Q&A: Michigan lobbyist notes policy priorities for next session, including health workforce legislation

Heather Nicholoff is a senior associate at Kheder, Davis & Associates and lobbies in the Michigan Legislature on health policy issues. She previously served as the chief of staff to the chairman of the House Health Policy Committee for five years. 

In this Q&A, Nicholoff discusses the importance of addressing workforce shortages in the 2022 general session and some important conversations that will continue from the 2021 general session. 

 

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Patrick Jones: What are some of the most important health policy conversations happening right now in Michigan from your perspective, and what important work has been done in the session?

Heather Nicholoff: “I know that House and Senate leadership have been meeting with the governor’s office to talk about how to spend the over $15 billion in federal dollars that the state has available…The priorities seem to focus around COVID [including] law enforcement funding, funding to recruit firefighters and EMS workers, which the house is taking the lead on. Water infrastructure has seen movement recently in the Senate. While there’s agreement that infrastructure should get the bulk of the federal aid dollars, a final agreement will probably not happen until the first part of next year. So I expect that discussion to continue but talks are going on right now and they’re hoping to make some progress before the end of the year. 

So while the legislature has done some work on addressing the opioid epidemic and mental health, I see that there will be further discussions into the new year on those types of health issues. Specifically, there’s the behavioral health and physical health integration legislation. There are a couple of bills that would create a process for a phased in integration. I could see that discussion continuing because we also have Representative Mary Whiteford’s proposal. [Her proposal] would pretty much do away with the state’s 10 prepaid inpatient health plans. So I could see discussions continuing on that front.

PJ: Any other issues that you think will be prioritized?

HN: “I think that we’re also likely to see further discussion on how to address health care workforce shortages, which is a huge concern now and the pandemic is only exacerbating those issues. We’ve seen a couple of bills discussed on this front as recently as [last] week even. We’ve seen Senate Bill 759 that was taken up in the Senate Health and Human Services Committee. That would codify allowing health care workers licensed in other states to work in Michigan during a pandemic. It has bipartisan support and it has been supported by the Whitmer administration. So that’s now on the Senate floor. 

I’m currently working on a couple of bills that deal with the workforce in health care on behalf of the Michigan Council of Nurse Practitioners. Senate Bill 191 is one that would add nurse practitioners, clinical nurse specialists, and physician assistants to the mental health code. They’re not mentioned right now as mental health providers and in the mental health code, but they serve patients in every type of behavioral health or mental health setting in literally every region of Michigan today. So adding them into the mental health code as mental health professionals and allowing them to issue the first certification to refer a patient for an evaluation by a psychiatrist will allow for better patient access to care when a patient is in crisis. 

Another bill that I’m working on concerns defining the scope of practice for nurse practitioners. That’s Senate Bill 680. So, allowing nurse practitioners (NPs) to practice to the fullest extent of their education and training and aligning Michigan statute. [Aligning] Michigan’s public health code with national standards of nurse practitioner practice will definitely help relieve the shortage of health care providers in our state. Removing barriers to practice that exist now creates greater access to care especially in underserved urban and rural areas.”

PJ: What would you say is the main theme of the 2021 session as it draws to a close? You noted that COVID was really big in this session.

HN: “I think that’s it. I think that has been the main focus we’ve all been trying to navigate through the pandemic, both in our personal lives as well as professional lives, and I think the legislature is no different. I think that has been the ultimate focus this year and it sounds like it will continue to be a focus next year as well.”

PJ: What would you say are the more contentious and potentially controversial arguments happening around health policy in the legislature?

HN: “I think we’re starting to see discussions about gun safety and our further need to evaluate our gun laws here in Michigan due to the issues with the Oxford high school shooting. I do see the potential for some health care organizations to weigh in on that. I don’t know how much traction it’s going to get in the Republican-controlled legislature, but I know that the Senate Democrats have already started a groundswell of vocalizing a need to address those types of laws here in Michigan, which will be contentious. I know that anything scope of practice, I think, is contentious, and I think we’re going to continue to see some discussions happening on that front, not just with nurse practitioners but with other health care professionals as well.

[Another controversial piece of legislation] has to do with price transparency for drugs. That may see some discussion as well into the new year. It is [however] an election year, so some of these are more controversial topics and I don’t know how much traction they will get, especially as we get further and further into the year and closer and closer to the election. You tend to see controversial bills kind of losing steam toward the end of an election year. I think [price transparency] is something that’s very controversial and we’ll see if the chair ends up bringing it up next year or not.

I know that there is legislation that will continue to be discussed on vaccine mandates, and that’s something that will probably be addressed in committee and continue to be discussed.”

PJ: Can you talk more about potential vaccine mandate legislation?

HN: “I know that Representative Allor had a couple of bills that would prohibit vaccinations as a condition of employment and I think she had one also that would prohibit governments from producing a coronavirus vaccination passport or requiring someone to show that type of documentation. There was a hearing late in the summer in the House Workforce, Trades, and Talent Committee that’s chaired by Representative Griffin. So there was some discussion on that, but there wasn’t a vote. I think she was waiting to make sure that there was a majority of committee members in support and I don’t think there was support at that time. That’s something that may come up again.”

PJ: How much emphasis do you think the legislature next session will put on improving and expanding behavioral health and mental health in Michigan?

HN: “I do think that will continue to be a very important topic going into this upcoming year. Mainly due to issues I mentioned before [around] workforce shortages. We see that a lot in mental health settings. We have a shortage of psychiatrists here in Michigan. I think that discussion will continue along the mental health realm as well. But also with COVID, I think those issues have been exacerbated and substance abuse problems have been on the rise. I think a lot can be attributed to the pandemic in that aspect as well. [There are bills] on medication assisted treatment and that has had some discussion recently.”

PJ: In the next session, what do you think is going to be the most important thing talked about? It seems like the workforce is one of the bigger issues in Michigan health care. Is that right?

HN: “Absolutely workforce. [We are] trying to ensure that we have all providers in Michigan practicing to the fullest extent of their education and training so that we have all hands on deck to deal with the physical and mental health needs of our residents in Michigan. The need is there and it’s continuing to grow. We’re seeing a lack of providers and that lack of providers is continuing to be exacerbated. 

I think throughout health care we need to make sure that all hands are on deck and everyone’s available and able to utilize their knowledge and training to the best of their ability to offer that assistance for our residents. I think that is the most important conversation.”

This interview was edited for clarity and length.