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Health Insurance Does Not Equal Access to Care

Health coverage is great, but doesn’t mean much without available providers

By TCCRI Staff. March 15, 2022

Texas has a longstanding and well-established healthcare provider shortage. In 2015, Merritt Hawkins released an extensive report examining the adequacy of the state’s physician workforce. The results were not encouraging, ranking Texas among the lowest ten states for the number of actively practicing physicians per 100,000 residents, with 2.2 million Texans residing in small counties that were served by only 2.5 percent of the state’s entire physician workforce.[i] While this study is worth noting because it is Texas-focused, it is admittedly growing dated. However, more recent studies show this trend continues to head in the wrong direction.

Later studies have again ranked Texas near the bottom of the nation in having an adequate number of physicians to meet demand, a problem that is compounded by the fact that a growing percentage of Texas doctors are nearing retirement age.[ii] While the state has invested in new medical schools and residency slots, one academic, who is also a medical doctor, posited that even if every Texas medical school graduate stayed within the state to practice medicine, it still would not meet the state’s demand.[iii] A Texas Department of State Health Services (DSHS) reportfound that by 2030, the additional need for primary care physicians across the state will have grown by 67 percent.[iv] Today, only five of Texas’ 254 counties do not have a primary care provider shortage, with the term “provider” including non-physician professionals.[v]

And while primary care and physician shortages offer some of the starkest statistics, similar data exists regarding lack of access to dental care in many parts of the state (and especially rural areas),[vi] as well as reports of issues accessing timely emergency eye care.[vii] The bottom line is that Texas has access to care issues for multiple provider types- these challenges are not limited to primary care physicians and specialists.

While some are quick to offer Medicaid or Medicare coverage expansions, this myopic approach is based upon the faulty premise that coverage equals access. Even if government programs were expanded to cover every person in Texas, this would not guarantee that everyone could actually receive care when they seek it. Fortunately, there are decisive actions that state policymakers can take to ensure safe and increased access to licensed healthcare providers.

Over the past several sessions the Texas Legislature has passed a number of laws to increase the availability of certain healthcare providers, including establishing new medical schools and residency slots; increasing access to telehealth and telemedicine platforms; and allowing greater licensing reciprocity with states participating in interstate licensure compacts. While these policies are helping our growing state address quickly expanding demand, more can be still be done.

There are trained non-physician healthcare professionals ready to step in and help fill some of the existing need, but they are prohibited from doing so by restrictive licensure laws. Lawmakers should look to permit such providers to “practice at the top of their licenses,” allowing them to fully exercise the education, training, and scope conferred by their current licensure.

For example, Texas is one of only about a dozen states that fully restricts the practice of advanced practice registered nurses (APRNs).[viii] While many states allow these highly trained providers to establish independent practices, Texas only allows them to practice under the delegation authority of a licensed physician. On the dental care side, Texas is also one of only five states that does not permit dental hygienists to administer local anesthesia, with many other states having allowed this practice for decades.[ix] Optometrists are also limited, not by their education and training, but by arbitrary state law, in diseases they may treat and which they must refer to an ophthalmologist that may or may not be accessible in certain areas of the state.

State leaders should allow the independent practice of APRNs; allow dental hygienists and optometrists to practice at the tops of their licenses; and seek to better utilize other non-physician providers, such as physician assistants and pharmacists, in meeting patient demand. These outdated practice restrictions not only make Texas less competitive in attracting skilled healthcare professionals, they also unfairly limit patients’ ability to access the care they need.

[i] https://dfwhcfoundation.org/wp-content/uploads/2015/04/mhaNTREC2015studyfinal.pdf [ii] https://www.houstonpublicmedia.org/articles/news/texas/2018/04/12/278991/doctor-shortage-in-texas-could-impact-patient-care-for-seniors/ [iii] https://www.statesman.com/story/news/2018/08/15/commentary-the-fix-to-texass-doctor-shortage-lies-abroad/9967697007/ [iv] https://dshs.texas.gov/legislative/2018-Reports/SB-18-Physicians-Workforce-Report-Final.pdf [v] https://www.ruralhealthinfo.org/charts/5?state=TX [vi] https://www.ruralhealthinfo.org/charts/9?state=TX [vii] https://www.texastribune.org/2019/02/04/texas-optometrists-prepare-legislative-fight-over-power-treat-patients/ [viii] https://www.aanp.org/advocacy/state/state-practice-environment [ix] https://www.adha.org/sites/default/files/7521_Local_Anesthesia_by_State_0.pdf