Lawmakers Were Sold Jobs. They Bought Bigger Government
Reciprocity, recognition, or a permanent interstate commission. Only one of these was on the ballot
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A Redditor posted, “I’m moving and have to stop seeing my therapist of seven years I have some personal stuff going on that’s resulted in having to forcibly move out of state. my T isn’t licensed there which means ill have to stop seeing them after 7 years of working together. we have such a good relationship and i love them and cant picture not seeing them anymore. im so so devastated and don’t know what to do. every time i think about it i just start spiraling.”
Every day, clients and therapists face similar situations, but with professional licensure tied to a single state, clients usually have to start over with someone new, even though therapy can be done over the phone.
Such situations, no doubt, factored heavily into the push to find a way for counselors and social workers to practice across state lines. And in a world of law and regulation, achieving widespread licensure recognition is mostly a matter of writing policy and getting lawmakers to vote for it. This is also where things go sideways.
Eeny, Meeny, Miny, Moe, Pick Good Policy By the Toe
It is the details of how a policy functions that tell us where the conflicts of interest are lurking and where incentives run, and the differences between one choice and another can be quite stark. Take these three ways to solve the professional licensure problem.
Reciprocity Agreements: With this solution, State A agrees to honor State B’s license, usually with both states extending the honor to each other. Depending on other state law, this can be achieved by the legislature passing a law (statute), or if the licensing board is already empowered, this can be made with a board level regulation. What’s good about reciprocity agreements is they are relatively easy to reverse. They can even be made with built-in sunsets, and they don’t require a new governmental structure to be built.
Universal license recognition: This is where State A unilaterally decides to recognize out-of-state licensees who meet stated conditions. This doesn’t require the permission of other states, and it can also be built with sunsets, transparency, or whatever else the state in question thinks will be important for its citizens. Arizona is already working from this model.
Compact: With a compact, each state legislature votes on model legislation that is identical. The legislation creates an interstate commission to manage the privilege of working across state lines. This commission, once established, doesn’t sunset; whatever transparency it has or doesn’t have is locked with whatever that model legislation called for. Compacts have rulemaking power, a budget, staff, accommodations, emergency power, broad immunity to lawsuits, enforcement authority, and whatever was written in to the fine print of the model legislation.
The first two options create space for a person to work in a different state market. The third, compacts, create an institution that functions above the level of the states, and has an unclear relationship to the U.S. Constitution.
What’s Behind Door Number Three?
As an agreement, a compact does allow for practitioners to work across state lines with just their home license as a requirement, in all other states that have also signed on. But they can also do more than just that. Sometimes a whole lot more.
Under Section 12. A of the Counseling Compact, rules that the commission makes carry the force of law in every member state. This is the specific text in question:
The executive, legislative, and judicial branches of State government in each Member State shall enforce this Compact and take all actions necessary and appropriate to effectuate the Compact’s purposes and intent. The provisions of this Compact and the Rules promulgated hereunder shall have standing as statutory law.
The Social Work Compact, which swept through state legislatures this year, has a small provision tucked in to Section 12. N which states:
No Member State’s rulemaking requirements shall apply under this compact.
The Dentist and Dental Hygienist Compact, currently adopted in 13 states, has a similar provision in Section 9. N.
This sentence says that the compact sidesteps state procedures to announce rule changes and allow for public comment on those changes. Instead, these compact commissions follow their own procedures, which don’t include a legislative review or allow for challenge in a state court.
In short, the rules for a profession could change, and if practitioners aren’t watching the compact’s communications, they might not know. If we don’t like the change, you have to fight it in federal court.
And what about states that join after the compact has made new rules? According to the Counseling Compact 13.B, Social Work Compact 14.A.4, and the Teachers Compact XI.C., new states are bound by every rule already on the books as of the day of their enactment, with the full force of law.
The question that clients, practitioners, lawmakers, and voters should be asking now is whether any of this is necessary to let a professional work in another state. If Arizona can be counted as a counterexample, the answer is a resounding no.
I Thought We Had an Agreement!
With a reciprocity law, if a state wants to close its doors, it can repeal the law, or decline to renew a sunsetting statute. All done.
With a compact, a state can repeal their involvement, but depending on the compact, they may wait roughly six months; all the while they must continue reporting to the commission and recognizing out-of-state licenses until the procedural bonds are fully severed.
Where the Rubber Meets the Road
While many citizens point out that it is harder to achieve the American Dream, they may also look at these details of professional licensure and think “so what”? But there is an important connection being overlooked here.
Legislators who were sold the idea that joining a compact will open up new markets and opportunities may be surprised if those market pressures don't deliver. Much like licensing itself allows practitioners to charge higher fees and limit competition, compacts populated by industry insiders with broad immunity from lawsuits will now be positioned to take that to another level.
Therapists and other professionals will still have to jump through whatever hoops their compact requires, including binding codes of ethics attached to mandatory national exams. If those include getting a degree approved by a specific accreditor, they may find themselves locked out, where reciprocity agreements could have provided faster, cheaper, and less regulated recognition.
Voters and clients will suffer real losses without knowing things could have easily been very different. The vast majority won’t realize that in sidestepping state rulemaking processes, compacts have even strictly limited their chance to publicly complain. If the commission writes a rule, your state representative or senator can’t do a thing.
The Redditor above should be able to maintain a therapeutic relationship that’s working even if they move. The question has never been, should practitioners be allowed to practice in another state. The question has always been who gets to decide how that’s done?
Lawmakers were sold job opportunities and more services for citizens, but what they bought was a new level of national governmental regulation that quietly stole state power.
Compacts are moving through state legislatures faster than folks are reading them. Subscribe, and I’ll keep you up to date on the fine print.
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About
Diogenes in Exile began after I returned to grad school to pursue a master’s degree in Clinical Mental Health Counseling at the University of Tennessee. What I found instead was a program saturated in Critical Theories ideology—where my Buddhist practice was treated as invalidating and where dissent from the prevailing orthodoxy was met with hostility. After witnessing how this ideology undermined both ethics and the foundations of good clinical practice, I made the difficult decision to walk away.
Since then, I’ve dedicated myself to exposing the ideological capture of psychology, higher education, and related institutions. My investigative writing has appeared in The Federalist, Real Clear Education, Heterodox STEM, Minding the Campus, The College Fix, and has been republished by the American Council of Trustees and Alumni. I also speak and consult on policy reform to help rebuild public trust in once-respected professions.
Occasionally, I’m accused of being funny.
When I’m not writing or digging into documents, you’ll find me in the garden, making art, walking my dog,