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Texas Tribune Discusses Hot Topics in Health Care for Upcoming Session


On March, 6, several hundred nurse practitioners (NPs) from across the state gathered at the Texas Capitol to discuss hot topics in healthcare and issues regarding full practice authority for Texas NPs. The headliner for the event was a Texas Tribune moderated panel with Representative Donna Howard and Representative Stephanie Klick on hot topics in healthcare for the upcoming 87th Legislative Session.

Texas Tribune’s CEO Evan Smith moderated the panel on healthcare.

“There are three million people in rural Texas – more than the population of 18 states,” Smith began. “Everyone who has a role should play a role.”

22 states in the U.S., plus the District of Columbia, the Department of Veteran Affairs, and all three branches of the military, have full practice authority for nurse practitioners. Texas is not one of those states.

The Texas Nursing Practice Act requires NPs to have a written contract with a physician – what’s called a delegation agreement – in order for NPs to practice and see patients. A 2019 study showed that NPs paid physicians up to $50,000 a year for this delegation agreement.

There is no doubt that Texas has a severe shortage of healthcare access in rural areas of Texas. But APRNs could be an answer to some of these shortages.

In a study by the University of Michigan, researchers found NPs are more willing to work in rural, lower-income areas than physicians. According to the study, the areas with the highest income – compared to the lowest – had 30 percent more physicians and 15 percent fewer NPs. When researchers examined where NPs work, they found that the availability of NPs was about 50% higher in the least healthy counties compared with the healthiest.

Texas has one of the largest populations in the country, and thee million of its citizens live in rural areas. Despite this fact, Representative Stephanie Klick said Texas has some of the most restrictive healthcare provider licensing laws in the country.

“As a growing state, we need to take off the handcuffs and let medical professionals do what they were trained to do.”

Representative Donna Howard said the only groups opposing full practice authority for NPs are physician groups.

“Anytime you restrict supply with restrictive licensing laws, you are increasing the cost and reducing access to care,” Klick said.

Both Howard and Klick emphasized the need to advance legislation next session to remove these regulatory barriers to health care providers in the upcoming 87th legislative session, especially to address some of the urgent needs of Texas’s rural areas.

“Having advanced practice nurses be able to practice to the full extent of their license and training would open up greater possibilities in the rural communities,” Howard said.

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