When Regulation Becomes the Illness
The following was adapted from a research paper written for ECN 4010: Economics of Public Policies at Northwood University. It presents a classical liberal case for full nurse practitioner practice authority in Michigan.
When I think of the word access, I picture a space without barriers — an open path that allows people to freely pursue what they want or need. In Michigan’s health care system, however, access too often looks like the opposite: layers of regulation that widen the gap between patients and the qualified professionals who could care for them.
Those rules operate like an illness moving through the system. They slow care, limit choice and make it harder for providers to meet patients where they are – especially in rural and underserved communities.
Nurse practitioners are a clear example. Michigan continues to limit nurse practitioners through a restricted-practice model. According to the American Association of Nurse Practitioners’ 2026 State Practice Environment map, Michigan is one of the states that requires career-long supervision, delegation or team management by another health care provider before a nurse practitioner can provide patient care. In practice, that means trained professionals are not always free to use the full scope of their education, certification and experience.
When regulation becomes the illness, the treatment should be the removal of barriers that should not have been erected in the first place. That is why Michigan should advance Senate Bill 268, legislation introduced in 2025 to update the state’s Public Health Code and modify the scope of practice for advanced practice registered nurses who hold specialty certifications as nurse practitioners. The Michigan Legislature’s bill record shows the measure was introduced April 29, 2025, and referred to the Senate Committee on Regulatory Affairs.
Michigan’s access problem is not simply a shortage of capable professionals. It is also a policy problem. The Citizens Research Council of Michigan has noted that scope-of-practice reform is one state-level option for addressing primary care needs, particularly as Michigan confronts a shortage and uneven distribution of primary care providers.
That matters because every unnecessary barrier has a cost. If a patient in a rural community has access to a qualified nurse practitioner but cannot receive timely care because the state requires an additional layer of physician supervision or delegation, the patient pays the price. The cost may come as a delayed appointment, another trip, another order or another reason to put off care altogether.
From a classical liberal perspective, this is exactly the kind of government interference that deserves scrutiny. The Northwood Idea emphasizes individual freedom, personal responsibility, limited government and the ability of free people to solve problems through voluntary exchange. A health care system that prevents qualified providers from serving willing patients violates that spirit. It substitutes bureaucratic permission for professional judgment and patient choice.
Supporters of reform are not arguing that nurse practitioners and physicians are identical. They are arguing that Michigan should allow qualified nurse practitioners to practice to the full extent of their training and certification, as many other states already do. Full Practice Authority does not erase professional standards. It recognizes that a licensed, educated and certified professional should not be blocked from providing routine care merely because the state has preserved an outdated gatekeeping model.
Opponents raise serious concerns, and those concerns should be heard. The Michigan Academy of Family Physicians has argued against HB 4399 and SB 268, warning that independent nurse practitioner practice could undermine physician-led care and threaten patient outcomes. Patient safety should never be dismissed.
But public policy should compare reform against the real status quo, not against an ideal system that many patients already cannot access. The question is not whether nurse practitioners should replace physicians. The question is whether Michigan patients are better served by a system that keeps qualified providers from offering care in communities where physicians are scarce.
Evidence from states with broader nurse practitioner authority weakens the argument that autonomy is inherently unsafe. The Citizens Research Council concluded that studies generally do not show poorer patient outcomes in states with expanded nurse practitioner authority, even though questions about costs, referrals and utilization deserve continued study. That is a reasonable basis for reform: move toward greater access while continuing to measure outcomes honestly.
Michigan Senate Bill 268 is not a complete cure for the state’s health care access challenges. It will not magically create more providers, eliminate every rural shortage or solve every cost issue. But it would move Michigan in the right direction by reducing unnecessary red tape and allowing the health care market to respond more efficiently to patient need.
Michigan should not continue operating under policies that delay care and limit choice. Full nurse practitioner practice authority is a practical reform rooted in a larger principle: people closest to the need are often best positioned to respond to it. Patients and qualified providers should have more freedom to make those decisions without the state standing unnecessarily in the way.
When regulation becomes the illness, freedom is the cure. Michigan should trust trained health care professionals, respect patient choice and move toward full nurse practitioner practice authority.