For an aging Texas, expand access to healthcare

Older Texans are in dire need of better access to health care. The warning signs of a looming crisis are clear.

3.7 million Texans are age 65 and older, and the senior population is growing. By 2050, the number of Texans age 65 and older will be 8.3 million. This increase will drive demand for all types of health services, from specialty geriatric care to primary care and mental health treatments.

All Texans need access to quality health care, and that need is especially acute for the quickly growing number of older Texans and their family members who support them.

An aging and growing population is putting a strain on our health care system, and the supply of primary care providers is not keeping pace. The lack of access to care is particularly real for Texans in rural areas where too many people have long – and potentially dangerous – wait times for primary care and mental health services.

The Legislature has taken steps to expand access to care via telehealth, and the state is moving toward expanding high-speed internet services in rural areas. While these are important actions that AARP Texas supports, it is essential that there are trained health care practitioners available to provide care in all of the communities across our state where they’re needed.

No one understands this better than Tracy Hicks of Longview, in east Texas. Hicks is an advanced practice registered nurse (APRN) with certifications in family practice and psychiatric mental health. Since 2015, she has run a private medical practice, seeing patients virtually and in-person throughout the pandemic.

Hicks’ practice – C-Trilogy Comprehensive Clinical Care – treats roughly 1,400 clients for mental health, addiction and general health needs in a rural area where the shortage of physicians and other medical specialists is pervasive.

About one-fifth of the patients in her practice, she estimates, are treated with antipsychotic medications. Hicks, however, cannot prescribe the medicines.

“It’s in my scope of practice to handle ADHD treatment,” said Hicks. “We (nurse practitioners) know how to prescribe those medications, and there’s no reason why we shouldn’t be able to do so.”

Hicks also cannot admit patients herself into psychiatric facilities. The prohibitions on her scope of practice creates a hurdle and time lags for patients. Under current Texas law, nurse practitioners are required to contract with a physician – and may have to pay them thousands of dollars – before they can do the job they have been trained and licensed by Texas to do.

Despite their experience, education and often impeccable track records of patient care, nurse practitioners do not have full practice authority in Texas. APRNs can practice to the full extent of their license and education only when they contract with a physician.

Texas is in the minority of states to require such supervision. The Veterans Administration and 26 states allow for full practice authority for APRNs, and Texas allowed it during the COVID pandemic.

Elimination of unnecessary physician supervision would increase rural access to health care as nurse practitioners are more likely to provide key primary care services in underserved areas.

In 2013, Texas ended direct, on-site physician supervision. This legislative session, AARP Texas is advocating for legislation to allow APRNs to do the work they already do, just without the administrative and financial barriers of contracts with physicians. Along with 30 organizations that represent business, consumers and a broad range of health care stakeholders, AARP Texas is a member of the Texans for Health Care Access, which supports full practice authority for APRNs.

State Sen. Cesar Blanco has filed Senate Bill 1700, the Healthcare Expanded & Accessed Locally (HEAL Texans) Act. The bill, which AARP Texas supports, expands health access by allowing full practice authority for nurse practitioners. A similar – though not identical – measure (House Bill 4071) has been proposed by state Rep. Stephanie Klick.

Older Texans, rural families and others need the Legislature to loosen the current restrictions facing nurse practitioners. As Hicks explained, “There’s a shortage of (physicians) in the state. And if there’s not a physician available, the patient goes without care…This situation” she said, “has got to change.”