A groundbreaking lawsuit filed this week by family nurse practitioner Marcy Markes could have major implications for nurse practitioners nationwide—especially in states like Texas where full practice authority remains restricted.
Markes, who owns Columbia Allergy and Asthma Specialists, is challenging Missouri’s requirement that nurse practitioners enter into costly “collaborative practice agreements” with physicians to provide care. Despite over 30 years of experience, Missouri law forces her to pay more than $50,000 annually to a physician for permission to practice—a requirement her legal team argues is unconstitutional and harmful to patient access.
The lawsuit, Marcy Markes v. Andrew Bailey, highlights how protectionist laws in Missouri—one of only 11 states with such restriction—exacerbate healthcare shortages. Nearly 80% of Missouri is considered a “medical desert,” yet laws still prevent qualified NPs from providing care to the full extent of their licensure.
This legal challenge underscores what Texas NPs already know: restrictive laws not only limit providers, but also harm patients—especially in rural and underserved communities. A win in Missouri could build momentum for full practice authority across the country, including in Texas, where similar barriers persist.
TNP will be watching this case closely. It serves as both a legal and moral reminder that access to quality care should not be stifled by outdated policies that prioritize gatekeeping over patient well-being.
