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Texas Ranked Dead Last for Occupational Freedom Among All 50 States

The latest “Freedom in the 50 States” rankings, released last month by the CATO Institute, places Texas dead last in the nation in occupational licensing laws.

From the report:

"Texas talks a good game about freedom … but could stand to deliver a more freedom-oriented policy regime for Texans... The extent of occupational licensing is high, but the state enacted a sunrise review requirement for new licensure proposals in 2013. It doesn’t appear like this reform was effective—Texas is our last-place state in this category. Nurse practitioners enjoy no freedom of independent practice.”

“Texas prides itself on being the number one state for business, however having the most burdensome occupational licensing laws in the nation puts that in jeopardy, particularly in the midst of significant workforce shortages across all industries, including health care,” said TNP President Erin Perez.

“Evidence is mounting that the way to improve health care access and expand our health care workforce is to give people more freedom, not less. Health care freedom is a no cost solution for all. Compared with other states, nurse practitioners in Texas have no freedom of independent practice and it costs patients and the entire health care system. The good news is we can modernize our laws and improve access for Texans.”

While in-person oversight requirements for nurse practitioners (NPs) were removed over a decade ago, Texas still requires NPs to contract with, and often pay high fees to, a physician before they can care for patients. And in Texas, this is a lifetime requirement, regardless of how long they have practiced. This means fewer health care clinics in the most underserved areas of the state, where they can bring much-needed care much closer to the people who need it the most. It also means fewer NPs want to practice in Texas.


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