Q&A: Lindsay Killen

On March 18, 2020, the Michigan Governor Gretchen Whitmer signed an executive order to address the coronavirus pandemic sweeping the nation. The Mackinac Center played a key role in advising the governor on what policies to include in the executive order, which empowers providers to meet the mounting treatment demands for COVID-19 patients. Additionally, the governor worked with state agencies to broaden telemedicine access—another of the Mackinac Center’s suggested reforms.

One week later, the Michigan Governor responded to encouragement and follow-up from the Center by issuing  another executive order, further expanding scope-of-practice. In short—the Mackinac Center developed a COVID-19 specific healthcare reform playbook, and the governor adopted all of it.

We sat down with Mackinac’s Vice President of Strategic Outreach, Lindsay Killen, to learn more about how Mackinac succeeded in working with a Democratic Governor to advance meaningful policies in Michigan.

First, can you explain what Michigan’s two executive orders do?

The Michigan Governor’s first executive order gives healthcare workers more flexibility in responding to the coronavirus. This includes easing certificate-of-need regulations, allowing certified nurse aides to treat patients, and waiving state rules that previously limited the number of hospital beds and mobile health care facilities. The order also loosens government restrictions on workers who assist, coordinate, volunteer, or feed patients.

The second executive order includes broader scope-of-practice reforms. Among other changes, nurses can now provide care without doctor supervision, pharmacists can help patients with maintenance of health efforts, and medical personnel can treat individuals across state lines.

What was Mackinac’s plan of action after the coronavirus crisis started to unfold?

We had an ambitious legislative agenda in Lansing this year. When it became clear that lawmakers and the governor’s administration were going to be forced to confront the pandemic and issue pragmatic policy, we pivoted as an organization and tabled our agenda. We put all of our energy and resources into suggesting polices that would have a direct impact on addressing the public health crisis.

What policy reforms did you recommend, and how did you get those recommendations in front of the Michigan governor?

We put together a condensed list of healthcare specific recommendations and shared it with the administration and legislative leadership. The list included descriptions of how to model language around specific healthcare reforms, including scope of practice, certificate-of-need, telemedicine, and licensing requirements. Two days later, the governor released her first executive order that lifted certificate-of-need and licensing restrictions. While it wasn’t included in the executive order, the governor also issued regulatory guidance to expand access to telemedicine. During the subsequent week, we continued to work with legislative leadership and the administration to explore further reforms, which lead to the release of her second executive order that further empowered medical providers to provide critical treatment to COVID-19 patients.

We also partnered with the Michigan Freedom Fund, an organization that champions conservative polices in the state, and released a comprehensive list of policy recommendations to help guide Michigan’s response to the coronavirus. These recommendations included not just healthcare reforms, but economic and budget suggestions as well.

What was key to Mackinac’s success?

There are a few reasons why we were able to be successful in appealing to the governor. First, we have a thirty-plus-years reputation for being the go-to-source for policy solutions in Michigan.

Second, Mackinac has worked on the healthcare issues we recommended for several years, including in the recent legislative session. We have been educating policymakers on these reforms—so they were top-of-mind to lawmakers and the governor.

Third, Mackinac has always been fair and nonpartisan in our assessment of public policy in Michigan, which has allowed us to work with policymakers across the political spectrum. We’ve built bridges with officials across the aisle on issues like criminal justice, occupational licensing, corporate welfare and certificate-of-need reforms. When we presented our coronavirus recommendations to the administration, they knew, despite not always being aligned, that we have the ability to bring leaders with differing views together to spearhead and support meaningful solutions.

Finally, it’s beneficial to collaborate with and learn from other state think tanks and healthcare experts. I’ve been a member of SPN’s Healthcare Working Group for years now, which has provided me with invaluable and innumerous opportunities to learn from peers in our Network who have been pioneering success on innovative healthcare reforms. This exposure has helped me shape and fine-tune recommendations and strategies for the Mackinac Center that enable us to have meaningful impact.

What advice do you have for other state think tanks hoping to work with a governor who might not be aligned?

First, be willing to table any previous priorities and be realistic about what the priorities are for the administration. Figure out how your solutions can fill a void for policymakers when they’re looking for immediate solutions to help with the current crisis. Essentially, be nimble and adaptive—and don’t let perfect be the enemy of the good.

Second, keep your suggestions concise. Don’t go to the administration with 20 to 30 recommendations—even though you may have that many and they may be important ideas. Narrow it down to five or less. Be prepared to tell the administration what the one thing is that they should do, and to put your energy and resources behind that one thing if necessary. And when your solutions are implemented, thank them and champion their actions publicly.

Third, be self-aware enough to know if you’re the right messenger. In our case, we’ve been able to work with people across the aisle—so we were able to carry that message to legislative leadership and the administration. For some organizations, and in some states, that’s not going to be the case. If you don’t have the appropriate relationship, be humble enough to arm your allies who may have better ones. At the end of the day, you’re looking for those wins and the implementation of those policies that help your fellow Americans.

What aspects of Michigan’s executive order should other states try and replicate?

In terms of policies that will have the most immediate and widespread impact, Michigan’s executive orders are the best I’ve seen so far. They immediately and broadly address scope of practice, certificate-of-need, and licensing restrictions. Historically, those three healthcare reform areas are among the hardest areas to reform in state legislatures. For the governor to include and broaden them as quickly and as widely as she did in her executive orders is very significant. Policy experts at state think tanks across the country who are looking for a model executive orders can start with Michigan’s. That said, there are certainly other good executive orders out there, so we should all continue to trade information and borrow heavily from all the best practices we can identify across the country.

Related Commentary

COVID-19: Coalition Offers Blueprint for Health, Safety and Economic Opportunity
Mackinac Center study

Gov. Whitmer, Legislative Leaders Unite Behind Budgeting and Health Care Priorities to Address COVID-19 Crisis
Mackinac Center blog post

Mackinac Center Applauds Gov. Whitmer’s Loosening of Health Care Regulations
Mackinac Center blog post

Resources

Five things state policymakers can do right now to address the coronavirus public health crisis
SPN’s Healthcare Working Group offers five solutions that states can pursue immediately to improve healthcare access for all Americans as we work to stem the spread of the coronavirus.

Increasing access to life-saving healthcare during the coronavirus crisis
A roundup of the latest healthcare solutions and resources from state think tanks

Federal responses to the coronavirus pandemic & what they mean for the states
What’s going on at the federal level and what does it mean for states?

How to adapt and thrive during COVID-19: A guide for nonprofits
SPN’s resources and tools to help state think tanks navigate the coronavirus