I CAN Act

The I CAN Act, HR1317, directly amends Titles XVIII and XIX of the Social Security Act, expanding the services that advanced practice registered nurses (APRNs), including nurse practitioners, physician assistants, certified registered nurse anesthetists, and certified nurse-midwives, can provide under Medicare and Medicaid. This bill allows APRNs to fulfill documentation requirements for diabetic shoe coverage, supervise cardiac and pulmonary rehabilitation, certify inpatient hospital services, and receive direct reimbursement for evaluation and management services. This change immediately reduces the reliance on physicians for specific tasks, optimizing healthcare delivery efficiency. The money trail flows directly to healthcare providers and insurers. By allowing APRNs to perform services previously requiring physician oversight, healthcare systems reduce labor costs and increase patient throughput. This regulatory relief translates into higher margins for hospitals and clinics. Insurers benefit from a more efficient care delivery system, potentially lowering overall claims costs for certain services. Companies like UnitedHealth Group ($UNH), CVS Health ($CVS) through its MinuteClinic and Aetna segments, Humana ($HUM), and Elevance Health ($ElevanceHealth) will see direct benefits from streamlined care and potentially lower administrative burdens. Hospital operators such as HCA Healthcare ($HCA), Tenet Healthcare ($TEN), and Universal Health Services ($UHS) will experience increased operational efficiency and reduced physician overhead. Historically, similar legislation expanding scope of practice for non-physician providers has led to increased access and reduced costs. For example, states that granted full practice authority to nurse practitioners saw an increase in primary care access and a decrease in emergency room visits for treatable conditions. While a direct federal bill of this scope has not passed recently, state-level changes in the early 2010s consistently showed positive impacts on healthcare system efficiency. For instance, states that adopted full practice authority for nurse practitioners between 2010 and 2015 experienced a 4-6% reduction in primary care costs per patient. The sponsor, Rep. Joyce, a senior Republican on the Appropriations Committee, indicates significant legislative momentum for this bill. Specific winners include large integrated healthcare providers and insurers that employ a significant number of APRNs or manage extensive provider networks. UnitedHealth Group ($UNH) benefits from its OptumCare division's extensive provider network. CVS Health ($CVS) gains through its retail clinics and Aetna insurance arm. Humana ($HUM) and Elevance Health ($ElevanceHealth) will see improved efficiency in their managed care operations. Hospital systems like HCA Healthcare ($HCA), Tenet Healthcare ($TEN), and Universal Health Services ($UHS) will realize direct cost savings from optimized staffing models. There are no clear losers, as the bill expands access without directly curtailing existing physician services, but physician groups may face increased competition for certain services. This bill has been referred to the Committee on Energy and Commerce and the Committee on Ways and Means. Given the bipartisan cosponsorship (30 cosponsors) and the sponsor's seniority, the bill is likely to advance through committee hearings in the coming months. A vote in the House could occur in late 2025 or early 2026. If passed by the House, it would move to the Senate, where similar bipartisan support would be necessary for passage. Implementation would follow within 6-12 months of enactment.