The federal government awarded Indiana nearly $207 million on Dec. 29, the first installment of roughly $1 billion from the new Rural Health Transformation Program.
As part of its application, Indiana promised that by 2028 it will pass legislation requiring nutrition education in medical schools. The state evidently knows how to promise a law when it wants money.
Yet, as part of its application process, Indiana refused to commit to a law giving registered nurses more flexibility to treat patients.
What would such a law fix? Today, an advanced practice registered nurse cannot prescribe so much as an antibiotic in Indiana without a written collaborative practice agreement with a physician, complete with biennial audits of the paperwork. Paying for a collaborative practice agreement with only biennial audits is a toll, not supervision. The physician never sees the patients.
Certified nurse midwives occupy an even stranger position: Indiana trusts them to deliver babies independently but not to prescribe the contraceptives, antibiotics or hemorrhage medications their patients need without a physician’s signature. A midwife who cannot prescribe cannot realistically open the practice that would serve a county no obstetrician will touch. Bills to end the agreement requirement, Senate Bill 60 and House Bill 1129, went nowhere in the Indiana General Assembly.
The stakes are spelled out in Indiana’s grant application itself: 47.3% of Hoosiers live in physician-shortage areas; the state needs 817 more primary care physicians by 2030; 24% of counties are maternity care deserts; and 10 birthing hospitals have ended obstetric services since 2022.
Nine of the 10 counties with the worst infant mortality are fully rural. The state’s billion-dollar plan answers this with physician stipends, residencies and telehealth, all worthwhile, while keeping its fastest-growing clinicians under paperwork lock.
While the supply of primary care physicians grows slowly, the nurse practitioner workforce is booming: more than 461,000 NPs are licensed nationwide. That’s up from 355,000 four years ago. And the Bureau of Labor Statistics projects NPs to be the fastest-growing healthcare occupation in America over the next decade.
The evidence says unlocking them works. In research that Moiz Bhai and I published in the Southern Economic Journal, we found children’s health measurably improves when states grant nurse practitioners independent practice. Research in the Journal of Health Economics found C-section rates fell about 6.3% in states where nurse midwives practice independently. That’s better outcomes and lower costs.
Other studies find full-practice states attract more nurse practitioners to rural shortage counties, exactly the redistribution rural Indiana needs. Physician groups warn quality will suffer; decades of research, and now CMS itself, say otherwise.
Indiana shouldn’t free its nurse practitioners and nurse midwives because Washington dangled a check. The evidence has pointed this way for years. But the arithmetic is now impossible to ignore: This is the only reform in the entire rural health transformation that costs taxpayers nothing and that the federal government will literally pay Indiana to adopt. When the Indiana General Assembly convenes in January, it should extend full practice authority to advanced practice registered nurses. Rural Hoosiers have waited long enough for the providers who are already here.
David Mitchell is the distinguished professor of political economy and director of the Institute for the Study of Political Economy at Ball State University.
This article originally appeared on Indianapolis Star: Indiana would rather tie down nurses than treat rural patients | Opinion
Reporting by David Mitchell, Opinion Contributor / Indianapolis Star
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By David Mitchell, Opinion Contributor | USA TODAY Network
