“I have no doubt suspending these scope-of-practice laws helped save countless lives and ensured our hospitals were fully staffed to care for COVID-19 patients,” Gov. Gretchen Whitmer said. “But our battle with COVID-19 is far from over. We owe it to the frontline health care workers, first responders and other essential workers to continue doing our part to slow the spread of the coronavirus — which includes wearing a mask and practicing social distancing — so our hospital systems aren’t overwhelmed with new patients.”
These remarks from the governor accompanied an executive order she issued on Monday, July 13, bringing her executive order count to 150 in this year alone. Some of the orders mapped out new and temporary policies in response to the COVID-19 crisis, others simply clarified or expanded on these policies, and a good number rescinded prior orders. Executive Order 2020-150 is among the latter, rescinding Executive Order 2020-61 from March, which had permitted certain licensed medical personnel to practice to the top of their skills and training without being restrained by the state’s scope-of-practice laws.
The governor’s earlier statement supporting the benefits of loosening these restrictions makes her move to reinstate them all the more perplexing.
While all states impose some form of scope-of-practice restrictions on medical professions, the specifics vary widely. According to Deena Kelly Costa, an assistant professor at the University of Michigan School of Nursing, Michigan had some of the nation’s most restrictive scope-of-practice laws for advanced practice nurses. (Costa advised Whitmer’s office in crafting Executive Order 2020-61, by the way.)
After Whitmer loosened these restrictions in March, Costa began advising the Whitmer administration to make the temporary changes permanent, as the Mackinac Center had also encouraged. This could be accomplished by working with the Legislature to pass statutory reform.
As Costa has noted, the RAND Corporation found that eliminating these regulations for nurse practitioners would increase public access to health care. Not only would patients experience fewer delays when booking appointments, they would also be more likely to use the available care to schedule annual visits and checkups. The result would be more preventive care and better outcomes, particularly for high-risk adults.
Why would the governor reinstate regulations that limit patient access to qualified care while her administration is beating the drum about the threat COVID-19 poses? For the same reason these laws were ever in place before the pandemic. Special interest cartels, represented by some of the best-funded lobbyists in Lansing, use their tremendous influence to restrict the delivery of certain services and procedures to a narrow class of providers and bar all others.
Whitmer implicitly acknowledged the negative effects of these restrictions when she suspended them in March. Her decision to reinstate them in July is, frankly, bizarre, and it hurts residents and patients. Here’s why:
Whitmer herself admitted that removing scope-of-practice barriers to care benefits Michigan patients — and in the very same breath, announced her plans to restore them.
Whitmer has assumed extensive emergency powers and refuses to subject them to oversight by the Michigan Legislature – a posture that implies the crisis remains severe. Yet reinstating red-tape regulations that limit access to care undermines that implicit claim.
Whitmer subsequently issued a statewide mask mandate, saying, “If we let our guard down, we could see a rapid increase in cases and deaths from this disease.” She added, “I know we can beat COVID-19, but it’s going to take everyone doing their part.” She has not explained how reinstating policies that limit the number of health care providers when there may be “rapid increases in cases” constitutes “doing her part” to keep Michiganders safer and healthier.
Whitmer has styled herself as a champion for women in the workplace through policy initiatives like equal-pay rules. Yet, Costa raised concerns about how the nursing profession, with a high percentage of women in its ranks, is devalued by scope-of-practice laws. “As a society, there is a systematic undervaluing of care work –which is predominantly done by women and people of color – and is deeply rooted in sexism, racism and the like. This leads to invisibility of nursing care. This plays out in various misconceptions and lack of clarity regarding nursing’s role in health care.”
Whitmer continues to suggest, in other executive orders, that the state needs to expand access to care. One such order waives regulations restricting access to telehealth services, and another allows medical professionals licensed in other states to practice in Michigan. The inconsistency is illogical, ignores scientific data, and deprives Michiganders of the wealth of options they should have at their disposal for addressing their health concerns.
When it comes to the COVID-19 crisis, the only consistencies in the Whitmer administration’s executive orders has been that they are predictably arbitrary and void of transparency.
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