Clarke Edwards Letter to Senator Brad Hutto (SC) Regarding S.45 / H.3580 and S.669

Office of Policy Planning
September 9, 2025
Senator Brad Hutto
South Carolina Senate
513 Gressette Senate Office Building
Post Office Box 142
Columbia, South Carolina 29202
Re: S.45 / H.3580 and S.669
Dear Senator Hutto:
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 and lowering prices in the health care sector are
among Chairman Andrew Ferguson’s highest priorities for the FTC.
I write to respond to your August 12, 2025, request for review of two bills pending in the
South Carolina legislature that would address the practice of Advanced Practice Registered
Nurses (“APRNs”). 1 According to your letter, Senate Bill 45 and identical companion House Bill
3580 would allow for a transition to full autonomous practice for three categories of APRNs
(Nurse Practitioners, Certified Nurse Midwives, and Clinical Nurse Specialists) upon completion
of 2,000 collaborative practice hours with a physician. In contrast, Senate Bill 669 would
increase restrictions on APRNs. Among other things, Senate Bill 669 would ban APRNs, as well
as Physician Assistants and Anesthesiologist’s Assistants, from practicing independently—
regardless of their experience, education, licensure and certification—and instead require them to
work as part of a physician-led team.
This letter highlights the FTC’s prior work in this area that you may find informative as
you consider these bills. Competition drives America’s economy and benefits its consumers,
producing lower prices, higher quality products and services, more choices, and greater
innovation.2 Promoting health care competition has long been a particular focus for the FTC’s
1 Letter from South Carolina State Senator Brad Hutto to Clarke Edwards, Acting Director, Office of Policy
Planning, Federal Trade Commission Regarding South Carolina S.45 / H.3580 and S.669 (Aug. 12, 2025).
2 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.”).
UNITED STATES OF AMERICA
FEDERAL TRADE COMMISSION
WASHINGTON, D.C. 20580

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law enforcement,3 research, 4 and advocacy.5 As part of these efforts, FTC staff have consistently
raised concerns with efforts to thwart competition between physicians and APRNs through laws
and regulations that prevent APRNs from practicing independently.6 For example, a 2015 FTC
staff letter “urge[d] the South Carolina legislature to avoid restrictions on APRN practice that are
not narrowly tailored to address well-founded patient safety concerns” because “removing [such]
restrictions may offer significant benefits to South Carolina’s health care consumers.”7 This
advocacy was 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, (“FTC Staff Policy Paper”), details FTC staff’s research
regarding APRN scope of practice restrictions.8 It also presents principles for state legislators
and policymakers to consider when evaluating proposed changes to limits on APRNs’ scope of
practice.9 “APRNs tend to provide care at lower cost than physicians” and increase supply for
3 See generally F ED. TRADE C OMM’ N S TAFF , O VERVIEW OF FTC A CTIONS IN H EALTH C ARE S ERVICES AND
P RODUCTS (Apr. 2025) (Bureau of Competition, Health Care Div. Staff, Bradley S. Albert et al.),
https://www.ftc.gov/system/files/ftc_gov/pdf/2025.04.04-Overview-Healthcare.pdf.
4 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).
5 See generally Fed. Trade Comm’n, Advocacy Filings, https://www.ftc.gov/legal-library/browse/advocacy-filings
(Filter: Industry, Health Care).
6 See F ED. TRADE C OMM’ N S TAFF , P OLICY P ERSPECTIVES : COMPETITION AND THE REGULATION OF A DVANCED
P RACTICE N URSES , 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 (“FTC Staff Policy Paper”). 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, 2015), https://www.ftc.gov/legal-library/browse/advocacy-filings/ftc-staff-
comment-south-carolina-representative-jenny-horne-regarding-house-bill-3508-3078-advanced (“Horne Letter”);
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), 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), https://www.ftc.gov/legal-library/browse/advocacy-
filings/ftc-staff-comment-kansas-house-representatives-concerning-kansas-house-bill-2412.
7 Horne Letter, supra note 6, at 1–2.
8 FTC Staff Policy Paper, supra note 6.
9 Id. at 3–4.

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basic primary care.10 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.11 Greater deployment of APRNs may be particularly helpful in instances where
health care professionals are relatively scarce.12 Conversely, undue restrictions on APRN
practice can harm patients, institutional health care providers, and both public and private third-
party payors. 13 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.14
Proponents often argue that patient health and safety concerns support APRN scope of
practice restrictions. We observed, however, that “[b]ased on substantial evidence and
experience, expert bodies have concluded that ARPNs are safe and effective as independent
providers of many health care services within the scope of their training, licensure, certification,
and current practice.”15 Further, even well-intentioned laws and regulations may include
unnecessary or overbroad restrictions that limit competition and its benefits to health care
consumers.16 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.17
I hope this information is helpful to you in considering these bills. Please do not hesitate
to contact the FTC’s Office of Policy Planning if we can be of further assistance.
Respectfully submitted,
_______________________
Clarke Edwards
Acting Director
Office of Policy Planning
Enclosures
10 Horne Letter, supra note 6, at 3.
11 FTC Staff Policy Paper, supra note 6, at 18–35. See also Horne Letter, supra note 6, at 4 (“Even in well-served
areas, a supply expansion tends to lower prices and drive down health care costs.”).
12 FTC Staff Policy Paper, supra note 6, at 20–27. See also Horne Letter, supra note 6, at 3–4 (“In underserved
areas and for underserved population, the benefits of expanding supply are clear: consumers may gain access to
services that otherwise would be unavailable.”).
13 FTC Staff Policy Paper, supra note 6, at 27–28. See also Horne Letter, supra note 6, at 1, 3.
14 FTC Staff Policy Paper, supra note 6, at 34–35.
15 Id. at 2.
16 Id. at 1.
17 See id. at 38–39.