March 20 was the worst day of the 2019 legislative session, according to Kansas House Majority Leader Dan Hawkins. That’s the day a coalition of Democrats and left-leaning Republicans overruled the chair of the House rules committee in order to strip a healthcare innovation bill dealing with nurse practitioner reform and replace it with Medicaid expansion.
Hawkins doesn’t mince words.
“I hate Medicaid expansion,” the Wichita Republican said. “Anybody who knows me knows I just hate it.”
The House passing expansion wasn’t what ruined March 20 for Hawkins, however. The bill lawmakers gutted to advance it was legislation Hawkins has been working to forward almost since the day he arrived in the Kansas Legislature in 2013.
“I can’t retire until this is done,” Hawkins said.
The legislation would allow nurse practitioners to practice in Kansas without having to procure a collaborative practice agreement. The contracts force advanced practice registered nurses to get permission from a doctor in order to provide services in Kansas. That requirement, according to nurse practitioner Laural Short, restricts access to healthcare, particularly for rural patients. Twenty-two other states, including Nebraska, give nurse practitioners full practice authority.
“In Nebraska, we’re seeing real improved access to care in rural areas,” Short said.
There are six Kansas counties that don’t currently have a practicing physician, Kansas Chamber lobbyist Kristi Brown told attendees at a health care symposium in Leavenworth on Thursday night. Another 18 counties have only one practicing physician. When that sole physician retires or moves away, people in those counties will have a difficult time finding a new local care provider.
Short told the audience about a nurse practitioner friend who specialized in mental health. He was providing services in 13 different counties in rural Kansas.
“It was so difficult to keep a collaborative practice agreement that he left,” she said.
It’s a numbers game, according to Hawkins. There are 8,000 doctors in Kansas and 65,000 nurses. That number includes all kinds of nurses, including nurse practitioners.
Short says advanced practice nurses don’t replace doctors, but they provide services that contribute to quality healthcare.
“We’re not trying to compete with physicians,” she said. “We want to work with them and to use the whole of our training.”
All of healthcare is collaborative, according to Short. In her work specializing as a nurse practitioner for patients with joint and nerve conditions, she often recommends patients see a specialty doctor, a surgeon, or a physical therapist. She’s hoping Kansas will allow her to do that in the future without tying her to a single doctor via a contract.
“Let us do what we’re trained to do to our full potential,” she said.
Hawkins believes lawmakers have the votes to pass his legislation next year. In fact, he introduced a similar bill, House bill 2412, shortly after the House killed the original bill in favor of expansion on March 20. He joined Short, Brown, and other medical professionals at Thursday’s symposium and at other innovative healthcare events, sponsored by Americans for Prosperity-Kansas, around the state, hoping to garner the support of activists.
“Nothing happens in the legislature until the grassroots makes it happen,” Hawkins said.
Though Hawkins’ legislation for nurse practitioners was the central focus of the events, participants also briefly discussed other ways to use technology to make health care more affordable and more accessible.
“We’re doing these to help educate Kansans on the fact that if we really want to provide access to quality care and lower the cost of health care, especially in a rural state like ours, the answer isn’t more government intrusion,” Elizabeth Patton, deputy state director for AFP-Kansas, said. “It’s eliminating policies that don’t allow us to take full advantage of health innovations.”