Ahead of midterms, Pennsylvania candidates back NP independence in survey

Eighty-one of the 82 Pennsylvania legislative candidates who answered a pre-election survey from the state's nurse practitioner lobby said they support letting nurse practitioners (NPs) practice without a contract with a physician, according to responses released Oct. 15.

The political action committee (PAC) of the Pennsylvania Coalition of Nurse Practitioners (PCNP) sent the six-question survey to all 382 major-party candidates for the General Assembly and followed up with reminders in August and September.

The lone dissent among respondents came from James Edwards, a Republican challenging Rep. Dan Goughnour (D-Allegheny County), the Pennsylvania Capital-Star reported.

The PAC posted each candidate's answers and announced the results at the coalition's annual conference in Erie.

“This November, we can make a difference at the ballot box, too,” Lorraine Bock, DNP, chair of the PCNP PAC, said in the announcement.

What the bills would change

Pennsylvania requires certified registered nurse practitioners to work under a written collaborative agreement with a physician.

NPs who prescribe also need a prescriptive authority collaborative agreement that names the collaborating physician and at least one substitute physician. The coalition describes the arrangement as a contract with two physicians.

Senate Bill 25 (SB 25), sponsored by state Sen. Camera Bartolotta (R-Washington County), and House Bill 739 (HB 739), sponsored by Rep. Nancy Guenst (D-Montgomery County), would lift that requirement for NPs who complete three years and 3,600 hours of collaboration with a physician.

SB 25 went to the Senate Consumer Protection and Professional Licensure Committee on Jan. 22, 2025, and HB 739 went to the House Professional Licensure Committee on Feb. 26, 2025. Neither had received a committee hearing as of June, the Capital-Star reported.

Bartolotta has introduced the bill every year since 2017, and a version passed the Senate 44-6 in June 2019 without becoming law.

Gov. Josh Shapiro called for full practice authority for NPs who have worked under a physician for three years in his 2025-26 budget proposal.

The PAC gave money to two candidates this cycle, Senate President Pro Tempore Kim Ward (R-Westmoreland County) and Rep. Peter Schweyer (D-Lehigh County), according to state campaign finance reports cited by the Capital-Star.

No full practice authority bill had passed the Senate since Ward took over the chamber's leadership, WFMZ reported in 2024, when a Ward spokesperson said the senator “continues to do her due diligence on the matter.”

The rural funding argument

At the Erie event, coalition member Tammy Huey, CRNP, who practiced in rural Venango County, said states with full practice authority receive $497 in federal rural health funding per rural resident on average, compared with $67 in Pennsylvania, citing an unnamed analysis.

“Pennsylvanians need to know which candidates will support unlocking this money for rural health care – and vote accordingly,” Huey said in the announcement.

The same two figures appear in a July blog post on Judge.com by a Penn Medicine nurse practitioner, which attributes them to “some RHT Program estimates” without naming a source.

The money comes from the Rural Health Transformation Program, a $50 billion fund created by the 2025 budget reconciliation law that pays states $10 billion a year from fiscal 2026 through 2030. Half of each year's money is split equally among states.

The Centers for Medicare & Medicaid Services (CMS) allocates the rest by formula, and scope of practice carries a 1.75% weight in that formula. The factor averages state scores for NPs, physician assistants, pharmacists and dental hygienists.

For NPs, a state earns 0 points for restricted practice, 50 for reduced practice and 100 for full practice.

Pennsylvania's February 2026 rural health plan lists the state at 50 points for NPs, 0 for physician assistants, 0 for pharmacists and 50 for dental hygienists. The plan commits the state to policy change on a physician assistant licensure compact and lists no commitment on scope of practice.

Pennsylvania received $193 million in the program's first year, or $78 per rural resident against a national average of $157, WESA reported in June.

Per-resident awards were generally smallest in states with the largest rural populations, according to a KFF analysis, because half of each year's money is divided evenly regardless of need. Texas, which has the most rural residents and the largest total award, received $66 per rural resident.

CMS rescores each state's policy and initiative factors every year and is due to announce fiscal 2027 allocations by Oct. 31.

The physician position

The Pennsylvania Medical Society (PAMED) says on its scope of practice page that expanding practice authority for non-physician providers “can lead to safety concerns, increased costs and an increase in unnecessary testing.”

The society cites research finding $43 higher monthly spending per member for patients with non-physician primary care providers, along with American Medical Association mapping that it says shows NPs tend to practice in the same areas as physicians regardless of state scope laws.

In a 2019 op-ed in The Morning Call, then-PAMED President Danae Powers, M.D., wrote that the society would support limits on what physicians can charge for collaborative agreements but would not accept eliminating them.

The PAC says 27 states let NPs practice without physician collaboration; the Capital-Star counted 28 in June.

NPs registered 5,097 new practices nationwide from Jan. 1 through Sept. 26, 2026, nearly six times as many as in the same period of 2019, according to a Medical Boulevard analysis of federal National Provider Identifier registry data.

Full-practice states had the most new NP practices per resident, but Florida and Texas, which both restrict NP practice, led in total registrations. The analysis counts registrations, not confirmed openings.

In a survey of physicians, many said NP independence has gone too far.

What's next

All 203 state House seats and 25 Senate seats are on the Nov. 3 ballot.

The two-year legislative session ends Nov. 30, and bills not enacted by then must be reintroduced in the next session. The House calendar lists five voting days before that deadline.