Access to Primary Healthcare in Texas Expands Under HEAL Texans Act

Six million Texans live in the state’s 224 counties with primary care shortages, and 13.4 million Texans live in mental health provider shortage areas.

Bipartisan legislation backed by AARP Texas and a coalition of groups would expand healthcare access and options to primary care by removing unnecessary barriers that now prevent advanced practice registered nurses (APRNs) from providing care to the full extent of their licensure and training.

Studies have consistently shown that APRNs, also known as nurse practitioners, are more likely to practice in rural and other underserved areas than other providers. But under current law, licensed APRNs must find and enter into a contract with a physician in order to provide care to patients.

On Feb. 5, Texas State Sen. Cesar Blanco (D-El Paso) hosted a press conference to reintroduce Senate Bill 911, the HEAL Texans Act, which would allow APRNs full practice authority. Texas Senate Health and Human Services Committee Vice Chairman Charles Perry (R-Lubbock) also authors the legislation, along with Texas Sens. Angela Paxton (R-McKinney), Mayes Middleton (R-Galveston), and Bob Hall (R-Edgewood).

In 27 states, the District of Columbia and the Veterans Administration, nurse practitioners are allowed to practice independently, at the top of their license, without burdensome contracts with attending physicians. These contractual agreements are often costly and, according to Blanco and other backers of SB 911, add no benefit to the quality of care.

Photo Credit: Mark Hollis, AARP Texas

“This bill will tear down the unnecessary barriers that keep Texans from getting care,” said Blanco. “It will allow nurse practitioners to do what they are already trained, licensed and prepared to do – without a bureaucratic permission slip. The lack of access to quality, affordable healthcare is a crisis and the HEAL Texans Act is the solution.”

SB 911 would not expand nurse practitioners’ current scope of practice, but allow for them to practice and see patients, as they are already doing, without additional red tape, such as calling a physician, who many times, are not even on site, to review patient records.

“[This is] not a inflection or reflection of my doctor community at all,” Perry said at the Feb. 5 press conference at the Texas State Capitol. “This is another symptom of a fast-growth state. We are growing 1,500 people a day. We cannot graduate enough doctors, specifically desiring to be in in primary care, to meet the needs of Texans. It’s not a reflection of those guys at all. They do great jobs.”

Added Perry, who represents a mostly rural Senate district: “We’re going to expand a market of already well-schooled providers…Texas is just too big, too diverse, too spread out to maintain a viable healthcare access system without this initiative.”

AARP Texas Director Tina Tran noted during the press conference that, in Texas, there are 3.9 million people age 65 and older and by 2050, there will be 8.3 million of these older Texans. She said the growth will dramatically increase the demand for all health services.

“Texans need access to quality healthcare, and that need is acute for the growing number of older Texans and the family members who care for them,” said Tran.

Similar legislative proposals have been considered in prior lawmaking sessions. This year’s measure aims to assuage concerns that have been raised about medical liability with SB911 including a provision requiring APRNs to carry medical malpractice insurance, which is already a requirement of their licensure.

Dr. Phillip Day, a physician and veteran who served 20 years in the U.S. Army and who spoke at the press conference in support of SB911, said there’s a vital need to let APRNs practice to the full extent of their training.

“The Department of Defense recognized the valuable contributions of nurse practitioners decades ago,” Day said. “The VA followed suit in 2016. Why not Texas, now?”


Charles Cascio is a senior associate state director at AARP Texas. Key advocacy areas he currently focuses at the Texas Legislature include matters involving healthcare, prescription drugs, health insurance and homeowner’s insurance. He can be reached ccascio@aarp.org or 214-208-4663.