Christy Blanco’s health clinic is sitting empty. A nurse practitioner in El Paso, Tex., Blanco says she has all the necessary equipment and a doctorate in nursing practice that prepared her to perform routine physical exams and treat diabetes, asthma, high blood pressure, and many other common ailments. About 50 miles away in Las Cruces, N.M., dozens of nurse practitioners at clinics like Blanco’s are busy caring for patients. The only difference is that in Texas, nurse practitioners are required to contract with a doctor to sign off on medical charts; the physician must also spend 1 out of every 10 days at the clinic. In New Mexico, no doctor is necessary. “I just want to get started,” says Blanco, who’s tried for nearly two years to recruit a physician for her clinic, which will specialize in care for low-income women. “I’m trying to work for the poor,” she says. “I’ve spent thousands of dollars of my own money. I have a waiting list of patients, and I have to tell them I can’t practice.”
Blanco is one of the nation’s 155,000 nurse practitioners caught in a tug-of-war with doctors over who will provide basic primary care for the 30 million U.S. citizens set to get health insurance under the 2010 Affordable Care Act. The nurses say they can do their jobs just fine without doctor supervision, and they’re lobbying lawmakers in as many as 34 states to get restrictions lifted.