With about one in four uninsured, Texas ranks last in the number of residents with health insurance. This dubious distinction coupled with poor utilization of limited professional resources further compounds the delivery of health care to a rapidly growing population. Additionally, despite low reimbursement rates for Medicaid providers, Texas Medicaid budget continues to grow.

One way to address the access and budgetary health care crisis is to restructure the medical matrix to more efficiently utilize currently available resources in our provider system. Granting full practice authority to advanced practice registered nurses (APRNs) would go a long way toward alleviating the crisis.

We filed S.B. 751 and H.B. 1885 to allow APRNs to practice to the full extent of their education and clinical capability, providing much needed access to primary care. Texas APRNs are already providing critical health care functions, including evaluating and diagnosing patients; ordering and interpreting diagnostic tests; and initiating and managing treatments, including prescribing medications. This legislation would authorize them to continue these activities, but would eliminate needless statutory and regulatory mandates that limit their ability to practice, particularly in rural areas.

Under current Texas law, APRNs can only prescribe medication under the authority delegated by physicians, and they must meet face-to-face with a supervising physician periodically. With few physicians opting to practice in rural areas, this requirement prevents many APRNs from providing care in these underserved settings.

Because Texas requires delegation, we are losing APRNs to the 20 states and the District of Columbia, where APRNs have full practice authority. The New Mexico Legislature appropriated funds to the New Mexico governor specifically to recruit APRNs from Texas. Every year, tens of millions of Texans taxpayer dollars go to educating APRNs. However, we are not reaping the benefits of our investment because states like New Mexico recruit our APRNs away to address their provider shortages. We cannot afford this drain on our resources.

Texas currently ranks 42nd in the U.S. in the ratio of physicians per population and 47th in the ratio of primary care physicians. In rural areas, the primary care shortage is even worse; 185 of our states 254 counties are medically underserved.

Opponents claim this legislation runs counter to the trend of team-based practices. However, with full practice authority, APRNs will continue to collaborate with physicians and other health care providers.

Texas currently has more than 18,000 licensed APRNs today whose vast expertise is not being fully utilized. Allowing APRNs to practice to the full extent of their education and clinical capability will not only provide access to much needed care but will do so without creating huge costs. APRNs perform many of the same functions physicians perform, but more cost-effectively and without compromising quality of service. The average cost of treatment by an APRN is 20 to 35 percent lower than that of a physician.

Opponents of this legislation argue that APRNs dont have as much education and training as doctors and say that extending full practice authority to them is a public safety concern. Hundreds of studies conducted over the past 40 years highly rated on strength of evidence have repeatedly found APRNs care to be equivalent, and in some cases superior, to that provided by physicians.

Chronic disease and health disparities among Texas rapidly expanding and aging population is an increasing concern, especially when fewer medical school graduates are choosing primary care practice (only nine percent in 2009). In contrast, 80 percent of our APRNs work in a primary care setting. An adequate primary care workforce is essential to providing quality, affordable health care.

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A practical solution to Texas health care delivery crisis