A proven way for Texas lawmakers to improve primary health care access

From the Panhandle to the Rio Grande Valley, from El Paso to Beaumont, and in many communities between, Texans suffer from an alarming lack of access to health care professionals. Our state has 432 “Primary Care Health Professional Shortage Areas,” communities where there are not enough primary care providers to go around. Worse yet, Texas ranks 47th in the nation in practicing primary care physicians per capita.

The shortage of primary care providers isn't just a rural issue. Shortages are found in major metropolitan areas and impact Texans of all coverage stripes — those with private insurance, no insurance, CHIP or Medicaid. A recent survey by Dallas-based Merritt Hawkins showed the nationwide average wait time to see a family practice physician in mid-sized cities was up to 122 days. That’s four months to find out if your belly pain is gas, an ulcer or cancer.

The continued decline in health providers comes while demand for basic primary care is growing. This leaves Texas’ leaders and lawmakers in need of a solution.

One proven legislative solution, implemented in 22 other states and the District of Columbia, is to use what we already have but cannot fully utilize: our own advanced practice registered nurses (APRNs.) In a historic first, House Bill 1415 by state Rep. Stephanie Klick was discussed in a Texas legislative committee this week. The bill and its identical companion — Senate Bill 681 by state Sen. Kelly Hancock — remove the regulatory barriers to full practice by APRNs.

APRNs are master- or doctorate-level health care providers who are currently subject to artificial occupational licensing barriers that limit access to care for patients and drive up the cost of healthcare in Texas. APRNs include nurse practitioners, certified nurse midwives, certified registered nurse anesthetists and clinical nurse specialists who practice throughout the state.

Despite growing evidence and a body of research showing favorable patient outcomes and excellent quality of care in states where APRNs have full practice authority, Texas still prevents APRNs from doing what they can do and what patients desperately need. As a result, Texans who could be treated by an APRN have no care at all.

Throughout the state, Texans experience unnecessary delays in receiving treatment, difficulty finding primary health care providers, and lack of access to safe, reliable and affordable care because of the state’s unnecessary and inefficient practice laws.

Additionally, the Texas Medicaid system faces a critical provider shortage and the state’s Medicaid population is seeing ever-increasing limitations on access to care.

Only 41 percent of Texas physicians accepted "all new Medicaid patients," according to a 2016 Texas Medical Association survey. The problem will only get worse. Over the next two years, estimates show Texas Medicaid growing by 52,000 people to serve 4.1 million children, seniors, pregnant women and Texans with disabilities.

APRNs could fill that void while saving scarce resources. Nationwide, nearly 80 percent of nurse practitioners accepted new Medicaid patients in 2016. A recent study found that states without APRN restrictions experience 50 percent fewer unnecessary hospitalizations of Medicare and Medicaid patients. Florida found it could save between $7 million and $44 million in Medicaid dollars by releasing restrictions on APRNs.

HB 1415 and SB 681 remove the burden of an unnecessary physician supervision requirement, end expensive pay-to-play contracts, and eliminate dual regulation of APRNs by both the Texas Board of Nursing and the Texas Medical Board. It is our hope that state lawmakers will see the undeniable benefits of allowing Texas APRNs full practice authority and pass the bill in the remaining days of the legislative session.

Our organizations are not often in agreement on policy issues. Yet each is a member of the Coalition for Health Care Access, a broad-based group of patient and policy advocates who represent disparate interests but have the same goal: getting medical care to Texans who currently have none.

Texas has the providers. We just need to release them to care for patients.

The Texas Medical Association, Texas Public Policy Foundation, Center for Public Policy Priorities, Texas Association of Business and AARP Texas have been financial supporters of The Texas Tribune. A complete list of Tribune donors and sponsors can be viewed here.

Deane Waldman

Director of the Center for Healthcare Policy, Texas Public Policy Foundation

Anne Dunkelberg

Associate director, Center for Public Policy Priorities

@ADunkCPPP

Bob Jackson

Director, AARP Texas

Amanda Martin

Government affairs, Texas Association of Business

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