Compacts are still in flux. It can be confusing for legislators, especially if they take policy positions based on political affiliation.

The Hamilton Project, founded by former Clinton administration members, supports healthcare compacts. However, unions like the SEIU strongly oppose them. Big Health Systems generally support.
Source: I highly recommend Nevada Independent's longform report published yesterday on NV's 3rd failure to pass a nurse compact bill. 

The libertarian-leaning Mackinac Center supported compacts before admitting that reciprocity was better.

Right-leaning American Legislative Exchange Council (ALEC) instead proposed model legislation for Interstate-Mobility and Universal-Recognition Occupational Licensing Act. 

Occupational licensing recognition promotes geographic mobility by allowing people with licenses, private certifications and work experience to apply that experience to a license in a new state. Licensing recognition is particularly important during times of crisis, like the COVID-19 pandemic, because licensed professions may be disproportionately needed in a particular state and not others. By recognizing people’s experience, it allows workers that are trained and educated in a profession to work where they are most needed and not be limited by a new state’s license that has a similar scope of practice as the license they already have. States that are particularly hard hit by COVID-19 will want the flexibility of attracting healthcare workers from other states by easing the process of obtaining licensure in their state.

As far as I can tell, nurses are ready to try anything that promises staffing relief. PTs trust their professional organization to speak for them. Neither of these positions can be considered particularly far-sighted, much less a defensive posture for clinician and patient freedoms.

The 2nd house hearing for Michigan's nurse and PT bills is this week. 

Wednesday, April 30, 2025      9:00 AM

AGENDA

HB 4101 (Rep. Bierlein)
Health occupations: physical therapists; physical therapy licensure compact; enact.

HB 4380 (Rep. Bierlein)
Health occupations: physical therapists; licensing process; modify to incorporate physical therapy licensing compact.

HB 4246 (Rep. Phil Green)
Health occupations: nurses; nurse licensure compact; enact.

Presentation on the Michigan Council on Maternal & Child Health

OR ANY BUSINESS PROPERLY BEFORE THIS COMMITTEE

This afternoon, a bill to modify APRN scope of practice was added to the hearing agenda.

It's a very interesting bill: 

• Pages 1-6 involve minor changes like degendering the law. While distasteful, these changes are more cosmetic than high-impact.
• Pages 7-8 add a completely new description of nurse practitioner qualifications.
• Page 9 provides NP's with new prescribing privileges for Schedule 2-5 controlled substances - without physician delegation or documentation.
• Pages 10-11 provide NP's with independent privileges for dispensing complimentary starter doses of Schedule 2-5 controlled substances.

This bill appears to expand APRN scope of practice without strings attached. If there are strings, they would be found in the lengthy new NP qualifications. I'd love to get current NP's perspective on this.

AGENDA

HB 4101 (Rep. Bierlein)
Health occupations: physical therapists; physical therapy licensure compact; enact.

HB 4380 (Rep. Bierlein)
Health occupations: physical therapists; licensing process; modify to incorporate physical therapy licensing compact.

HB 4246 (Rep. Phil Green)
Health occupations: nurses; nurse licensure compact; enact.

HB 4399 (Rep. Prestin)
Health occupations: advanced practice registered nurses; scope of practice of registered professional nurses who hold specialty certifications as nurse practitioners; modify.

Presentation on the Michigan Council on Maternal & Child Health

OR ANY BUSINESS PROPERLY BEFORE THIS COMMITTEE

New podcast today via Mackinac Center is very relevant.

https://www.mackinac.org/podcasts/the-overton-window/jessi-troyan-on-licensing-reciprocity

‘What’s not to love?’

Jessi Troyan on licensing reciprocity

May 2, 2025 |  By Jessica Wyeth

 

West Virginia is making it easier for professionals to get to work — no matter where they’re coming from.

Jessi Troyan, Director of Policy and Research at the Cardinal Institute, unpacked the significance of a new universal licensing recognition law passed in West Virginia on The Overton Window Podcast.

Too many people are blocked from working simply because their license doesn’t transfer across state lines. “Almost one in four workers require a government permission slip to be able to work,” Troyan says. The problem isn’t just the paperwork. It’s the hoops professionals have to jump through when they move. Even a seasoned worker might be forced to repeat coursework, re-take exams, or pay steep fees — just to prove they’re still qualified.

“If I were a licensed professional moving to Michigan, I would have to possibly go through education again, more training, take another exam to prove that I am a competent professional despite the fact that West Virginia has said so,” Troyan explains. “But Michigan says, ‘No, we don’t trust West Virginia’s judgement.’”

Now, West Virginia is flipping that script. The new law accepts out-of-state licenses for most professions. “If you were good enough for your old state, you’re good enough for ours,” Troyan says. “Welcome to the wild and wonderful. Let’s help you get back to work. Let’s earn that honest paycheck.”

Universal recognition isn’t a new fight for the Cardinal Institute. Six years ago, they began digging into occupational licensing data. They asked practical questions — how many professions are licensed here? What are the education requirements? How much are the fees? The answers, especially when compared to neighboring Ohio and Pennsylvania, weren’t flattering.

“West Virginians do not enjoy the same sort of economic quality of life on average as our neighbors… We have lower incomes. We have lower workforce participation rates.” And licensing rules aren’t helping. “We want more people in West Virginia to be working. We want them to be working good jobs… And yet we are pulling off these bottom rungs of the ladder and hoping that you have an NBA vertical leap to be able to catch the first rung.”

The first attempt to introduce universal licensing in 2020 didn’t even make it to a vote. The Cardinal Institute kept working behind the scenes, helping lawmakers shape the bill. They didn’t start from scratch. Instead, they looked at other states where similar reforms had already passed.

Not everyone was on board. Professional boards pushed back — especially accountants. “They were highly opposed to this: ‘No, we have these great standards in West Virginia, and we can’t go around willy nilly trusting the judgement of these other states in the union.’”

According to Troyan, that resistance often comes down to self-interest. Fewer licensed professionals mean less competition and higher wages for those already “in the club.” But she argues that’s not a good trade-off. “It is not an economic benefit to the entirety of West Virginia that we are artificially reducing the number of professionals who are in the market to be able to provide these services to the state.”

The Cardinal Institute published narratives of professionals struggling to work in the state due to the licensing barriers until, eventually, support from the governor helped push the bill across the finish line. And for professionals moving to West Virginia, it means one less hurdle — and a quicker path to getting back to work.

Listen to the full conversation on The Overton Window Podcast.

Jessica Wyeth joined the Mackinac Center for Public Policy as a marketing analyst in June 2024.

Wyeth received her B.A. in politics with a minor in writing from The Catholic University of America in 2023. While in Washington, DC, she worked for the Columbus School of Law and Federal Communications Commission. In addition to her work and studies, she founded the literary magazine, Vermilion.

After living in DC for four years, she has returned to her Michigan roots and is diving head-first into state politics at the Mackinac Center. She enjoys spontaneous travel, contemporary memoirs, and hypothetical questions.

The NP scope of practice bill is back in this committee for its 2nd hearing this week Wednesday.

Watch the hearing for lobbyists, amendments, and potentially a vote out to the House floor.