Medicaid expansion needs to pass with plan granting NC nurses autonomy, lawmakers say
A bipartisan group of state lawmakers introduced a proposal Tuesday that would grant high-level nurses more independence.
Their proposal, filed as bills in the North Carolina House and Senate, would allow advanced practice nurses who meet educational and clinical practice requirements to diagnose illnesses, administer anesthetic and prescribe medicine without physician supervision.
This would expand access to affordable health care in the state, bill sponsors said.
One of them, Republican Sen. Joyce Krawiec, said Tuesday that the proposal known as the SAVE Act would “cut costs, but it will not cut corners. It will continue to deliver good-quality health care across our state.”
Krawiec cited a 2015 study by Duke health care economist Chris Conover, which estimates the state could save between $433 million and $4.3 billion per year if the nursing-practice proposal passed.
Democratic Sen. Gail Adcock, another main bill sponsor, said that in order for the state to make high-quality care more accessible to more people across the state, it needs a multi-pronged approach which includes increasing the number of adults with health insurance through Medicaid expansion, increasing the size of the health care workforce and making “full use of the licensed health care providers we currently have.”
“Access to care is increased when health care providers are allowed to do everything they’re trying to do and allowed to go wherever they are needed,” Adcock, who is a nurse practitioner, said.
She said North Carolina advanced nurses are often charged thousands of dollars for supervision services by physicians which amount to little more than a twice-yearly check-in, which can be done via telephone, and a collaborative practice agreement, equivalent to a “permission slip.”
But the North Carolina Patient Safety Association, a coalition of medical professionals in North Carolina, said in a written statement opposing the SAVE Act that the bill would remove physicians from patient care, risk patient safety and raise health care costs without increasing access to care.
Groups representing doctors and specific groups of doctors, including dermatologists and anesthesiologists, are among the opponents.
Tacked on to Medicaid expansion again
Last year the nursing practice proposal was among policy changes tacked on to the Senate’s Medicaid expansion bill, which passed with bipartisan support. But the tacked-on policies caused an impasse with the House, which wanted to pass a “clean” Medicaid expansion bill.
This year, while the Senate and the House are initially tackling the SAVE Act independent of expansion, the two remain linked.
Rep. Carla Cunningham, a Democrat, one of House bill’s main sponsors and a nurse, said “you can’t offer coverage to more people if you don’t have a workforce to deliver the care.”
“There’s simply no way to do it without advanced practice registered nurses,” said Cunningham, “We recognize in order to expand Medicaid the SAVE Act must expand.”
Republican Sen. Ralph Hise, another main bill sponsor, said Tuesday that North Carolina couldn’t expand Medicaid to 600,000 more people “and have no ability to expand services to meet that need.”
“Medicaid expansion will be a failure If we do not have the ability to have nurses meet that health care need, all across this state, particularly in rural areas,” Hise said.
Earlier on Tuesday, Hise told advocates with the American Cancer Society gathered on Halifax Mall outside the Legislative Building that the Senate and the House were in the process of negotiating Medicaid expansion but that expansion “is not, nor has it even been, an end goal for coverage and services in North Carolina. It’s an important step.”
“We need more individuals choosing nursing and health care career paths so we can continue to serve an aging population,” Hise said. “You, along with other groups have finally put a lot of pressure on this General Assembly and we’re hoping that that will result by the end of March in a bill that will finally expand Medicaid in North Carolina.”
Other main sponsors of the SAVE Act, filed as Senate Bill 175 and House Bill 218, include Reps. Donna White, Donny Lambeth and Wayne Sasser.
Asked about the prospects of the SAVE Act this year, considering past failures, Hise said that opponents, largely anesthesiologists, were able to stop Medicaid expansion and the other policy provisions tied to it last year, “but the environment continues to move.”
“The number of legislators continually elected that support the nurses and the advanced practice nurses in their district continues to grow every session, and it is inevitable that we will pass the SAVE Act in the state of North Carolina,” Hise said.
“It might just be a matter of whether they’re out of the way or in front of the train,” he said of opponents.
This story was originally published March 1, 2023 at 8:00 AM with the headline "Medicaid expansion needs to pass with plan granting NC nurses autonomy, lawmakers say."
