Letter | S.C. legislators: Remove red tape and increase number of health care providers

We, along with a majority of legislators in both chambers of the South Carolina General Assembly, have rejected Obamacare’s invitation to increase enrollment in our state’s Medicaid program from its current population of 1.1 million to 1.6 million people. We think having 35 percent of all South Carolinians on Medicaid is a bad idea; it would eventually either bankrupt our state or necessitate massive tax increases.

Our Democratic friends are fond of saying our rejection of Medicaid expansion proves we are either unaware of the sad state of health care in South Carolina or unwilling to do anything about it. Neither is true.

There’s no question that many people in our state lack adequate access to quality health care. A report recently issued by the nonpartisan United Health Foundation gives South Carolina an “F” in overall health status, emergency care, primary care, chronic disease management, mental health and prenatal care. This is unacceptable.

But enrolling 500,000 more South Carolinians into Medicaid – even if such were affordable, which it isn’t – would do nothing to address the core and fundamental problem: There are not enough health-care providers in South Carolina to meet the needs of its residents. In order to truly improve access to health care, there must be an increase in the supply of providers.

South Carolina, with its estimated 3,600 primary-care physicians, ranks 40th among the states with just 77.5 physicians per 100,000 of population (compared with 90.1 per 100,000 nationwide). Moreover, there is a strong bias in the distribution of those physicians to urban or suburban areas, and 42 of our 46 counties are medically underserved. One county (Lee) has no physicians at all.

This supply problem is compounded by the fact that, in recent years, medical students have been choosing specialties outside of the primary-care field. There is now an emphasis and increased value placed on specialized skills. Primary-care providers have historically been the backbone of the rural health-care system, and increasingly there are less of them to go around.

So what can we do to increase supply? One way, we think, is to better utilize our state’s estimated 3,500 advanced-practice registered nurses. These nurses hold at least a master’s degree in nursing, supplemented with advanced education and clinical training to autonomously assess, diagnose and manage a patient’s health care at the primary-care level.

The problem, however, is that South Carolina laws severely restrict the health-care services these nurses are able to provide. These restrictions impose limitations on delivering care and prescribing certain medications, referring patients for diagnostic care, and certifying hospice or long-term care for patients.

Perhaps the most restrictive law is the one that prohibits these nurses from providing care for any patient who lies outside a 45-mile radius of a supervising physician. Since the majority of physicians practice in urban or suburban areas, nurses who are ready, willing and able to fill unmet health-care needs are legally barred from doing so.

We have filed bills – H. 3078 and S. 246 – to remove these legal barriers so that these nurses stand alongside our primary-care physicians to provide basic health-care services to South Carolinians. Such a dramatic increase in the supply of providers would not only improve health-care outcomes, but also drive down costs (since the market equilibrium price decreases when the supply curve shifts to the right).

Our legislative efforts are opposed by the South Carolina Medical Association, ostensibly not to protect economic turf but to protect the quality of patient care. It has been our experience, however, that those to be protected by this paternalism are rarely on organized medicine’s side; they consider increased access to health care at a lower cost a good thing.

Moreover, a multitude of studies show that the quality, efficiency, patient satisfaction, and cost-effectiveness of advanced-practice nurses’ care is as good as the care provided by physicians. In any event, we believe patients should have the option of choosing to receive health care from these nurses, especially since the alternative now is in far too many cases no care at all.

So let’s cut the red tape that prevents nurses from providing the care they are qualified to give. Better access of health care at a lower cost is a clear win for all South Carolinians.

Tom Davis is a South Carolina State Senator representing District 46. Jenny Horne is a South Carolina Representative representing District 94.

This story was originally published April 21, 2015 at 1:57 PM with the headline "Letter | S.C. legislators: Remove red tape and increase number of health care providers."