For far too long, Indiana has faced a self-induced health care crisis caused in part by outdated regulations and a lack of commitment by our legislature to change them. The issues we’re facing as a state now leaves Indiana a disappointing 32nd among states on measures of health quality, access and public health. The Indiana General Assembly has an opportunity, though, to begin to address these challenges. Together, our organizations are urging the legislature to take action in January to expand Hoosiers’ access to the health care they need and deserve by making full practice authority (FPA) the law in Indiana. Failing to make commonsense, no-cost changes to these restrictive, outdated and inefficient policies has expansive impacts on our state. They limit the supply of health professionals, risk our ability to attract new business, endanger the health of aging Hoosiers, restrict access to mental health services and compromise health outcomes for expectant mothers and their families.
Today, more than 2 million Indiana residents live in federally designated primary care provider shortage areas. Along with these Hoosiers, 6.6 million more residents lack access to mental health care. In addition, 33 of Indiana’s 92 counties are classified as maternal health care deserts where women don’t have access to even the most basic obstetric and gynecological services they need. Older Hoosiers are unable to access primary care in their own communities and our existing businesses find it difficult to recruit and retain a healthy workforce without adequate health care access. When it comes to new businesses, they may refuse to invest and locate to areas without adequate access to care.
It is time for urgent action by the legislature to join the 26 other states that already authorize nurse practitioners and other advanced practice registered nurses (APRNs) to practice to the full extent of their license. By doing so, Indiana will eliminate financially burdensome and duplicative regulations that limit patient access to high-quality health care delivered by Indiana’s 8,000 APRNs. This outdated rule requires those nurses to contract with physicians as a condition of practice which in turn discourages them from practicing in our state. FPA was temporarily implemented in Indiana, by executive order, for 22 months of the COVID-19 pandemic with great success. It is already the law of the land in the majority of states and Washington D.C., and the national VA health system also offers FPA.
Under current law, a physician retrospectively reviews 5% of an APRN’s prescribing charts, often at a high cost. This review typically occurs months after care is delivered, providing no benefit to patients. This contractual arrangement often costs APRNs or their employers thousands of dollars per month. If no contracting physician can be found, APRNs could leave the profession or may be forced to travel out of state to work, leaving communities and patients without any health care provider in their area. This increases health care costs and reduces access to care for Hoosiers.
For the entirety of the COVID-19 pandemic, until Gov. Eric Holcomb’s emergency orders lapsed earlier this year, Indiana temporarily waived these requirements and APRNs answered the call to serve patients during the most difficult of circumstances. This action alone demonstrates the commitment APRNs have to the health of Hoosiers and the critical role that they play in our state’s health care system. If Indiana identified this regulation as a barrier at the height of a pandemic, why aren’t we recognizing this every day for Hoosier patients?
Following passage of FPA in states such as North Dakota, the APRN workforce increased by 83% within six years. In Arizona, the APRN workforce doubled across the state and grew 70% in rural areas within five years. We have also seen significant increases in APRNs setting up practices in rural areas. Additionally, while Indiana sits toward the bottom of most U.S. health rankings, states whose health outcomes rank at the top have implemented FPA.
Unfortunately, without changes to these policies, Indiana may be losing talented clinicians to other states, where they are free to practice to the full capacity of their training, and patients have unfettered access to the care they deliver. If we want to grow our economy and improve the health of our communities, this cannot continue.
The Indiana legislature has the opportunity in 2023 to prioritize patient health and the health of our state’s economy. We implore lawmakers to build a healthy future for Indiana where every citizen has access to the health care they deserve, delivered by the provider of their choice. By giving Hoosiers full and direct access to APRNs, Indiana will take a vital step forward to ensure it is among the healthiest and most business-friendly states in the nation. For more information, please visit www.hoosiersforhealthcareaccess.com.
Sarah Waddle is the state director for AARP Indiana.
Josh Webb serves as the state director for Americans for Prosperity Indiana.