Advanced RN practitioners deserve fair reimbursement


As a pediatrician, I have dedicated my career to improving necessary access to health care, with an emphasis on eliminating racism and other injustices.

The devastating effects of the COVID-19 pandemic have increased our need for primary, specialized, and behavioral health care providers. Across our state, especially in rural and underserved areas, the need for advanced Registered Nurse Practitioners (ARNPs) has never been higher. Many people in our communities are in need of vaccines, others have delayed their checkups and preventive care, and still others have greater needs for mental health.

The more than 6,000 ARNPs in this state provide every aspect of health care, from primary care, anesthesiology, midwife, mental health, and more. Some ARNPs have their own primary care or behavioral medicine practices, while others work in hospitals, outpatient surgical centers, and medical practices. Their extensive education, absolute authority, and dedication enable them to work in any setting, making them an integral part of our business infrastructure and beloved communities.

The health insurance companies have arbitrarily reduced the reimbursement of ARNP services to just 85% of their usual rates. ARNP’s own practices and local doctors’ clinics that use ARNPs are threatened by these cuts, especially when our communities particularly need their services. Families find that their insurance is no longer accepted, benefits are no longer available, or waiting for an appointment can take many months. This is particularly detrimental in Washington, where Spokane, Kitsap, South Thurston, and Mason counties have the worst basic service shortages in the country. Closing a clinic can mean hours of driving for basic services.

Washington deserves a well-functioning health system, and ARNPs are essential to ensure we all receive quality, timely care. ARNPs are particularly critical in rural areas. For example, certified Registered Nurse Anesthetists serve 93% of rural hospitals. They are the only anesthesia providers in 72% of rural facilities.

Various low-income communities are hit harder when reduced reimbursement rates force ARNP’s own practices to cut services. Almost half of Medicaid recipients in Washington receive their basic care from ARNPs. Various communities rely heavily on ARNPs for primary care. Studies consistently show that access to primary care increases life expectancy, improves health outcomes, and reduces health inequalities.

The passage of Senator Emily Randall’s “equal reimbursement for equal benefit” legislation is a critical part of improving access to primary and mental health care. This draft law addresses the ARNP reimbursement gap by requiring insurance companies to cover ARNP benefits at 100% of the standard rate. It also prohibits insurance companies from circumventing this requirement by cutting reimbursement from the doctor. The bill will not add to the cost to the patient; Oregon passed a similar law and stated that health care costs for consumers will not go up.

Inequalities in reimbursement rates lead to inequalities in care. Right now we need to protect access to health care across the state. This bill ensures the same quality of care, whether from a doctor or ARNP, and is reimbursed at the same rate. Medical practices that offer ARNP services will remain sustainable, especially in rural and low-income areas. And we all receive high quality and functioning health care.


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