Opening Doors: A Bill to Improve Healthcare Access and Costs

Heather, a Greenville North Carolina resident, lost her primary care provider and a year later, she still does not have a new PCP.

“In Greenville most of the PCPs are not accepting patients, and when they do it is a minimum of a six month wait to get an appointment,” she said.

Many North Carolina legislators and healthcare advocates say that changing laws for advanced practice registered nurses (APRN) will alleviate access and cost challenges. North Carolina currently requires most APRNs to have a supervising physician, even though their training and education prepares them for full practice authority.

States that have allowed APRNs to practice to the full extent of their education — aka "full practice authority" — have seen improved care, cost savings, and greater access to healthcare.

The APRN Full Practice Authority Act

Enter the APRN Definitions bill (formerly the SAVE Act) filed this March by North Carolina legislators. It aims to address the health care shortage by allowing APRNs to practice independently.

Representative Donna White, who has supported this legislation since 2013, said that North Carolina has spent a substantial amount to attract physicians into rural areas and they do not stay. APRNs are willing to fill the gap in rural areas.

Besides increasing the number of providers and improving rural access to healthcare, White said the legislation will have financial benefits as well. She said it is estimated that the bill will save the state over $650 million per year on healthcare costs.

This is the sixth consecutive session to see this bill introduced. Opponents of the bill are primarily physician groups, although many individual physicians support APRNs having full practice authority. The physician groups have put a significant amount of money into preventing the Act passing from committee to be voted on by the legislature.

The American Medical Association argues that APRNs lack extensive training and experience, increase costs by ordering more tests and prescribing more medications, and that patient safety is at risk. A review of research showed that these claims are not true. It should also be noted that in North Carolina, supervision can be provided by a physician who is not physically near. It is a paperwork requirement.

What can AARP members do to propel the legislation to a vote?

Senator Gale Adcock, co-sponsor of the bill, said AARP members can advocate for the bill with the legislators for their area, “where the member’s power lies is in their ability to make it real to the people that represent them.”

Adcock said voters 50 and older are most likely to influence legislation. “They have a lot of power, and they're listened to,” Adcock said.

She recommends that people meet with or call their representatives and tell them specifically why more access and lower costs are important to them.

When it comes to calling your representatives, AARP can help. Click here to show your support for better health access and lower costs.

References

DePriest, K., D’Aoust, R., Samuel, L., Commodore-Mensah, Y., Hanson, G., & Slade, E. (2020). Nurse practitioners’ workforce outcomes under implementation of Full Practice Authority. Nursing Outlook, 68(4), 459–467. https://doi.org/10.1016/j.outlook.2020.05.008 (Abstract available here)

Dunbar-Jacob, J., & Rohay, J. M. (2025). State health and the level of Practice Authority for Nurse Practitioners. Nursing Outlook, 73(1). https://doi.org/10.1016/j.outlook.2024 (Article available here)

Laurant, M., van der Biezen, M., Wijers, N., Watananirun, K., Kontopantelis, E., & van Vught, A. J. (2018). Nurses as substitutes for doctors in primary care. The Cochrane database of systematic reviews, 7(7), CD001271. https://doi.org/10.1002/14651858.CD001271.pub3

Opeka, T., & Kraemer, B. (2023, April 11). Follow the money: The save act. Carolina Journal.

Poghosyan, L., Timmons, E. J., Abraham, C. M., & Martsolf, G. R. (2019). The economic impact of the expansion of nurse practitioner scope of practice for Medicaid. Journal of Nursing Regulation, 10(1), 15–20. https://doi.org/10.1016/s2155-8256(19)30078-x (Abstract available here)