In the ongoing debate over the Affordable Care Act in Texas, conservatives are frustrated by its costly mandates and regulations, while liberals are frustrated by conservatives’ rejection of the law’s Medicaid expansion and a general unwillingness to implement “Obamacare” on behalf of the federal government.
The temptation for state lawmakers on both sides of the aisle is to throw up their hands in exasperation and claim that nothing can be done at the state level — either because the ACA consolidates power in Washington, D.C., or because whatever can be done at the state level won’t be enough to make a difference.
Both sides are wrong. Although the ACA does indeed concentrate regulatory power over our health care system in the nation’s capital, and yes, that’s a sore spot for conservatives, there’s a lot that lawmakers in Austin can do to solve pressing health care problems.
For starters, we can expand the scope of practice for advanced practice nurses. Texas lags far behind other states when it comes to allowing nurses to practice to the extent of their training and competency. Nineteen other states, including neighboring New Mexico, allow nurse practitioners to independently operate free-standing clinics and serve as primary care providers.
But in Texas, where we have an acute shortage of primary care providers, nurses are not allowed to operate primary care clinics independently but are subject to outdated physician supervision requirements. Liberalizing state scope of practice laws to allow nurses the ability to safely diagnose, treat and prescribe would bring them in line with other states and could help solve our primary care shortage, especially in rural and underserved areas.
The same goes for other types of health care providers. For example, access to dental care is woefully inadequate in Texas — 115 counties are designated as Dental Health Professional Shortage Areas, and 46 counties don’t even have a practicing dentist. And yet state law does not allow licensed dental hygienists to administer local anesthesia — a routine task that is allowed in 45 other states.
Clinical psychologists in Louisiana and New Mexico have authority to write prescriptions, but not in Texas. Optometrists in Oklahoma can perform laser eye surgery, but Texas won’t allow it.
Relaxing scope of practice laws across the provider spectrum would increase access to care for low-income Texans and those in rural areas, and lower costs for everyone. The power to do so rest entirely in Austin.
Experts agree that improper use of emergency rooms is a major cost-driver for Texas hospitals. Proponents of Medicaid expansion under the ACA claim it will reduce ER overuse, yet studies have shown that expanding Medicaid actually increases it.
But there are proven ways to address this problem. The state could fund a pilot program for Medicaid HMOs that sends on-call nurse aides or community health workers to Medicaid patients’ homes before they show up in the ER.
These same workers could also visit Medicaid and Medicare patients in the days after being discharged from the hospital, helping to ensure they’re taking their medications and following the doctor’s orders. Similar pilot programs in other states have drastically reduced hospital readmission rates.
By utilizing a combination of new technologies and good old-fashioned common sense, there’s a lot state lawmakers can do next year to improve health care for all Texans — without waiting around for Washington bureaucrats.