SPRUCE PINE, N.C. - Nurses and nurse practitioners would play a bigger role in North Carolina's health-care system under some new legislation.

A bipartisan bill that has the support of more than 60 state lawmakers would make access to basic health-care services easier by cutting red tape for advanced-practice nurses and nurse practitioners. Sen. Ralph Hise, R-Spruce Pine, said he introduced Senate Bill 143 so that nurses can provide more primary-care services in areas that need it most.

"Representing a rural area in western North Carolina, one of the challenges we find is that it's very difficult to recruit primary-care doctors to our region to practice," he said. "We really have a gap in people being able to access services, and this really allows us to use nurses to fill some of that gap."

Companion legislation, House Bill 185, is being carried by Rep. Josh Dobson, R-Marion.

Critics have pointed out that nurse practitioners receive less training than doctors and may not be fully prepared to work without a doctor's supervision. However, Hise said the need is great. Rural North Carolina has higher rates of drug and alcohol use, suicide and teen births, plus more uninsured patients and preventable hospitalizations. These areas also face a shortage of almost every type of provider.

"This is work that nurses already do," he said. "The requirements right now - they have to constantly be under a doctor's supervision in order to do that. This bill would allow them to operate in hours that they may not currently be able to, because there's not a doctor there, and would move them more into working to a team approach with their doctors."

Twenty counties in the state don't have a pediatrician and 26 don't have an OB-GYN, according to the North Carolina Health Professions Data System. Hise said the bills don't change what nurses are allowed to do, but lets them work within their current scope without unnecessary restrictions.

AARP North Carolina is one group lending its support to the bills. State president Cathy Sevier said it's a matter of the rising demand for health-care services, due in part to an aging population that's growing, even as the number of primary-care doctors is shrinking.

"Nurse practitioners, advanced-practice nurses in all of the fields - midwifery, anesthesia, clinical nurse specialists - all provide the level of care in a much more affordable way, and very safely," she said.

The Senate bill is working its way through the Rules Committee before being considered by the Health Care Subcommittee in coming weeks.

Texts of SB 143 and HB 185 are online.


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Health disparities in Texas are not only making some people sick, but affecting the state's economy.

A new study shows Texas is losing $7 billion a year because it does not adequately address quality-of-life issues and the health care needs of its lower-income residents.

The research was sponsored by the Episcopal Health Foundation, Methodist Healthcare Ministries of South Texas, and St. David's Foundation.

Brian Sasser, chief communications officer for the Episcopal Health Foundation, said health care includes more than doctors' visits and medication.

"Everything from increasing access to affordable health insurance to investing in under-resourced neighborhoods to give them more options, whether that's exercise options or food options," Sasser outlined. "Look at policy changes that expand health insurance coverage for new moms."

The report breaks down the economic costs of preventable health differences for every Texas county. It found Bexar, Dallas, Harris, Tarrant and Travis counties are losing the most money annually because of health disparities.

The amount of the economic impact depends on the racial and ethnic makeup of the county and the size of its working-age population. Sasser added the report shows Black and Hispanic children are more likely to grow up in neighborhoods with high poverty levels, and higher rates of diabetes and obesity.

"What can we do to work to make sure that the rate of diabetes isn't dramatically different between white households and Black households?" Sasser asked. "That we can make sure the food insecurity isn't dramatically different between someone who makes over $100,000 and someone who makes less than $30,000?"

The Texas Legislature has passed laws to address some of the disparities, including House Bill 12. It extends Medicaid health coverage for 12 months for new mothers, and pays for maternal health services for community health workers and doulas.

There is light at the end of the tunnel for Tennesseans struggling with opioid addiction, as a bill has been passed to increase access to treatment for opioid use disorder at Community Health Centers.

More than 3,800 lives were lost to overdose in the state in 2021, according to the Tennessee Department of Health.

Emily Waitt, policy and advocacy manager for the Tennessee Primary Care Association, said the original bill limited the number of patients nurse practitioners and physician assistants could treat with buprenorphine. The update removes the limitations, allowing more Tennesseans to access medication assisted treatment in their communities.

"It allows NPs and PAs to prescribe to 100 patients at a time, versus 50," Waitt explained. "Basically doubling the number of patients that they can prescribe to."

Community Health Centers serve more than 423,000 patients across Tennessee, regardless of their insurance status or ability to pay. About 7.7% of Tennesseans do not have health insurance.

Libby Thurman, CEO of the Tennessee Primary Care Association, said bringing the treatment to rural health centers expands access to a crucial service for patients who otherwise could not afford it. She noted it is important because people in remote areas often face challenges finding specialists and treatment facilities.

"We really wanted to work on this issue, because we know our Community Health Centers are where patients go for care," Thurman emphasized. "We really believe in an integrated model. So we want to treat the whole person, including if they are struggling with an addiction issue or a substance abuse disorder issue."

Health Centers offer behavioral health care, including counseling, along with treatment. The clinics also focus on creating a supportive network to help patients with family resources, job assistance and community connections.

While Black Maternal Health Week is wrapping up, health disparities for pregnant Black women continues to be an issue.

From April 11-17 this year, the high death rate of Black mothers is in the spotlight. Black women are three times more likely to die from pregnancy-related causes than their white counterparts.

Dr. Patricia Egwuatu, a family practice physician at Kaiser Permanente in Seattle, said racism is at the root of the disparities, which create barriers to health care access. She pointed out lack of access can lead to problems during pregnancy that are preventable or treatable.

"They may exist prior to pregnancy and then it gets worse during pregnancy if it's not managed as part of that maternity care," Egwuatu emphasized. "There are more pregnant women that have chronic conditions such as hypertension, diabetes and heart disease that are amplified during pregnancy."

The White House released a proclamation recognizing Black Maternal Health Week. The Biden administration began recognizing the week in 2021.

Egwuatu noted there are some warning signs any pregnant woman should be aware of and check in with their physician if they develop.

"You might get some changes in your vision that is not your normal. So, like, fuzziness, you can't see as well, or an excruciating headache," Egwuatu outlined. "You could also develop new swelling in your lower extremities that's making it difficult to get around or even new shortness of breath."

Egwuatu stressed physicians also need to recognize the role of racism in medicine. She argued continuous medical education is important for learning how to confront biases, and it is important for doctors to understand how they can provide people with resources.

"Asking the questions about personal barriers," Egwuatu suggested. "Does a patient have issues with getting to work, child care, transportation? What's their education, what's their cultural background and language? And do they even have a cell phone so we can connect with them?"