A bipartisan group of state lawmakers has teamed up with advocates for nurses, rural communities and regulatory reform to file a bill they say will make health care both cheaper and more widely available in North Carolina.
It’s the 2021 version of the SAVE Act, which has been filed in past years and defeated by opposition from groups representing doctors. The bill would allow specially trained nurses to perform more medical duties, without having to be supervised by a doctor.
Sen. Ralph Hise, a Republican from Mitchell County on the Tennessee border, said there has long been a shortage of doctors in North Carolina. It’s particularly acute in rural areas like his Western North Carolina district, Hise said, and is only getting worse as the state’s population grows and ages.
“The only solution that fills that role is to expand the use of nurses,” said Hise, who co-sponsored the Senate version of the bill, SB 249.
COVID-19 may bring support
Although the bill has not been successful in the past, supporters hope that the increased spotlight COVID-19 has put on the health care system — as well as the economic strain it has caused many families — will help the bill muster more support this year.
“This would help alleviate the healthcare disparities of people of color that have been adversely impacted by the pandemic, at higher rates than our white counterparts and patients,” said Democratic Rep. Carla Cunningham of Charlotte, who is a nurse as well as co-sponsor of the House version of the bill, HB 277.
In years past, however, the idea of lifting restrictions on nurses has gone nowhere. In 2019, for example, that year’s versions of the bill weren’t even allowed to come up for a vote in either the House or the Senate.
The bill has been opposed by the North Carolina Medical Society, a large pro-doctor lobbying group, as well as other niche groups representing specialists, like dermatologists.
Opponents say that “patients believe it is important for a physician to lead their health care and that a physician’s education plays an important role in providing care,” according to the N.C. Institute of Medicine’s synopsis of a 2019 debate it hosted with advocates from both sides.
Sen. Joyce Krawiec, R-Forsyth, who co-chairs the Senate Health Committee, said that passing the bill would lower healthcare costs — not just for state government through Medicaid, but also for people on private health insurance.
She cited studies that found that passing the SAVE Act might save hundreds of millions, if not billions, of dollars per year by letting patients get more types of treatments from nurses instead of doctors.
“We need to take advantage of every single opportunity that we have to make safe, quality healthcare affordable,” she said.
The bill would apply only to APRNs, or advance practice nurse practitioners. Those are nurses who have at least a master’s degree, if not a PhD. They can work in highly specialized roles, like in anesthesia, or in more general clinical roles.
‘We do not need their supervision’
Rep. Gale Adcock, a Cary Democrat, is an APRN herself. She said Thursday the doctors she works with day to day don’t oppose the bill, but it’s opposed at higher levels. However, she said, passing the bill would not only mean more and cheaper healthcare for people, but also less paperwork for doctors, who would no longer have to supervise nurses as much or write up reports on their work.
“We have the workforce in place, but we do not use it to its fullest extent,” she said, adding, “I enjoy working with my physician colleagues but we do not need their supervision.”
The bill also has backing from a number of lobbying groups, ranging from the North Carolina Rural Center to the North Carolina Nursing Association to the state chapters of the AARP and Americans for Prosperity, a conservative group that often lobbies for regulatory reform measures.
Chris McCoy, executive director of the state’s AFP chapter, said “it’s high time” for North Carolina to follow the lead of about half of the rest of the states in the U.S., which have passed similar bills.
According to the North Carolina Nurses Association, Arizona passed a version of the law in 2002 and by 2007, the number of nurse practitioners working in rural areas had jumped by 73%. Patrick Woodie, president of the North Carolina Rural Center, said Thursday that his group serves 80 of the state’s 100 counties, and 63 of them have shortages of medical professionals.
Catherine Sevier, president of the NC AARP, said they’ve supported the bill in the past but feel there’s more urgency now.
“More people turn 65 each day,” she said. “Our state is aging. And the number of seniors looking for health care in North Carolina is growing dramatically.”
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