These Utah bills will expand health care and lower costs

This op-ed by Libertas policy intern Benjamin Shelton appeared this week in the Deseret News.

Nobody wants their medical needs to go untreated or for their health to be put in jeopardy by confining laws. Restrictive laws regarding scope of practice (SOP) have made this a reality for many individuals.

Scope of practice refers to the responsibilities that a health care practitioner is permitted to undertake. Scope of practice is normally applicable to medical professionals classified as advanced practice providers, including registered nurses (RNs) and physician assistants (PAs). RNs are those who have passed a national licensing exam and perform hands-on patient care. PAs provide many of the same aspects of care that a physician does, but have not received a medical degree.

Kandice Mallard, suffering from schizophrenia, experienced how restrictive scope of practice laws can impair treatment. Kandice was forced to drive 212 hours from her home in Abilene, Texas, to see a psychiatrist who could prescribe the medicine she needed. The shortage of those able to prescribe medicine in Texas, due to scope of practice laws, has created an environment where those like Kandice now suffer. Many now are put on physician waitlists, which may exacerbate their symptoms, to get needed prescriptions.

Utah is not exempt from this narrative.

The fact is, Utah must expand its scope of practice laws to better serve this state’s health care needs, especially when faced with a deadly pandemic.

Three bills have been proposed this legislative session that attempt to expand scope of practice laws. These bills aim to create better health outcomes for Utahns. All these bills work to allow Utahns to get the care they need when they need it.

Senate Bill 27, proposed by Sen. Curt Bramble, R-Provo, expands the scope of practice for PAs. This bill absolves PAs from supervision by medical doctors and other health care professionals. With this bill, more physician assistants may move their practices to Utah.

Senate Bill 28, also proposed by Sen. Bramble, would allow for a physician assistant to specialize in psychiatric care. This bill would help combat a lack of mental health professionals operating in Utah.

Rep. Doug Welton’s bill, House Bill 287, would allow nurse practitioners to prescribe medicine without having to consult with a doctor, improving access and convenience for patients.

Expanding scope of practices will provide the state with an increase in the quality of care patients receive. Findings consistently show there is no evidence of harm to patients associated with the degrees of restrictiveness of SOP laws. A 2016 study found expanded scope of practice laws for nurse practitioners did not negatively affect a variety of outcomes including chronic disease management, cancer screening, and ambulatory care. Also in 2016, it was found that less restrictive scope of practices for certified nursing midwives create improvements in infant health metrics.

Less restrictive laws have already been shown to alleviate the shortage of medical professionals and create easier access to medicine. Counties in states with less restrictive scope of practice laws are less likely to be plagued by a shortage of health professionals and are better able to keep medical professionals from moving their practices.

The Utah scope of practic bills will begin to undo legislation that limits the number of advanced practice providers who can legally work in the state. The new legislation will create more employment opportunities and allow more medical professionals to serve Utah’s needs, especially in rural areas.

SB27 and SB28, and HB287, will also work to reduce health care prices. Prices for health care services are lower when RNs and PAs have fewer scope of practice restrictions. Savings on health care are evident as the price of child well-care visits decreased by 3%–16% when there are less restrictive scope of practice laws for nurse practitioners. Expanded scope of practices for PAs are also associated with savings, creating a 12%–14% reduction in the cost of outpatient claims among Medicaid patients.

COVID-19 has taught us how important it is to have a plethora of health professionals that are equipped to treat the public and can act with great autonomy. Unfortunately, the reality is that many people are unable to get the care they desperately need right now. New scope of practice laws, as proposed in these bills, would allow for a more robust health care system in the face of adversities like COVID-19.

Expanding scope of practices is not a radical idea. States from Kentucky to Missouri have already adopted policies that expand SOPs.

It is now Utah’s turn to do the same and create a better health care system within the state.