David Mitchell and Kristy J. Umana: Improve health care by lifting nurse practitioner restrictions

As Indiana’s 2025 legislative session approaches, lawmakers have a critical opportunity to address our state’s ongoing health care crisis. With more than 2 million Hoosiers living in health professional shortage areas, the state’s outdated and restrictive regulations on nurse practitioners are standing in the way of better health access and outcomes along with cost savings.

Nurse practitioners are highly trained health care professionals who deliver high-quality, patient-centered care, often in primary care settings. With graduate degrees and extensive clinical experience, nurse practitioners—or NPs—have the skills to diagnose, treat and manage illnesses. Yet in Indiana, they face significant barriers: Restrictive laws prevent them from practicing to the full extent of their training unless they enter costly and unnecessary “collaborative agreements” with physicians.

These agreements require NPs to pay monthly fees to physicians for oversight that often involves little more than the review of a small fraction (5%) of patient charts—long after care has been delivered. This antiquated requirement stifles NPs’ ability to open clinics in underserved areas, where they are desperately needed. The result? Fewer patients receiving timely care, particularly in rural and low-income communities.

The lack of accessible primary care providers in Indiana is dire. The state ranks 33rd in the nation for the number of active primary care providers per capita. Modernizing NP practice laws could save lives: A Journal of Public Economics study estimates that fully using NPs could reduce health-care-amenable deaths—those avoidable with timelier access to health care—by 12 per 100,000 people, translating to more than 800 lives saved in Indiana.

There’s no reason for Indiana to lag behind the 27 states, the District of Columbia and two U.S. territories that have already adopted full practice authority. These states empower NPs to provide care without physician oversight, improving access to health care while maintaining high-quality outcomes. Decades of research confirm that NPs deliver care that is just as effective as that of physicians. A study in Health Services Research found that “patients reassigned to NPs experienced similar outcomes and incurred less utilization at comparable cost relative to MD patients.” Additionally, a study in Health Affairs demonstrated that care from NPs leads to lower costs overall by detecting and treating health concerns earlier.

While the number of primary care physicians in the United States is growing slowly, the number of NPs more than doubled from 2010 to 2017. However, a study in the Journal of Labor Research found that NPs are far more likely to move to full-practice states than to restricted-practice states, highlighting Indiana’s risk of losing qualified practitioners to states with better laws.

Indiana legislators have a rare opportunity to implement a no-cost, no-delay solution to our primary care shortage. Modernizing these restrictive laws would save lives, increase health care access and reduce costs. With the start of the legislative session, policymakers must prioritize passing bipartisan legislation that allows NPs to work independently, helping address the state’s urgent health care needs.

Let’s not miss the chance to do what’s right for Indiana. Expanding access to NP-provided care is a common-sense solution that will benefit all Hoosiers—rural, urban and suburban alike.•

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Mitchell is the distinguished professor of political economy and director of the Institute for the Study of Political Economy at Ball State University. Umana is the president of the Coalition for Advanced Practice Registered Nurses of Indiana.