Recent Michigan bill hearings on Physical and Occupational Therapy licensing compacts further advance globalization of healthcare. In addition, a Physician Assistant compact bill is reportedly back in the legislature.

Centralized control of professional licensing advances population care and puts your healthcare freedoms at risk.

License Compacts: a Lansing timeline

Three compacts represents a rapid increase in Michigan health professions empowering new regulators called compact commissions.

• In 2018, MI physicians accepted the Interstate Medical Licensure Compact as part of “a crummy deal” to curb manipulative certification practices.
• The enhanced Nurse Licensure Compact (eNLC) bill passed the legislature in 2020 and was vetoed by the governor. It was recently reintroduced after going nowhere last term.
• The Psychology Interjurisdictional Compact (PSYPACT) became law in 2022.

I researched and testified against the eNLC on behalf of Michigan Healthcare Freedom on April 11, 2019. Other compact provisions follow a similar pattern: Miichigan joins a nationwide compact, governed by an independent commission with rulemaking, data collection, and fee assessment authority, with an annual fee ($6000) paid by Michigan taxpayers.

Distancing rule-making power from clinicians and their elected state officials suppresses free choices and constitutional, representative government.

Who gets to decide healthcare?

A major tenet of progressivism is the rule of experts. With compact bills, academic and corporate experts seek more control over clinicians through standardization.

In contrast, those who believe in self-governance value individual autonomy as vital to front-line healthcare innovation.

Many healthcare jobs are controlled by professional elites through HR department hiring practices, education and facility entry standards, internal policies, boosting degree requirements, and more. Voting with our feet and pocketbooks may be the best we can do to affect these barriers.

But with compacts, we lose our greatest impact: to voter for those who control licensing. Through our elected officials, we can hold LARA accountable.

Mission Creep

Licensing has always suffered from mission creep. How long will a duplicate structure last before compacts take over, given our prevailing faith in the rule of experts?

“But,” you say, “Compact licenses are voluntary.”

State Nurse Registries of a century ago began as voluntary.
They quickly morphed into mandatory licensing.

Since the $20 fee when I graduated from nursing school, Michigan has doubled fees, added mandatory Continuing Education hours (CE) and increased fees again, added voluntary online renewal and a CE computerized filing system, and increased fees yet again. Nurse licenses now require online renewal, $121, and 26 CE including Implicit Bias Training.

Given the trend, filing CE online may be mandatory by the time you’ve finished reading this. Or maybe the eNLC Commission will just absorb CE filing along with the rest of licensure for more expert efficiency.

Who asked for the compacts? Not bedside clinicians.

Claims that the compact helps the nurse shortage were thoroughly debunked at the first hearing. Shortages are nationwide, and only 8% of nurses travel for a living. Those entering Michigan can be legal to practice within two weeks, or in one day in an emergency.

Reports of Michigan nurses obtaining licenses in neighboring states do suggest that lower fees would be welcome.

State to state mobility was so low in real-world nursing concerns in 2018, it didn’t even make the list. The Michigan Nurses Association opposed the bill.

Michigan’s Department of Licensing and Regulatory Administration (LARA) didn’t like it, either. They objected to the bill’s unfunded mandate to create a parallel licensing structure. (Michigan government’s IT cost overruns are legendary.)

Who benefits? Corporate interests.

Lacking voter accountability, independent compact commissions are wide open to industry influence.

• The top national regulator of US nurses is the National Council of State Boards of Nursing (NCSBN).
  Besides controlling nurse licensure exams, NCSBN is the author of the eNLC, and provided the lead expert testifying in support of Michigan’s bill. NCSBN advertised its 2018 global nursing regulatory atlas as a service to global customers. Controlling an entire nation of healthcare professionals under one regulatory regime comes before complete global regulation.
• Nursing Compact supporters included the Michigan Health and Hospital Association, AARP, and an assortment of regional health and provider networks. Labor unions were divided.
• Corporate interests have reason to want state borders gone. Hospital and insurance mergers crossed state lines long ago, and have now gone vertical with acquisitions of their own pharmacy and pharmaceutical middleman operations.
  The latest hot deals are trans-national healthcare mergers and acquisitions (including travel nurse agencies), all of whom potentially benefit from negotiating with one entity.
• Trans-border interests led at a Detroit summit sponsored by the Michigan Economic Development Corporation, Beaumont Health, and the Wayne State University School of Medicine. The event featured “a regional health care innovation cluster comprising health care providers, universities, and economic development organizations in southeast Michigan and southwest Ontario.”
• Wayne State University Dean of Nursing testified in support, citing benefits to incoming grad students and faculty who taught an out of state clinical.

No vote, no choice, no freedom

Compacts set us up for violation of individual rights by benefiting monopolies beyond state lines. State lines stand in the way of globalization because state elected officials exist to defend our individual rights to decide, to choose for ourselves.

Choice of care. Choice of employer. Choice of profession.

All are blessings we owe to freedom.

Choices disappear under monopoly mergers, and even more with acquisitions of allied industries. Monopolies of multiple service lines produce “coal towns,” where people have no choice of where to work or where to get care. They owe their souls to the company store.

Are Licensing Compacts Constitutional?

Compacts bring together Big Health, state universities, professional boards, and state ambitions.

In opposition to these forces, we elect legislators to represent our interests, not to get us a “piece of the pie,” but to secure our healthcare freedoms.

Do legislators have the right to pass these compacts?

Constitutionally, there are two reasons the answer is No.

1. The US Constitution provides compacts for a group of states to assume a federal power. But licensing is a state power. The licensing compacts do not fit the constitutional model.
2. The Kansas Attorney General ruled licensing compacts an unconstitutional delegation of authority. Voters give legislators the power to make law, but not the right to delegate the power. The non-delegation principle traces back to John Locke, a physician and primary source of American founding principles.

Legislators can solve licensing without compacts

Michigan legislators have better options to simplify matters.

• Send independent decisions back to the individual instead of to elite experts.
• Peel back excess licensure.
• Term limit license laws: last in, first out.
• Restore entry-level  jobs like nurse’s aide and pharmacy tech to their proper, unlicensed place as the first rung of the healthcare career ladder.
• Expand license reciprocity with other states.
• Reduce continuing education mandates.

Removing barriers meets Michigan’s needs for healthcare access, job mobility, choices, and innovation.

 

Updated October 19 and 21 to replace an image, add a link, and correct the status of Michigan’s nurse license compact.