Sen. Blanco files HEAL Texans Act in hopes of expanding rural healthcare options

AUSTIN — On March 7, State Sen. César Blanco filed the Healthcare Expanded and Accessed Locally for Texans Act, or the HEAL Texans Act. The legislation would allow advanced practice registered nurses (APRNs) to provide primary care to patients without contracting a doctor — a restriction that doesn’t apply in 26 other U.S. states. 

Blanco’s district encompasses a vast area in Far West Texas, including some of the state’s least populated counties. “If you live in one of the state’s many underserved counties and need care, you have only two options: a long trip to find a provider, or go without care,” Blanco explained at a press conference. “The HEAL Texans Act will eliminate barriers to care, expand local options across the state — particularly in rural and underserved communities — and most importantly, put patients first.”

The HEAL Texans act is designed to counter existing restrictions that Blanco feels are unnecessary and redundant. Since 2013, Texas has not required direct on-site observation by a primary care physician for APRNs providing medical services within the scope of their certifications — instead, current law requires a monthly check in from a contracted physician.

Creating such a contract can be time-consuming and costly, Blanco explained. Proponents of expanding scope of care for APRNs say that overall costs will be lower for patients across the board — according to a report from the Brookings Institution, annual spending on physician care is roughly 10 times that of spending on care provided by nurses. 

The report concludes that the spending gap doesn’t sacrifice quality of care — or fair wages for nurses. The number of nurses entering the workforce has been outpacing the number of doctors, many of whom are encouraged to go into lucrative specialty fields — APRNs could potentially fill the gaps left by new doctors pursuing specialties rather than general practice. 

Opponents disagree, arguing that filling roles typically assigned to doctors pushes nurses into roles beyond their training. At the press conference hailing Blanco’s introduction of the bill, lobbyists from the Texas Medical Association staged a public interruption. “We say ‘no’ to nonphysician practitioners who want to expand their legal scope of practice beyond what their education, training, and skills safely allow,” the organization wrote in response.

Blanco felt the Texas Medical Association mischaracterized his legislation, which he differentiated from other states’ pushes to expand the “scope of care” for nurse practitioners. “APRNs would only be doing work they already do, just without the administrative and financial barriers of contract agreements with physicians,” he wrote in a press release.

JD Newsom of the Big Bend Regional Hospital District said that the HEAL Texans Act was one of a few pieces of state legislation he was keeping an eye on. “I think it’s an innovative approach to try to solve a crisis in rural areas — about having enough providers to provide the services we need,” he said. 

The federal government uses a metric that designates certain areas as health professional shortage areas (HPSA). Almost 7.5 million Texas residents live in HPSAs, and a total number of 1,038 providers are needed to fill all the gaps. Presidio County is designated as a “high need” HPSA, requiring another provider to meet existing needs — though where that provider should be placed within the county is not specified. 

Getting medical providers to relocate to the remote county has always been a challenge. Newsom believes that challenge will still remain, even if restrictions on APRNs are lifted. “I don’t think it solves that problem for us — but it does make it easier for [APRNs] to practice in the long term,” he said. 

A particularly attractive part of APRNs’ role in community medicine is additional certifications that allow them to practice as midwives. Fears about nurse shortages have persisted in the Big Bend region since 2021, when the labor and delivery wing cut hours and diverted patients to Fort Stockton. “It would be great if we had different options for labor and delivery,” Newsom said. 

For now, Newsom — and other rural healthcare specialists — are waiting for the end of the legislative session. If the bills die, it’ll be another two years before the cycle begins again. “Will it help us? Maybe — but it’s on my list of bills that I’m watching,” Newsom said.