empowering people to get to work.

Policy recommendation

Adopt the Breaking Down Barriers to Work Act, which reduces red tape and helps experienced, licensed professionals get to work faster. This Act universally recognizes out-of-state occupational licenses based on the training or testing requirements that a person has already completed. This allows professionals who already hold a license in good standing in one state to be approved to work quickly in their new home state. At a time when many Americans are out of work, states should reduce burdens on licensed workers and empower them to contribute their experience and expertise to their new communities. This policy can also help ensure there are adequate licensed medical professionals in a state in case of another crisis.

Stories of success

In 2019, Arizona became the first state to adopt the Breaking Down Barriers to Work Act. It has proven wildly successful: More than 1,100 people were approved for licenses in the first six months that the law was in effect, in professions ranging from cosmetology to mechanical engineering. In the months following the passage of Arizona’s law, more than 20 states introduced—and nearly a dozen state legislatures passed—variations of universal recognition. More states will revisit this reform when legislatures reconvene. 

Fiscal considerations

Because the Breaking Down Barriers to Work Act streamlines licensing processes, it is unsurprising that state fiscal notes reflect a zero net cost to the state. In fact, depending on the requirements of a particular profession, the savings to an individual could be thousands of dollars. As state economies look to recover from the coronavirus pandemic, the economic growth from removing redundant regulations and getting Americans to work faster should also result in higher tax revenue.

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Protect Home-Based Businesses

Issue overview

Over the past few decades, technological advances have afforded entrepreneurs unprecedented opportunities to start businesses from their homes, allowing them to save money, maintain a flexible schedule, and realize their dreams of self-employment. 

The vast majority of small businesses have always started out of someone’s home, and many continue to operate that way for years. But the coronavirus crisis has made the ability to work from home even more important. Unfortunately, scores of outmoded zoning, licensing, and permitting requirements are impeding people’s freedom to run a business from their home. Some cities even make operating a home-based business a crime, punishable by stiff financial penalties and even jail time, regardless of whether that business has any impact at all on the neighboring community. While local governments should protect neighborhoods against nuisances, they should not impose blanket prohibitions on home-based businesses. Such restrictions violate private property rights, hinder economic growth, and do little to address neighborhood problems.

Policy recommendation

Eliminate unnecessary local regulations that needlessly intrude on people’s ability to work from home. The Home-Based Business Fairness Act allows local officials to target nuisances, ensure that buildings are safe, and prevent noise and traffic problems—but protects homeowners against lengthy, uncertain, and expensive licensing and permitting processes that prevent people from working from home instead of in a traditional office.

If a mother can teach her daughter to play the violin in her living room, it makes no sense for the government to penalize her for teaching someone else’s daughter in the same living room for money. If it’s legal to do your income taxes at your kitchen table, there’s no reason an accountant should be barred from doing someone else’s taxes in her home office (assuming she follows the rules of the profession). As long as they’re not disrupting traffic or causing loud noises, there’s no reason entrepreneurs shouldn’t be free to sell things on the internet or repair furniture in the garage to help pay the bills.

Examples of Abuse

Cities from San Francisco to Phoenix routinely prohibit people from earning money by providing much-needed services from home, such as cutting hair, giving violin lessons, tutoring schoolchildren, teaching yoga, or doing people’s taxes. Some cities even require artists to get permission from the government to work in at-home studios. A Springfield, Virginia, woman who ran an internet clothing sales business from her home was forced to shut down because local zoning doesn’t permit “retail sales establishments” in homes—even if those sales only occur online. Many cities even prohibit home-based businesses from employing off-site nonresidents. Kim O’Neil, a resident of Chandler, Arizona, ran afoul of a similar restriction when she tried to run an unobtrusive home-based medical billing business that helped doctors and patients, and provided flexible jobs to a few women—only to be shut down by city officials because she employed people who didn’t even work out of her house.

Fiscal considerations

Eliminating or simplifying the permitting process should minimize costs associated with that bureaucracy. Economic growth resulting from a more sensible and streamlined process could also result in higher tax revenue from successful home-based businesses.

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Promote A Fair Permitting Process

Issue overview

Economic recovery in the wake of the coronavirus crisis will require new and innovative business methods and the swift transition of capital to new models of industry. Perhaps the most obvious barriers to that transition are the many different types of licensing and permitting requirements state and local governments impose. To prevent unjust and crippling bureaucratic delays, we must ensure that licensing laws are written in objective language, include a specific deadline, and provide a meaningful opportunity for judicial review in cases where permits are wrongfully denied. 

Policy recommendation

Require that when government imposes a requirement for a permit or a license, the criteria for the permit be clear and unambiguous, the timeline for the permit be specific, and that the applicant have a meaningful right to appeal a wrongful denial.

Examples of Abuse

Vague licensing requirements and delays in permitting are major barriers to job creation and to the opening of new businesses. Criteria for getting licenses or permits are also vaguely phrased much of the time. For example, in the city of Mesa, Arizona, residential building rules require that houses have “adequate design features to create visual variety and interest” and “create a distinctive and appealing community.” As desirable as “visual variety” might be, such subjective, aesthetic terms don’t give the kind of clear guidelines that the law should provide. Similarly vague rules often apply to occupational licenses. Louisiana, for instance, requires florists to be licensed, and to get a license, applicants must take a test where they are graded on their understanding of such artistic notions as the “harmony” and “effect” of flower arrangements. Baltimore prohibits food trucks from operating within 300 feet of a brick-and-mortar restaurant if they sell the “primarily same type of food product.” In some states, laws that require “good moral character“—without explaining what that means—can prevent people from getting their lives back on track for merely being accused of a misdemeanor, even if they’re never convicted. 

The coronavirus pandemic makes it all the more important that licensing requirements be written in objective terms and provide specific deadlines. An April 2020 survey by the National Multifamily Housing Council found that over half of the respondents are experiencing construction delays due to the pandemic, and three-quarters of which were caused by delays in permitting. Countless communities across the country have posted warnings like the one in Prince George’s County, Maryland, which tells would-be business owners that they “may experience a delay in receiving the application” for a permit.

Fiscal considerations

Requiring speedier approval of permit applications could conceivably cost more in the short run, but requiring objective criteria should also prevent burdensome and redundant bureaucratic processes in the long run, streamlining the process and costs for applicant and government alike. Economic growth resulting from a fairer and speedier process should also result in higher tax revenue from successful businesses.

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Allow communities to support local businesses through crowdfunding

Issue overview

With all of the economic damage that coronavirus has caused, many Americans would like to do their part to help local businesses survive and thrive. But some of those businesses need new ways to raise capital besides small business loans. What if there were a way for local residents to invest small amounts of money in local businesses, outside of traditional channels?

There is: intrastate crowdfunding, which allows businesses to raise small sums from a large number of people, usually via an online platform. Until recently, businesses were required to comply with burdensome—and enormously expensive—federal securities regulations to engage in local funding, even at small dollar amounts. This meant that many small- and medium-sized businesses were denied a mechanism for raising capital that has long been available to larger businesses, which can afford the associated costs.

Enter crowdfunding, wherein intrastate residents can give small- to medium-sized amounts of money to a local business to help it grow. A company using an intrastate crowdfunding exemption can raise an aggregate amount between $100,000 and $4 million within one year. Depending on the jurisdiction, individual investors can contribute up to $100,000 to a business through this method. 

Policy recommendation

Open this simple funding mechanism to the business community.

According to the North American Securities Administration Association, state and federal securities laws require companies to register their securities unless they are exempt from regulation. This makes it complicated, expensive, and ultimately infeasible for many small- and medium-sized businesses to raise capital. Crowdfunding can bridge the gap. While businesses conducting crowdfunding are usually exempt from federal regulations, states must specifically exempt them from state requirements, too.

Stories of Success

By 2014, 13 states had adopted rules that allow for intrastate crowdfunding. By 2018, 35 states had done so. Consider the success of FK Frozen Custard, in California’s Bay Area. For years, the company was food truck-only. Then in 2016, its owners decided to open a brick-and-mortar location. They set an initial crowdfunding goal of $30,000 and ultimately wound up raising nearly $37,000 to successfully open their new store. 

Fiscal considerations

None

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Ensure consumers get access to the food they need

Issue overview

The coronavirus crisis, coupled with the regulatory burdens on food producers, has created the real possibility of food shortages throughout the United States. This risk is largely the result of a bottleneck created by food inspection requirements that can only be satisfied at a small number of facilities—too small to meet the shift in demand brought about by closures of restaurants or shifts to take-out service. Expanding the options for consumers will help ease that bottleneck, give consumers greater choices, and meet safety requirements both in times of crisis and in times of plenty. Allowing home-based food makers to sell directly to consumers, and freeing consumers to buy shares in livestock to be delivered directly upon slaughter (while still meeting safety requirements), will help keep food on Americans’ tables and foster new businesses.

Policy recommendation

Adopt the Food Freedom Act, which facilitates farmers’ markets, permits the sale of homemade foodstuffs, and allows consumers to buy direct from farms. Specifically, the Act lets people sell homemade foods at farmers’ markets and specially designated sections in stores, allows the sale of “shares” in livestock—thereby enabling direct-to-consumer sales of meat—and permits the direct sale of poultry, eggs, rabbit, lamb, and farm-raised fish, so long as the sales are consistent with state law and the food is not involved in interstate commerce.

Stories of Success and Examples of Abuse

Versions of this reform have been adopted in Maine and Wyoming, and scaled-back versions (called “cottage food laws”) have been passed in California, Texas, and elsewhere. There have been no reported cases of foodborne illness from foods sold under these laws. The number of farmers’ markets in Wyoming alone has increased by some 70% since the reform’s adoption. 

People sell or exchange homemade food all the time—whether it be tortillas in Texas or brownies in Wisconsin—but the practice is actually illegal in many states. Laws against safe, homemade food lead to arbitrary and sometimes crushing punishments against people who have done nothing unsafe. By contrast, when home-based food businesses are allowed to flourish, they offer a real opportunity for economic success and provide buyers with better food choices. Hannah Shaw of Black River Falls, Wisconsin, was threatened with jail time and $10,000 in fines for selling cakes she made in her kitchen. When a trial judge found the punishment unconstitutional, she was free to advertise online and her business flourished. When California legalized (on a much smaller basis) certain homemade food sales, more than a thousand new businesses were started, including that of Mark Stambler, a baker whose business had been shut down after he placed an ad in the newspaper following a first-place win in the Los Angeles County Fair. When Texas passed its cottage food law, it gave birth to some 1,400 new businesses.

Fiscal considerations

Economic growth resulting from increased sales should result in higher tax revenue. There will be no increased outlays by the state. 

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Increase deductible charitable giving

Issue overview

Charitable nongovernmental organizations (NGOs) and philanthropic nonprofits are key to disaster recovery and relief. In the context of today’s coronavirus recovery efforts, grassroots and local-level responses rely heavily on charitable donations. Unfortunately, these donations have been declining for the past several years, especially in low- and middle-income circles. Declining donations make humanitarian organizations’ responses more difficult, and in turn, increase reliance on government, meaning an inefficient return on taxpayer investment.

Policy recommendation

Establish or increase allowable state income tax deductions for charitable giving, and allow these deductions regardless of whether a taxpayer files the standard deduction. This decreases the tax burden on filers, who are better equipped than government to handle disaster and pandemic relief efforts, while empowering people to make philanthropic donations to the grassroots organizations they prefer and trust.

Increasing the maximum deduction especially benefits the state’s middle- and lower-income filers. If a middle-income filer with an annual salary of $50,000 can have a $100 tax reduction, for example, then as a percent of income, this filer benefits more than a high-income earner. An increase in the maximum charitable deduction is a progressive tax reform that benefits the middle class the most.

Stories of Success 

Charitable giving is estimated to decrease nearly $21 billion per year due to the 2017 Tax Cuts and Jobs Act. Between late May 2018 and late May 2019, nationwide charitable deductions fell from over $32 million to just over $11 million, with corresponding dollar amounts falling from nearly $150 billion to under $92 billion. Allowing charitable deductions to be tacked on to the standard deduction could stop or reverse this trend.

Arizona passed a law in 2019 which allows up to 25% of a filer’s charitable donations to be added to the standard deduction. This empowers taxpayers to give to charities—including those funding pandemic relief—regardless of whether or not they choose to itemize.

Fiscal considerations

While tax credits and deductions can reduce total state revenues, and if crafted narrowly can cause distortions in the market, broad-based charitable tax credits like the one proposed here can actually produce a net financial benefit to state government and local organizations. As MIT economics professor Jonathan Gruber has written, “a large number of studies” have shown that “for each 1% reduction in the relative price of charitable giving, the amount of giving rises by 1%.” By contrast, $1 of government spending on charitable causes “raises overall spending by [only] 30 to 90 cents. … Thus, it appears that … subsidizing private giving is a more efficient way of providing resources … than direct spending.”

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Minimize crisis-related cronyism

Issue overview

Passed in response to the coronavirus crisis, the federal Coronavirus Aid, Relief, and Economic Security (CARES) Act and related measures have authorized unprecedented levels of federal spending to be disbursed to public and private entities in all 50 states. Although government is required to disclose how it gives away this money to a degree, significant sums are at risk of being allocated in a more opaque—and arbitrary—fashion. To cite one example, the Wall Street Journal reported in April 2020 that the “Small Business Administration rejected multiple requests … for detailed information about borrowers in the new Paycheck Protection Program, saying it needed to prioritize its effort to assist businesses.” With $150 billion distributed to state and local governments under the Coronavirus Relief Fund alone—and few restrictions on how those funds should be disbursed—it is essential that government entities responsible for allocating public funds do so transparently and with reasonable controls to promote fairness, avoid fraud and waste, and ensure the expenditure of public funds achieves public purposes.

Policy recommendation

Require (within 60 days) the disclosure of any CARES Act funds distributed by a state or local government entity, including the amount—by recipient—and the criteria by which funding allocations were made. The expenditure of public funds should be for public purposes and accompanied by measures that avoid fraud and ensure a public purpose is accomplished.

Stories of Success 

Many state and federal laws and grant provisions already require the disclosure of expenditure information. Even the application for the Governor’s Emergency Education Relief Fund (GEER) under the CARES Act requires states to “submit to the [U.S. Department of Education], within 45 days of receiving GEER funds, an initial report detailing the State’s process for awarding those funds to LEAs [school districts], IHEs [institutions of higher education], or other education-related entities … and a description of the process and deliberations involved in formulating those criteria.”

Moreover, organizations like the Goldwater Institute have demonstrated that “gift clause” provisions in state constitutions can help ensure that taxpayer funds are not inappropriately spent in ways that fail to advance a public purpose.

Fiscal considerations

The disclosure of funding should not materially increase state or local government costs.

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Eliminate restrictions on retrofitting businesses for safety

Issue overview

Speeding economic recovery from coronavirus-related shutdowns will require eliminating barriers to economic growth. One way to accomplish this is to give businesses the needed flexibility to reconfigure their buildings and spaces to accommodate practices that have been changed because of the crisis. For instance, restaurants may find it necessary to reconfigure their kitchens to better protect workers, or they may need to reconfigure their dining rooms to provide better spacing between customers. Some may wish to add a walk-up window. Similarly, manufacturers may need to reconfigure assembly lines.

Whatever the case, individual businesses are in the best position to make these decisions. Virtually all of them have suffered economic setbacks due to the crisis. Now is the time to eliminate burdensome and restrictive approval processes for making needed changes. Not only will this speed up the process—thereby improving public safety—it will also reduce the cost of making changes. Government approvals should be as fast, streamlined, and inexpensive as possible.

Policy recommendation

State legislatures should pass legislation that requires cities and counties to dramatically streamline—or eliminate—approval processes for any building modifications that a business makes in order to (1) improve customer safety, (2) improve employee safety, or (3) modify operations to address changed circumstances in light of the pandemic (for instance, installing a walk-up ordering window).

Stories of Success 

Tesla’s modifications to its factories have been exemplary. For instance, after retrofitting its Gigafactory in Shanghai, China, the company reports that the factory “has seen smooth and healthy operations for the last three months.” Tesla is now implementing similar modifications to its American factories, including adding partitions or barriers to separate work areas and minimizing employee interactions by positioning parts closer to where the task is completed on the line.

Likewise, the National Restaurant Association has released a 10-page guide for its members to safely reopen. In addition to simple and obvious steps like sanitizing surfaces more frequently and requiring employees to wear face masks, the guide includes more expensive modifications such as spacing tables and booths by six feet, modifying waiting areas, expanding outdoor seating, and changing ingress and egress points. These steps can be costly, and government should get out of the way of any business seeking to implement them.

Fiscal considerations

Streamlining or eliminating burdensome processes could result in local governments collecting fewer fees for permits, but fewer resources would be expended for processing applications. Moreover, economic growth generated from this policy could also result in higher tax revenue.

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Protect the right to rent homes to overnight guests

Issue overview

The right to own private property is a fundamental human right. It includes a homeowner’s right to decide whether to let others stay in his or her home. Many property owners who open their homes to visitors use the rental income to pay for medical bills, mortgages, food, and other essentials. Particularly in times of crisis, home-sharing can provide a financial lifeline. Unfortunately, some cities and states willfully violate this right, placing unfair restrictions on how property can be used, often with a specific focus on short-term rentals. In some cases, these actions impose arbitrary searches on homeowners, discriminate against non-residents, and subject them to extreme punishment without fair warning or clear guidelines.

During the COVID-19 crisis, many states wisely chose not to prohibit short-term rentals, instead allowing responsible homeowners to provide clean, safe lodging options to first responders—as opposed to directing these caregivers to more densely populated hotels where social distancing might be more difficult to practice. Allowing homeowners to provide this safe alternative is an effective way to allow them to generate much-needed income while providing convenient lodging for medical personnel.

Policy recommendation

Adopt the Home-Sharing Act to protect the rights of responsible homeowners. This reform empowers communities to focus regulatory efforts on bad actors while ensuring that short-term rentals are not banned or unfairly targeted. In addition to the financial security that home-sharing can provide, the benefits extend outside of a home’s property lines. The local spending that accompanies short-term rental visitors will be invaluable for economic recovery at the community level, particularly for restaurants and other businesses hard-hit by mandated closures. States should act to bolster private property rights while allowing communities and visitors to benefit from the positive effects of home-sharing.

Stories of Success 

The Home-Sharing Act already protects essential private property rights in Arizona, Indiana, Nebraska, and Tennessee, and has been introduced in several other states. The Act prohibits local governments from banning home-sharing or subjecting property owners to needless and burdensome regulations. It protects the rights of homeowners to rent their property to overnight guests, while preserving city officials’ authority to punish and prevent actual nuisances such as noise, traffic, and trash problems. Arizona’s Home-Sharing Act meant the world to homeowner Glenn Odegard, who spent his own time and money restoring an abandoned home in the town of Jerome (and at the same time reducing neighborhood blight at no cost to taxpayers), only to have the city outlaw short-term rentals and threaten him with criminal penalties. The Home-Sharing Act restored his right to responsibly use his property and contribute to the local economy.

Fiscal considerations

Home-sharing has long had a positive impact on local economies and state budgets. Online platforms have made home-sharing easier than ever, resulting in hundreds of millions of dollars in positive economic impact for state economies. By protecting the right of Americans to open their homes to visitors, the Act benefits local economies by generating spending by visitors, and improves state and local government revenues as a consequence. Further, cities can save time and money by focusing their enforcement actions on genuine nuisances instead of targeting law-abiding citizens.

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Stop police from needlessly seizing property

Issue overview

Due to the economic crisis caused by the coronavirus pandemic, states and cities are anticipating large budget shortfalls. If officials do not exercise fiscal restraint, they may be tempted to turn to civil asset forfeiture to make up budget shortfalls. Police and prosecutors around the country have a long history of using forfeited cars, cash, and other assets to fund their operations—despite the fact that many property owners who have their property forfeited are never convicted of, or even tried for, a crime. Fortunately, many states have reformed their civil forfeiture laws in recent years to better protect property owners and put the focus of forfeiture actions back on prosecuting actual crimes rather than “policing for profit.” The looming state and municipal budget crisis should not be used as an opportunity to reverse these reforms. On the contrary, now is the time to ensure that states that have not implemented these important protections adopt them.

Policy recommendation

Reform civil forfeiture laws and strengthen protections for private property owners.

Examples of Abuse 

In 2016, a sheriff’s deputy in Muskogee, Oklahoma, pulled over a car for a broken taillight. During the stop, he discovered that the driver, Eh Wah, had approximately $53,000 cash in the car. Eh explained that he was the manager of a Christian music group from Burma and had been touring the country playing in churches to raise money for their church back in Burma and for an orphanage in Thailand. Some of the money was even in envelopes marked “donation,” with the name of the orphanage on them. Despite this, the sheriff seized all the money and released Eh without charging him with any crime. The sheriff returned the money only after a front-page story about the case ran in the Washington Times.

In 2017, Phil Parhamovich was pulled over during a routine traffic stop in Wyoming. During the stop, deputies discovered he had $91,800 cash in the car. Phil explained that it was his life savings. No drugs or any other indications of wrongdoing were found in the car. Under aggressive questioning, deputies convinced Phil to sign a roadside waiver “giving” the money to the Wyoming Division of Criminal Investigation. Phil was then issued a $25 ticket for not wearing his seatbelt. He was never charged with any other crime. Only after Phil sued to get his money back, and after substantial media attention, did the deputies relent and return the cash.

Fiscal considerations

There is no negative fiscal impact from maintaining current protections against civil forfeiture. Depending on current levels of abuse, reforms that seek to curb that abuse can carry fiscal implications. But nothing in these reforms stops law enforcement from using revenue collected from people who have been convicted of a crime. 

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Give parents more choice in education

Issue overview

Traditional public education is often poorly suited to meet the needs of individual students—whether they are gifted, have special needs, or simply do not fit into one-size-fits-all modes of instruction. As witnessed during the pandemic, many school systems have struggled to adapt to the learning needs and life circumstances of students, with some districts even suspending all instruction for all students because they could not guarantee equitable services for students with special needs or without internet access. 

Given the failure of so many school systems to meet the needs of their students, it is perhaps no surprise that 40% of families surveyed in the midst of the coronavirus crisis stated they are now more likely to enroll their children in a homeschooling co-op or virtual school as a way to ensure their children receive an education that best fits their needs.

Policy recommendation

Implement, broaden, and/or accelerate access to education savings accounts (ESAs). ESAs take a portion of what a state would have spent on a student in a public school and instead deposit those funds into flexible spending accounts that parents can use to meet their children’s individual educational needs, whether via tutoring, textbooks, private school tuition, special education therapies, online instruction, or at-home curricula. Especially during times in which school systems are being disrupted, ESAs can ensure that families have the resources, flexibility, and control necessary to continue supporting their children’s learning.

In states that have already implemented ESAs, policymakers should require the expedited processing of new applications to ensure that families can more seamlessly transition to an ESA if the need arises. In states like Arizona, while statute requires new applications to be processed within 45 days, the vast majority of applications submitted in spring/summer are delayed well beyond this.

Stories of Success

Five states—Arizona, Tennessee, Mississippi, Florida, and North Carolina—have successfully implemented ESAs for special needs or other student groups most in need of educational flexibility, including students from D- and F-rated public schools, foster care, Native American reservations, and military families.  

ESAs have found champions like one Arizona mother who testified in 2019 to legislators in support of her state’s program: As a “former public school teacher, army veteran, special needs mom, and now an ESA parent … having access to this incredible program has literally saved my special needs son and my family.” 

Fiscal considerations

ESAs generate fiscal savings for taxpayers. In Arizona, for example, the median (non-special needs) ESA award in FY 2019 cost roughly $6,100, compared to over $10,000 in per pupil spending in public schools. ESAs can also reduce budget pressures on school districts by serving high-need, high-cost special needs students, who—according to districts—cost more to educate than districts receive in funding. 

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Protect online charter schools

Issue overview

As states across the country closed school campuses in response to the COVID-19 outbreak, several states also intentionally closed off students’ remaining educational opportunities at online schools. The Oregon Department of Education, for example, declared: “Virtual public charter schools may not enroll new students or withdraw existing students during the period of school closure.” There was no health or safety rationale for doing so; this was done simply to protect enrollment levels at district schools. But it’s wrong to deprive students of educational opportunities simply to serve the budgetary needs of education bureaucrats.

Policy recommendation

Prevent government entities from arbitrarily freezing online (charter) school operations or enrollment during the disruption or closure of physical school campuses when no reasonable health or safety rationale exists for doing so.  

Stories of Success

In March 2020, Arizona Governor Doug Ducey issued an executive order prohibiting any county, city, or town from making “any order, rule, or regulation” that restricts any activity designated as an essential function, including “educational institutions” that operated online.

Looking elsewhere, the Success Academy charter school network has distinguished itself over the years by offering academic opportunities even to the most disadvantaged students in New York. While many districts struggled to develop learning plans amid campus closures, Success Academy’s students achieved a 97% attendance rate in their first week after transitioning to remote learning, which featured “twice-daily phone debriefs with their teachers.” In fact, so remarkable was the success of this high-quality charter’s online instructional approach that it began sharing its remote learning plans with district superintendents and principals around the country during the coronavirus outbreak. Such innovation should be encouraged, not prevented.

Fiscal considerations

Allowing the continued operation of online schools need not have a fiscal impact on state budgets. Depending on the structure of a particular state’s school funding formula, students who transition to online charter schools can reduce overall taxpayer costs. 

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Ensure schools provide educational services during shutdowns

Issue overview

Early in the COVID-19 outbreak in the U.S., several school districts announced draconian policies to cease all student instruction. Rather than simply complying with mandated closures of school facilities, these districts also actively opposed that teachers instruct their students in any form out of fear of not being able to serve all students equally. As Philadelphia school district officials directed their teachers, for example, “To ensure equity, remote instruction should not be provided to students, including through the internet, technology at home, by phone, or otherwise.” At the same time, district staff and public school teachers around the country generally continued to receive paychecks funded in large part by state K-12 formula dollars.  

Policy recommendation

Require that, to the extent possible, school districts and charter schools continue to provide educational services to students during the closure of physical school campuses in order to continue receiving state formula funding. 

Stories of Success

Emergency K-12 legislation passed in Arizona lifted seat time/attendance requirements during the coronavirus-related school closures, but state legislators also insisted that public schools continue to offer educational services to students to continue receiving state funding. Unlike other school districts around the country—which sometimes took up to six weeks to begin offering educational services to students, if they did so at all—Arizona mandated that schools resume educating students within two weeks of the closure, ensuring the least possible disruption to student learning. 

Fiscal considerations

This will result in no additional fiscal cost to taxpayers. 

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Ensure that nonpublic education remains a Viable option amid economic uncertainty

Issue overview

While many states face enormous budgetary pressures in the wake of the economic disruption caused by coronavirus, public schools around the country continue to receive state formula assistance and were the primary beneficiaries of roughly $15 billion in federal K-12 aid via the CARES Act. Meanwhile, private schools remain almost wholly dependent on tuition payments from families to sustain their operations, and historical evidence suggests these institutions will soon face massive declines in enrollment. Such a dramatic exodus of students would not only devastate the private school sector, but would also lead to an enormous strain on state budgets as public schools absorb the influx of new students.

Policy recommendation

Implement or expand private school tax credit scholarship programs to (1) help ensure the affordability of nonpublic educational options for families, (2) prevent the collapse of all nongovernment-run education providers, and (3) ease the budgetary impacts of a surge in public school enrollment. 

Stories of Success

Tax credit scholarship programs have been successfully enacted in 18 states, offering positive academic and financial benefits. For example, the progressive Urban Institute found in 2019 that the Florida Tax Credit scholarship program, the nation’s largest school choice program, in which low-income students from low-income schools are the primary participants, “has a positive effect on college-going and graduation rates.”  

Fiscal considerations

While tax credit scholarship programs can reduce total state revenues, they simultaneously lower state and local costs by an even greater amount, leading to a net economic benefit to the state. With an average scholarship value of $6,195, for example, Florida’s tax credit scholarship program has helped thousands of students at a cost that’s $3,000 less per student than Florida’s public school per pupil spending.

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Foster financial accountability, not blank checks

Issue overview

Public schools across the country joined together to request $175 billion in federal support for public K-12 systems in response to the coronavirus pandemic, in addition to the approximately $15 billion already allotted to them under the federal CARES Act. While many school systems have no doubt incurred substantial new costs (procuring laptops and wireless hotspot devices for students, etc.), they have also accrued unprecedented savings (such as reduced fuel costs for idled buses and lowered utility costs at dormant campus buildings) that should be taken into account in budgeting.

Moreover, public schools receiving federal funds are required to provide “equitable services” to private schools within their boundaries (which entails paying for certain instructional goods or services for the private schools, but not actually transferring funds to them). However, districts’ compliance with this requirement can vary, potentially leaving private schools further disadvantaged and without even the modest aid intended for them. 

Policy recommendation

Require school districts that receive emergency K-12 funding to report to the state’s legislature (1) the total costs and savings incurred as a result of COVID-19 pandemic, (2) the amount of emergency state and federal relief funds received, and (3) the total expended to provide “equitable services” to surrounding private schools. 

Stories of Success

The federal Every Student Succeeds Act—passed with bipartisan support in 2015—requires public disclosure of school-level expenditure data beginning in 2020 and is poised to bring unprecedented levels of transparency to public school finances. Moreover, some states already disclose highly detailed school spending data in user-friendly formats to legislators, such as the Arizona Auditor General’s annual School District Spending profiles. States could solicit similar transparency from districts, either as a statutory mandate or by directing their state audit agencies to review the financial impact of the COVID-19 outbreak on schools. 

Fiscal considerations

The fiscal impact of such a proposal could vary. While preparing reports may require additional staff time, an accurate accounting of school expenditures could save money in the long run by ensuring that school officials do not make arbitrary funding demands that lack connection to financial realities. Transparency can also improve efficiency by identifying where, and to what extent, additional aid is most warranted. 

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Promote academic transparency over politicized curricula

Issue overview

Politically radical content is being introduced into curricula and student learning materials in K-12 schools across the country. The New York Times’s 1619 Project, for example—which claims that the United States Constitution was written to protect slavery—reached more than 3,500 classrooms within months of its introduction in 2019, despite widespread criticism from professional historians and such marked flaws that the Times itself was forced to publish a “clarification” backing away from some of the articles’ more extreme claims.  Nevertheless, it and similar materials are rapidly gaining favor among educators in many of the nation’s largest school systems. Even as polling found that almost half of all voters are concerned by such politicized content in the classroom, parents typically have little information about the use of these materials and minimal ability to find out in advance whether their children will encounter them in school. 

With essentially all students learning from home during the COVID-19 pandemic, however, parents have—for the first time—been given unprecedented access to information about the materials presented to their children. Lawmakers and educators should take this opportunity to sustain and build on that transparency going forward. 

Policy recommendation

Empower parents to choose schools that teach academically rigorous material instead of politically motivated content. By requiring public schools to disclose on their websites all materials used as part of student instruction, policymakers can ensure that parents have access to the information they need to protect their children and are better able to vet their options and exercise meaningful choice. 

Stories of Success

Arizona’s Senate Education Committee approved legislation in 2019 that would have required schools to post on their websites a listing of all instructional materials. While the COVID-19 outbreak interrupted Arizona’s legislative session and prevented enactment of the bill, the Goldwater Institute has released a policy brief with a variety of examples of schools (from K-12 to higher education) successfully posting syllabi and other detailed course information online so that parents and students can access it while making decisions about where to enroll. 

Curriculum transparency is already common on the college level. For instance, at Arizona State University, which is consistently rated as “The #1 Most Innovative University” by U.S. News and World Report, prospective students can easily access course syllabi showing individual textbooks, articles, and other readings that students will encounter. K-12 schools should shine a light on the materials they use, too.

Fiscal considerations

Especially in states like Arizona, where teachers are commonly expected to submit lesson plans to principals or curriculum staff in advance, most instructional materials should already be documented. Making this information public should thus require only modest additional time or expense. 

VIEW MODEL LEGISLATION

Ensure doctors have the information they need to help their patients

Issue overview

In the midst of the coronavirus crisis, and with no FDA-approved vaccines or treatments for COVID-19, many doctors and hospitals across the country reported using chloroquine or hydroxychloroquine, often in combination with Zithromax (commonly known as a Z-Pak), to treat COVID-19 patients. All three are FDA approved: chloroquine and hydroxychloroquine for malaria, lupus, and rheumatoid arthritis, and Zithromax as an antibiotic. But prescribing them to treat COVID-19 is an “off-label” use, meaning the use of a medicine to treat conditions other than what the FDA approved that medicine to treat. Off-label uses are legal and common. In fact, roughly 20 percent of all prescriptions are off-label.

Unfortunately, federal laws sometimes prevent drug manufacturers from sharing important information about off-label uses, and violating those rules can result in criminal prosecution and penalties. Of course, the ability to share truthful, scientific, and up-to-date information about off-label treatments is critical to ensuring doctors can provide the best treatments for their patients, especially when lives are at stake. 

Policy recommendation

Adopt the Truth in Medicine Act, allowing manufacturers to share truthful scientific information about off-label treatments. This protects the right to freely exchange valuable data about legal treatments and provides doctors and payers with the tools they need to make informed healthcare decisions with their patients.

Stories of Success

Arizona and Tennessee both adopted this law with unanimous legislative support. 

Fiscal considerations

None

VIEW MODEL LEGISLATION

Facilitate telemedicine

Issue overview

The coronavirus crisis has demonstrated like never before the benefits of telemedicine—technology that enables people to obtain medical assistance and talk to physicians directly on their smartphones or tablet computers. During lockdowns, telemedicine has enabled doctors to conduct initial patient screenings, treat patients with minor ailments who might otherwise be forced to break home quarantine, and monitor the status of sick patients remotely.

Both the private and public healthcare sectors have rapidly adopted telemedicine. Some private insurers waived copays for any and all telemedicine visits during the height of the crisis. Others waived cost sharing for all video visits through services such as CVS MinuteClinic app and Teledoc. Medicare, the primary healthcare program serving the nation’s aged population, announced it would temporarily reimburse providers for telemedicine visits for a wide range of services.

Unfortunately, there have been efforts in some states to impose new regulatory restrictions on telemedicine that have no connection to patient safety. For example, some states require patients to get an in-person exam or physically visit a doctor before that doctor can provide a prescription. Rather than allow physicians to exercise their professional judgment whether to require a patient to visit a clinic in person, lawmakers have often imposed one-size-fits-all rules that prevent medical innovation and restrict the availability of medical services to patients in need.

Policy recommendation

Allow medical professionals to provide telemedicine services to both new and existing patients. Patients should be able to consent to care from an out-of-state provider. Where supervision of a provider is required by law, it should not have to be in real time or limited by geography.

Stories of Success

Dr. Beverly Jordan of Enterprise, Alabama, recently saw about 30 patients via telemedicine in one week. While telemedicine was already available in the state, the cost of using an online platform, as well as a lack of insurance coverage for telemedicine services, made the expense and effort out of reach for her medical practice. But as a direct result of the Centers for Medicare and Medicaid Services’s new flexibility, online platforms began offering free trials of their services. Insurers in Alabama followed the federal government’s lead and began covering these visits. Prior to this crisis, none of these 30 telemedicine visits would have been covered by insurance and thus unlikely to be available to these patients.

Fiscal considerations

The Medicaid program has a long history of fraud and abuse, and telemedicine is susceptible to such abuse. The same measures that are now used to combat such abuses in Medicaid must apply to any expansion of medical services.

Some have expressed concern that if it is easier to obtain an appointment through telemedicine, Medicaid spending on appointments and services will increase. But it’s long been recognized that when patients get “well visits” and health-maintenance visits in a convenient and timely manner, costs tend to decrease because patients can better manage their conditions and lower their reliance on emergency room visits—ultimately saving program dollars. Additional monitoring and evaluation is needed to determine the fiscal impact of telemedicine expansion. Lawmakers should avoid policies that provide for telemedicine payment parity.

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Allow healthcare workers to practice at the top of their training

Issue overview

State “scope of practice” laws dictate how doctors, nurses, pharmacists, and other healthcare practitioners may care for and treat patients. These laws vary widely from state to state, and they often needlessly prevent healthcare professionals from helping patients, even those who are trained and competent to do so.

Regulated medical professionals include but are not limited to:

  • Physician Assistants
  • Nurse Practitioners
  • Certified Registered Nurse Anesthetists
  • Respiratory Therapists
  • Registered Nurses
  • Nursing Assistants
  • Dental Therapists
  • Dental Hygienists
  • Pharmacists
  • Pharmacy Technicians
  • Physical Therapists
  • Optometrists
  • Emergency Medical Technicians
  • Paramedics

Too often, the laws governing these professionals limit what services they can provide, not to protect patient safety but to prevent legitimate economic competition between providers. The result is to increase the cost of care by forcing consumers to pay higher prices than they otherwise would.

Imagine if the law only allowed car dealers to provide oil changes. Customers who might have had their oil changed for $30 at Jiffy Lube would be forced to spend $80 at the dealership instead. Not only would this cost customers more money, and cost potential jobs, but it would deter car owners from getting oil changes they needed—resulting in long-term damage to their cars. In the same way, scope of practice laws for medicine often result in patients paying more than necessary, which reduces employment opportunities for nurses and other paramedical providers, and harms patients by discouraging them from seeking care when they need it.

Some states have reduced their scope of practice restrictions and allowed for more provider autonomy—and the results have been a reduction in the cost of healthcare services, an increase in the availability of providers, and no reduction in safety for patients. The Centers for Medicare and Medicaid Services allowed for the reimbursement of services performed outside of a provider’s government-approved scope of practice during the COVID-19 crisis under Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP).

Policy recommendation

Allow medical professionals to practice at the top of their education and training by removing barriers that artificially limit the availability of qualified healthcare providers. In addition to scope of practice requirements, requirements for in-person, real-time supervision and collaborative agreements should also be modified or rescinded.

Stories of Success

Certified Registered Nurse Anesthetists (CRNAs) receive highly specialized education and training that goes beyond Registered Nurse (RN) certification. CRNAs may administer anesthesia, intubate, and ventilate patients, which is often necessary for the most severe COVID-19 patients. As a result of important reforms in Arizona, hospitals are now expanding their use of CRNAs across the state. For example, Santa Cruz Regional Hospital in Green Valley, Arizona, will now have CRNAs as part of their ICU teams to help meet the needs of their sickest patients.

Reforms like this are particularly important in rural areas where there is already a severe shortage of highly specialized providers who have the education and training to provide anesthesia and perform other necessary procedures related to COVID-19.

Fiscal considerations

None

VIEW MODEL LEGISLATION

Remove restrictions on healthcare settings

Issue overview

In addition to artificially limiting new hospital facilities, the numbers of hospital beds, and new technologies, states also restrict the types of care settings where medical professionals may see patients. This is often done under so-called certificate of need (CON) laws.

CON laws require government approval before physicians can open new facilities or expand their services. This approval requirement applies to everything from building a new hospital to acquiring an MRI machine. But the government approval process depends on approval from existing clinics and providers. In other words, these laws prohibit new or expanded medical facilities from operating if existing providers don’t want to face economic competition from newcomers. CON laws therefore often serve the private interests of existing hospitals rather than the needs of patients.

In the late 1970s, the federal government and most states abandoned CON laws when it became clear that they drive up healthcare costs, lower quality, and limit the availability of needed services. Yet these laws still remain in many states, and in many different forms.

Some CON laws prevent healthcare providers from serving people in homes or other alternative care settings. These restrictions may limit the ability of nursing homes, for example, to quickly move exposed residents, as well as those still testing positive for COVID-19 after returning from the hospital, to an alternative setting to be cared for by their familiar caregivers.

Policy recommendation

Provide more flexibility in the supply of healthcare beds and technology, the allowable healthcare settings, and the types of professionals allowed to provide care in those settings.

Stories of Success

In order to allow facilities to expand patient capacity, Arizona Governor Doug Ducey used his executive order authority to direct healthcare facilities to optimize their staffing levels and expand bed capacity in healthcare facilities. In addition, facilities were allowed to “level up” their provision of care when needed; for example, a pediatric unit would be authorized to care for those up to age 21, and a Level III trauma unit would be authorized to provide Level II care if and when possible and appropriate. These orders also align with federal flexibilities for programs under Medicare, Medicaid, and CHIP.

Fiscal considerations

None

VIEW MODEL LEGISLATION

Increase liability protections to promote care

Issue overview

Some states do not have adequate liability protections for in- and out-of-state medical professionals who are able and willing to assist in a medical emergency. Absent protections, healthcare professionals face lawsuits and financial ruin for a variety of reasons: infecting another patient, failing to prescribe a medication that might help, prescribing a medication that might make the patient worse, or a delayed response in responding to a patient’s call because of the time required to don the mandatory personal protective equipment. As a result, doctors, nurses, and other medical professionals may be reticent to provide care when it is most needed, such as during a public health crisis.

The state’s insurance commissioner should identify and recommend temporary or permanent waivers of limitations in current policies, in order to extend the necessary protections. In some cases, the state’s insurance commissioner may have independent authority to waive, modify, or rescind some provisions or limitations of malpractice coverages that could further protect healthcare professionals working in the state.

Policy recommendation

Waive liability when possible, or extend protections to include both volunteers and paid personnel.

Stories of Success

The Illinois Emergency Management Agency Act, for example, extends civil liability protections to healthcare workers operating under the direction of the government during a declared disaster or emergency. The governor’s executive order declaring such an emergency during the COVID-19 crisis directed the “rendering of assistance” to healthcare professionals, volunteers, and facilities. The healthcare workers, volunteers, and facilities responding to the order received civil liability protections for any patient injury or death while providing care in response to the COVID-19 outbreak, and patients were still protected against gross negligence or willful misconduct.

Fiscal considerations

None

VIEW MODEL LEGISLATION

Allow for the easy transfer of prescriptions between pharmacies

Issue overview

State laws often make it difficult to transfer a prescription from one pharmacy to another. While states sometimes make limited exceptions for health and weather emergencies, patients are usually required to petition a pharmacy directly to transfer a prescription. This requires the patient to invest significant time and can even result in a patient missing needed medications.

Fortunately, new federal rules allow patients to have more control over and access to their personal healthcare information, including their prescription history. Beginning in 2022, patients will be able to access their medical information through their smartphones. States can complement these new federal rules by adopting pharmacy transfer reforms or by making their temporary exceptions to pharmacy transfer restrictions permanent. This would give customers greater control over the transfer of their prescriptions between pharmacies and more power to shop for the best prescription drug prices.

Imagine having access to your prescription history on a smartphone. A third-party e-prescribing network could take your prescription (via an app), shop around for the best price, and then send your prescription to that pharmacy. This would serve patients who are away from their home pharmacies or searching for lower prices. E-prescribing networks could regularly search for better deals or longer refills and report the results directly to the patient, who could request the transfer instantaneously. Making prescription transfers seamless—instead of relying on the pharmacy, which has no incentive to quickly transfer a prescription to a competitor—empowers consumers and increases price competition and transparency.

Policy recommendation

Allow a patient’s current medication history (at the patient’s written, electronic, or oral request) to be accessed from a real-time, electronic database to serve as an equivalent to an electronically transmitted prescription or refill order to be filled by the pharmacist.

Examples of Overreach

Prescription drug prices should not only be transparent to the consumer, they should be shoppable. Consider the following: A 30-day supply of montelukast, the generic form of the asthma and allergy drug Singulair, costs about $120. The cost on GoodRx.com, an online price comparison tool, is about $60. The cost through an employer health insurance plan is about $16, while getting the drug through a direct primary care (DPC) arrangement that charges at cost for their members can be as low as $1.

Unlike most products, the prices of prescription drugs are difficult to understand and often vary from person to person, depending on their insurance coverage. As a result, patients are unaware of significant discounts through mail-order pharmacies. Even when they do learn about a lower price, they often face the time-consuming and burdensome process of transferring a prescription. Personal control over one’s prescription information enhances a patient’s ability to take advantage of competitor prescription prices.

Fiscal considerations

None

VIEW MODEL LEGISLATION

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