Letter from Office of Policy Planning Acting Director Clarke Edwards to Senator Juan Barnett Concerning Mississippi H.B. 1057 to Address the Practice of Advanced Practice Registered Nurses

Office of Policy Planning
January 5, 2026
Senator Juan Barnett
Mississippi State Senate
New Capitol
Post Office Box 1018
Jackson, MS 39215-1018
Re: H.B. 1057 (2025)
Dear Senator Barnett:
I am the Acting Director of the Federal Trade Commission (“FTC”) Office of Policy
Planning. My office is charged with engaging with state legislatures, regulatory boards, and other
government officials on competition and consumer protection issues to champion the interests of
the American people. Promoting competition to increase access to care, improve quality, and lower
prices in the health care sector is among Chairman Andrew Ferguson’s highest priorities for the
FTC.
I write to respond to your December 22, 2025, letter requesting review of a bill from the
2025 Mississippi Legislature Regular Session to address the practice of Advanced Practice
Registered Nurses (“APRNs”).0F
1 You indicated that you intend to introduce a bill to replicate this
bill in the 2026 Regular Session around January 6, 2026. H.B. 1057 would amend sections 73-15-
5 and 73-15-20, Mississippi code of 1972, to authorize certified nurse midwives to practice as an
APRN and deliver babies of low-risk mothers without requiring a “collaboration practice
agreement” with a physician.1F
2 Your letter noted that, “Mississippi consistently ranks among the
worst in the nation in all prenatal and post-natal care for women, and there is a vast shortage of
obstetrical physicians in the State with the majority choosing to practice exclusively in large urban
areas.”2F
3 As you analyze H.B. 1057, I encourage you to consider the incentives of those who oppose
the bill. It “may be in the economic self-interest of . . . physicians to propose and advocate [for]
1 Letter from Mississippi State Senator Juan Barnett to Clarke T. Edwards, Acting Director, Office of Policy Planning,
Federal Trade Commission Regarding Mississippi H.B. 1057 (2025) (Dec. 22, 2025), [hereinafter Barnett Letter].
2 Miss. H.B. 1057, 2025 Reg. Sess. (2025), https://billstatus.ls.state.ms.us/2025/pdf/history/HB/HB1057.xml; see
Barnett Letter, supra note 1, at 1.
3 See Barnett Letter, supra note 1, at 2; see also FED. T RADE COMM ’ N STAFF, POLICY PERSPECTIVES: COMPETITION
AND THE REGULATION OF A DVANCED PRACTICE N URSES, 31 (2014) [hereinafter FTC Staff Policy Paper],
https://www.ftc.gov/system/files/documents/ reports/policy-perspectives-competition-regulation-advanced-practice-
nurses/140307aprnpolicypaper.pdf (“In some cases, the costs imposed on independent APRNs seeking collaborative
practice agreements may be prohibitive, destroying the economic viability of an existing APRN practice or deterring
entry by others”).
UNITED STATES OF AMERICA
FEDERAL TRADE COMMISSION
WASHINGTON, D.C. 20580

2
restrictions on APRN licensure and scope of practice; and such physicians might be biased towards
doing so.”3F
4
This letter highlights the FTC’s prior work that you may find informative. Competition
drives America’s economy and benefits its consumers, producing lower prices, higher quality
products and services, more choices, and greater innovation.4F
5 Promoting health care competition
has long been a particular focus for the FTC’s law enforcement,5F
6 research,6F
7 and advocacy.7F
8
The FTC has long emphasized the potential “lasting damage” caused by “unnecessary
occupational regulation” that excludes qualified professionals from the market and saddles
“consumers with higher-priced, lower-quality, and less convenient services.”F
9 Such competitive
concerns are particularly acute “when ‘entrants are effectively required to obtain permission from
incumbent competitors to enter or expand within a particular market,’”9F
10 as is the case when
physicians can effectively control whether and when certified nurse midwives can compete to
deliver babies of low-risk mothers by dint of a collaborative practice agreement requirement.
In 	their 	advocacy 	against 	anticompetitive 	health 	care 	and 	occupational 	licensing
restrictions, FTC staff have consistently raised concerns with restrictions that may thwart
competition between physicians and APRNs—including laws and regulations that prevent APRNs
from practicing independently.10F
11 For example, FTC staff have submitted written comments
4 See FTC Staff Policy Paper, supra note 3, at 14–15.
5 Standard Oil Co. v. FTC, 340 U.S. 231, 248 (1951) (“The heart of our national economic policy long has been faith
in the value of competition.”).
6 See generally FED. TRADE COMM’ N STAFF, O VERVIEW OF FTC A CTIONS IN H EALTH CARE SERVICES AND PRODUCTS
(Sept. 2025) (Bureau of Competition, Health Care Div. Staff, Bradley S. Albert et al.), https://www.ftc.gov/system/
files/ftc gov/pdf/2025.09.30-Overview-Healthcare.pdf.
7 See generally Fed. Trade Comm’n, Health Care Competition, The FTC’s Health Care Work, https://www.ftc.gov/
news-events/topics/competition-enforcement/health-care-competition (Reports).
8 See generally Fed. Trade Comm’n, Advocacy Filings, https://www.ftc.gov/legal-library/browse/advocacy-filings
(Filter: Industry, Health Care).
9 FED. T RADE COMM’ N, PREPARED STATEMENT OF THE FEDERAL TRADE COMMISSION BEFORE THE U NITED STATES
SENATE COMMITTEE ON THE JUDICIARY SUBCOMMITTEE ON A NTITRUST , COMPETITION POLICY AND CONSUMER
R IGHTS “L ICENSE TO COMPETE : O CCUPATIONAL L ICENSING AND THE STATE ACTION D OCTRINE ” 1–2 (Feb. 2, 2016)
(presented 	by 	Commissioner 	Maureen 	K. 	Ohlhausen), 	https://www.ftc.gov/system/files/documents/public_
statements/912743/ 160202occupationallicensing.pdf.
10 FTC Staff Comment regarding Proposed Amendment to Rule 1 of the Rules Governing Admission to the Bar of
Texas, 5 (Dec. 1, 2025), https://www.ftc.gov/system/files/ftc gov/pdf/ftc-staff-comment-tex-s.-ct.pdf (quoting
Maureen K. Ohlhausen & Gregory P. Luib, Brother, May I?: The Challenge of Competitor Control over Market Entry,
4 J. A NTITRUST E NF’ T 111, 111 (2016), https://doi.org/10.1093/jaenfo/jnv028).
11 See FTC Staff Policy Paper, supra note 3, Appendix 1 (2014) (collecting advocacies through Jan. 2014),
https://www.ftc.gov/system/files/documents/reports/policy-perspectives-competition-regulation-advanced-practice-
nurses/140307aprnpolicypaper.pdf; see also FTC Staff Comment to State Rep. Jeanne Kirkton Regarding Mo. H.B.
1481 and H.B. 1491, 1–2 (May 5, 2014), https://www.ftc.gov/legal-library/browse/advocacy-filings/ftc-staff-
comment-missouri-house-representatives-regarding-missouri-house-bills-1481-1491; FTC Staff Comment to State
Rep. Jeanne Kirkton Regarding Mo. H.B. 633, 1–2 (Apr. 21, 2015), https://www.ftc.gov/legal-library/browse/
advocacy-filings/ftc-staff-comment-representative-jeanne-kirkton-missouri-house-representatives-regarding-
competitive; FTC Staff Comment to State Rep. Jenny A. Horne Regarding S.C. H. 3508 and H. 3078, 1–2 (Nov. 2,

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analyzing the likely competitive effects of proposed APRN regulations in various states, and
observing that removing excessive supervision requirements can achieve significant consumer
benefits.11F
12 Such advocacy letters are backed by FTC staff’s expertise with health care competition
issues and extensive study of the particular implications of various APRN scope of practice
restrictions. The enclosed FTC staff policy paper, Policy Perspectives: Competition and the
Regulation of Advanced Practice Nurses, details FTC staff’s research regarding APRN scope of
practice restrictions.12F
13 It also presents principles for state legislators and policymakers to consider
when evaluating proposed changes to limits on APRNs’ scope of practice.13F
14
When APRNs can effectively address the needs of patients, health care consumers likely
benefit from improved access to health care, lower prices, and additional innovation.14F
15 As FTC
staff advocacy letters have observed, “APRNs tend to provide care at lower cost than physicians”
and increase supply for basic primary care.15F
16 Greater deployment of APRNs may be particularly
helpful in instances where health care professionals are relatively scarce.16F
17 Conversely, undue
restrictions on APRN practice can harm patients, institutional health care providers, and both
public and private third-party payors.17F
18 State-mandated collaboration or supervision requirements
that restrict APRNs from practicing to the full extent of their abilities, may impede access to care,
and may frustrate the development of innovative team-based approaches to health care.18F
19
2015), 	https://www.ftc.gov/legal-library/browse/advocacy-filings/ftc-staff-comment-south-carolina-representative-
jenny-horne-regarding-house-bill-3508-3078-advanced; FTC Staff Comment to State Sen. Kent Leonhardt Regarding
W. Va. S. 516, 1-2 (Feb. 10, 2016), https://www.ftc.gov/legal-library/browse/advocacy-filings/ftc-staff-comment-
senate-west-virginia-concerning-competitive-impact-wv-senate-bill-516-regulation; FTC Staff Comment Before
Dep’t Veterans Affairs Regarding RIN 2900-AP44-Advanced Practice Registered Nurses, 1–2 (July 25, 2016),
https://www.ftc.gov/legal-library/browse/advocacy-filings/ftc-staff-comment-department-veterans-affairs-proposed-
rule-regarding-advanced-practice-registered; FTC Staff Comment to State Rep. Jesse Topper Regarding Pa. H.B. 100,
1–2 	(Jan. 	3, 	2018), 	https://www.ftc.gov/legal-library/browse/advocacy-filings/federal-trade-commission-staff-
comment-pennsylvania-state-house-representatives-regarding-likely; FTC Staff Comment to State Rep. Thomas E.
Brinkman, Jr. Regarding Ohio H.B. 177, 1–2 (Jan. 9, 2020) [hereinafter Brinkman Letter], https://www.ftc.gov/legal-
library/browse/advocacy-filings/ftc-staff-comment-ohio-house-representatives-concerning-ohio-house-bill-177; and
FTC Staff Comment to State Rep. Daniel R. Hawkins Regarding Kan. H.B. 2412, 2–3 (Jan. 9, 2020) [hereinafter
Hawkins 	Letter], 	https://www.ftc.gov/legal-library/browse/advocacy-filings/ftc-staff-comment-kansas-house-
representatives-concerning-kansas-house-bill-2412.
12 See, e.g., Brinkman Letter, supra note 11, at 11 and Hawkins Letter, supra note 11, at 4.
13 FTC Staff Policy Paper, supra note 3.
14 Id. at 3–4.
15 FTC Staff Policy Paper, supra note 3, at 18–35; see also Brinkman Letter, supra note 11, at 7 (“Even in well-served
areas, a supply expansion tends to lower prices and drive down health care costs.”) and Hawkins Letter, supra note
11, at 7 (same).
16 Brinkman Letter, supra note 11, at 6 and Hawkins Letter, supra note 11, at 7.
17 FTC Staff Policy Paper, supra note 3, at 20–27; see also Brinkman Letter, supra note 11, at 6–7 (“In underserved
areas and for underserved populations, the benefits of expanding supply are clear: consumers may gain access to
services that otherwise would be unavailable.”) and Hawkins Letter, supra note 11, at 7 (same).
18 FTC Staff Policy Paper, supra note 3, at 27–28; see also Brinkman Letter, supra note 11, at 2, 6 and Hawkins Letter,
supra note 11, at 2, 7.
19 FTC Staff Policy Paper, supra note 3, at 34–35; see also Brinkman Letter, supra note 11, at 2 and Hawkins Letter,
supra note 11, at 2.

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Proponents often argue that patient health and safety concerns justify APRN scope of
practice restrictions. We have observed, however, that “[b]ased on substantial evidence and
experience, expert bodies have concluded that APRNs are safe and effective as independent
providers of many health care services within the scope of their training, licensure, certification,
and current practice.”19F
20 Further, even well-intentioned laws and regulations may include
unnecessary or overbroad restrictions that limit competition and its benefits to health care
consumers.20F
21 FTC staff therefore recommended that policymakers examine whether purported
safety justifications for APRN practice restrictions are supported by credible evidence and
consider whether less restrictive alternatives would protect patients without imposing undue
burdens on competition and patients’ access to health care services.21F
22
I hope this information is helpful to you in considering legislation relating to APRNs.
Please do not hesitate to contact the FTC’s Office of Policy Planning if we can be of further
assistance.
Respectfully submitted,
Clarke T. Edwards
Clarke T. Edwards
Acting Director
Office of Policy Planning
Enclosures
20 FTC Staff Policy Paper, supra note 3, at 2.
21 Id. at 1.
22 See id. at 38–39.