FRANKFORT, Ky. — More than 420,000 Kentuckians have health insurance now because of the federal Affordable Care Act, many for the first time in their lives.
Now who is going to treat them?
A state commissioned study last year said Kentucky is already short about 4,000 doctors - and that was just to meet current demand. But state officials hope a new law that takes effect Tuesday will help ease that burden.
Beginning Tuesday, nurse practitioners who meet certain requirements can prescribe some medications without having a collaborative agreement with a doctor. Supporters say it will remove a barrier from nurse practitioners seeking to open their own practice, where they can prescribe blood pressure and cholesterol medicine, antibiotics and even some antidepressants.
Nurse practitioners in Kentucky have been able to prescribe some medication - but only if they had a collaborative agreement with a doctor. But it's not always easy to get those agreements. And many nurse practitioners were hesitant to open their own practice because their business would be dependent upon an agreement with another doctor that could change if that doctor left the state or lost his or her medical license.
"Lots of practices out there ... always lived in fear or concern that something is going to happen to their collaborating physician and they will have to close their doors," said Julianne Ewen, president of the Kentucky Coalition of Nurse Practitioners and Nurse Midwives. "This takes that fear away."
Under the new law, nurse practitioners who have had a collaborative agreement for at least four years would be exempt from having one. As a nurse practitioner in Shelby County, Jean Stodghill says she routinely sees sick patients who could not get an appointment with their regular doctor. The new law has her hatching plans to open her own business.
"Family doctors are completely overburdened. There are more patients than they can see," said Stodghill, who says she has been a registered nurse since 1982 and a nurse practitioner since 2010. "I see our role as supplementing that."
The Kentucky Medical Association agrees. Executive Vice President Pat Padgett said the new law "promotes a team based approach to care, which we certainly support."
"We think that could help address many of the concerns that people have with a shortage of primary care physicians, if that turns out to be the case," he said.
The federal Affordable Care Act allowed states to expand their state health insurance programs to cover more people. It also allowed them to set up a health insurance marketplace where some people could purchase discounted plans. In Kentucky, more than 420,000 people signed up for health insurance through kynect, the state's marketplace.
A 2013 study commissioned by Democratic Gov. Steve Beshear found the state already needed an extra 3,790 doctors. That included a shortage of 183 primary care doctors across the state. The study projected that shortage to increase to 205 primary care doctors by 2017, mostly in the more rural western part of the state.
"We're hoping some of these (nurse practitioners) will locate in those places and we can provide everybody with adequate care," said state Sen. Paul Hornback, R-Shelbyville, who was the law's primary sponsor. "It will make health care more available and at a more reasonable cost to a lot of people."
Hornback's proposal could pay off. The 2013 study found that Spencer County had the largest need for primary care physicians in the state. Stodghill said Spencer County is one of the places she is considering opening a practice of her own.
"I see a great promise here," she said.