Capitol Ideas | Issue 2 | 2021 | The Pandemic: One Year Later by The Council of State Governments

T H E

C O U N C I L

O F

S TAT E

G O V E R N M E N T S

2 0 2 1

Faces from the Front Line State health officials and emergency managers shaped state response to COVID-19

Breaking Down the American Rescue Plan Fiscal analysis, funding distribution and guidelines for states

States Renew Focus on Mental Health Legislators emphasize impact of pandemic on anxiety, depression and more

T H E PA N D E M I C : O N E Y E A R L AT E R Sima Merick, president of the National Emergency Management Association, a CSG affiliated organization, helped lead state emergency managers through 2020

I S S U E

The Council of State Governments is the nation’s largest nonpartisan organization serving all three branches of state elected and appointed officials. CSG champions excellence in state government to advance the common good.

STRONGER TOGETHER 3 B R ANC H E S OF GOVE RN M E N T 5 6 STAT E S AN D T E RRITORIE S 4 ST R ONG RE GION AL OF F ICE S

Join us.

THE PANDEMIC: ONE YEAR LATER

ISSUE 2 / 2021

Sima Merick, executive director, Ohio Emergency Management Agency

ON THE COVER

Ohio Emergency Management Agency Executive Director Sima Merick, who serves as president of the National Emergency Management Association (NEMA), started her career as a dispatcher for the Ohio State Highway Patrol. Today, she leads Ohio’s response to COVID-19 and other emergencies. NEMA is an affiliate of The Council of State Governments.

06 16 48 STAY CONNECTED

The American Rescue Plan Act of 2021, a $1.9 trillion economic relief package, was signed by the president in March. Part of this package includes the Coronavirus State and Local Fiscal Recovery Fund, which provides federal assistance for states, territories, tribes, counties and municipalities. Learn more about where the money is going and how it can be used.

FACING THE PANDEMIC

Setting politics aside, dedicated state health officials and emergency management professionals stepped up, established data-driven plans and assembled cross-disciplinary, interagency teams to protect their communities and save lives. Meet just a few of the leaders who rose to the challenge.

F O C U S I N G O N M E N TA L H E A LT H

Across the U.S., Americans grappled with their mental health long before the arrival of COVID-19, but in many cases the virus exacerbated existing problems. Concerns regarding the increasing number of mental health struggles in the wake of this global pandemic are currently top-of-mind for many legislators as states focus on recovery.

SOME ESSENTIAL WORKERS ARE SHUT OUT

Throughout the COVID-19 pandemic, state officials worried over the supply of medical and personal protective equipment as well as the essential workers needed to care for sick populations. A number of states are shutting out potential essential workers as a result of past criminal records.

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ISSUE 2 2021 | CSG CAPITOL IDEAS

F E D E R A L S T I M U LU S A N A LY S I S

THE PANDEMIC: ONE YEAR LATER / ISSUE 2 / 2021

6 Federal Stimulus Analysis

30 Strength in Numbers

Interstate compacts — or agreements between states — helped states temporarily modify health care licensing during the pandemic in order to address pressing public health concerns and save lives. Looking ahead, these compacts can provide long-term solutions for states.

8 Tracking State Budgets

CSG continues to track the ongoing fiscal impacts of COVID-19 on states following its 2020 examination of the effects on nearterm budgets and the resiliency of states’ ability to respond and strategies for fiscal recovery.

12 Q&A with Sima Merick The director of the Ohio Department of Emergency Management and the current president of the National Emergency Management Association (NEMA) reflects on her career and experiences that prepared her to manage during a global pandemic.

16 Facing the Pandemic

ISSUE 2 2021 | CSG CAPITOL IDEAS

F E AT U R E S

WHAT’S HAPPENING AT CSG

THEY TWEETED IT

52 REGIONAL ROUNDUP | east 53 REGIONAL ROUNDUP | midwest 54 REGIONAL ROUNDUP | south 55 REGIONAL ROUNDUP | west

40 Working Together From vaccine development and distribution to technology and connectivity, throughout the COVID-19 pandemic, the country’s private sector has played a key role in helping communities fight the virus while promoting science and collaboration.

45 Innovative Legislation

26 Reliable Responders

48 Some Essential Workers

Emergency managers, led across the country by the National Emergency Management Association (NEMA), faced a record-breaking year of natural disasters, from floods to wildfires to COVID-19.

28 Restoring Trust in

34 Focusing on Mental Health

Public Health

Since the start of the COVID-19 pandemic, many state and territorial health officials have left office as a result of conflicts with local politicians or the public. In a time when states have greatly relied on advice from these professionals, state health officials hope to reestablish confidence in the system.

The CSG Shared State Legislation member-driven committee selects bills to help answer collective state policy challenges. Discover the latest docket and learn how you can submit legislation to this annual digital database.

are Shut Out

56 Final Facts: Chariots of Fire

Recognizing all of the essential workers who have served during COVID-19, Final Facts explores little-known details about the vehicles of our everyday heroes.

Gov. Laura Kelly

Sen. Joan Ballweg

KANSAS CSG National President

WISCONSIN CSG National Chair

Publisher

Graphic Designers

DAVID ADKINS dadkins@csg.org

THERESA CARROLL tcarroll@csg.org

Managing Editor

STEPHANIE NORTHERN snorthern@csg.org

BLAIR HESS bhess@csg.org

Associate Editors JOEL SAMS jsams@csg.org

JESSICA RUSHER jrusher@csg.org

Email capitolideas@csg.org

MARY ELIZABETH LONERGAN mrobertson@csg.org

Hon. Ted Arnott, Speaker ONTARIO, CANADA CSG East Chair

Speaker Cameron Sexton TENNESSEE CSG South Chair

Sen. Gary Cammack SOUTH DAKOTA CSG Midwest Chair

Rep. Clark Kauffman IDAHO CSG West Chair

Contributing CSG Staff Writers TIM ANDERSON tanderson@csg.org

ROGER MOORE rmoore@csg.org

ANDREW BATES abates@csg.org

SARAH NEEDLER sneedler@csg.org

RONA COHEN rcohen@csg.org

SEAN SLONE sslone@csg.org

VERONIQUE CAVAILLIER vcavaillier@csg.org

BILL SWINFORD bswinford@csg.org

SIERRA HATFIELD shatfield@csg.org

MEGAN QUATTLEBAUM mquattlebaum@csg.org

LAURA KLIEWER lkliewer@csg.org

David Adkins CSG EXECUTIVE DIRECTOR/CEO dadkins@csg.org

Lindsey Gray CSG SOUTH DIRECTOR lgray@csg.org

Michael H. McCabe

Edgar Ruiz

CSG MIDWEST DIRECTOR mmccabe@csg.org

CSG WEST DIRECTOR eruiz@csg.org

Mailing lists are available for rent upon approval of a sample mailing. Contact the sales department at (800) 800-1910. Copyright 2021 by The Council of State Governments. An accessible version of this publication is available upon request. Please email capitolideas@csg.org.

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ISSUE 2 2021 | CSG CAPITOL IDEAS

David Biette CSG EAST DIRECTOR dbiette@csg.org

CSG CAPITOL IDEAS, ISSN 2152-8489, ISSUE 2, Vol. 70, No. 1 – Published five times annually by The Council of State Governments, 1776 Avenue of the States, Lexington, KY 40511-8536. Opinions expressed in this magazine do not necessarily reflect the policies of The Council of State Governments nor the views of the editorial staff. Readers’ comments are welcome. Subscription rates: in the U.S., $42 per year. Single issues are available at $7 per copy. POSTMASTER: Send address changes to Capitol Ideas, Sales Department, The Council of State Governments, 1776 Avenue of the States, Lexington, KY 40511-8536. Periodicals postage paid at Lexington, Ky., and additional mailing offices.

WHAT’S

HAPPENING AT CSG

CSG Selects Professions for New Interstate Compacts for Occupational Licensure Portability In partnership with the Department of Defense, CSG announced five professions selected to work with the National Center for Interstate Compacts (NCIC) to develop model legislation to help military spouses and other practitioners gain professional license portability. Through this cooperative agreement, the NCIC will work with the Department of Defense to assist the professions of cosmetology and barbering, dentistry and dental hygiene, massage therapy, social work and K-12 teaching in developing interstate licensing compacts to address occupational licensure portability. These professions were selected through a competitive proposal process.

ISSUE 2 2021 | CSG CAPITOL IDEAS

Inaugural CSG University Provides Resources to More than 100 New Legislators

After each major election year, thousands of new state lawmakers are elected for the first time. To help these new policymakers — members of The Council of State Governments — jumpstart their time in legislative service and find success in their new roles, CSG launched CSG University to introduce newly elected legislators to peers from around the country who share their same passion for public service. In February and March, CSG University hosted four virtual session featuring tenured state policymakers who addressed communicating with constituents, drafting effective legislation, planning a productive committee meeting and more. More than 130 legislators attended the programs.

Continue the Conversation with CSG Capitol Ideas Presents Each issue of CSG Capitol Ideas magazine features a virtual program that brings to life one article from its pages. Through these programs, state elected and appointed officials can continue the conversation on current and shared issues between the states. On May 6, don’t miss “CSG Capitol Ideas Presents: A Year of Recovery,” where CSG is joined by the National Emergency Management Association (NEMA) and the Association of State and Territorial Health Officials (ASTHO) in a conversation with emergency managers and state health officials as they discuss state response to COVID-19, lessons learned and how their industries are more important than ever. Learn more on page 25.

New Partnership with The Commonwealth Fund Addresses Mental Health Issues Social isolation is one of four mental health topics that are a focus this year for a partnership between CSG and The Commonwealth Fund, a New York-based foundation that promotes “a high performing health care system.” Other areas highlighted are maternal mental health, social determinants of mental health and mental health insurance parity. CSG has convened a 20-member advisory group of state legislators and executive branch health officials from across the country and four subject matter experts that will work to inform a new CSG resource guide for policymakers, providing a roadmap for addressing some of the most pressing mental health challenges, including one that is likely to receive renewed attention even as the pandemic recedes.

CSG Awards USDA Funds to Improve WIC Certification in States and Localities The Council of State Governments, with funding from the U.S. Department of Agriculture Food and Nutrition Service, awarded grant funds to six state and local Women, Infants, and Children (WIC) agencies as part of the WIC Special Project Innovation Grant. Agencies selected for funding include Public Health Foundation Enterprises WIC, Long Island Jewish Medical Center WIC, Colorado WIC, Pennsylvania WIC in collaboration with West Virginia WIC, Family Service Lincoln WIC and Michigan WIC. The projects funded through these subgrants are focused on improving the WIC certification process, which could result in reduced appointment no-show rates, shortened certification appointments and clinic wait times, increased participant satisfaction and reduced temporary or shortened certifications that are completed.

THEY T WEETED IT Carla Nelson @CarlaNelsonMN • February 10, 2021 We can empower a new generation of low-income learners with high-quality early learning scholarships. I recently wrote about how we can do it for @CSGovts. I hope you will take a moment to read it and let me know your feedback! #mnleg Read it here: csgmidwest.org/policyresearch/0121/sen-nelson.pdf

The Campaign for Disability Employment @CDETweets • Feb 2, 2021 Watch a recording of a recent webinar from @CSGovts, @USDOL’s State Exchange on Employment & Disability and @usmayors on “Telework: Adapting to the #COVID19 Economy” to learn about #telework and accommodations for employees with disabilities. #TechTuesday buff. ly/2KZPaLW

Institute for Justice Research & Development @ijrd_fsu • Feb. 24, 2021 Read @abc27news below to learn how unpaid fines/fees bring ppl to jail. A @CSGovts report suggests 28% of prison admissions are due to technical violations. tinyurl.com/ y9mufa5p Ryan Fecteau @SpeakerFecteau • Feb. 22, 2021 I’ll be one of the lawmakers you’ll hear from today @CSGovts #CSGUniversity along with Representative @Martin4GA of Georgia and Senator @TonyVargas of Nebraska

NEMA @NEMA_web • March 10, 2021 Thanks @CSGovts for featuring two articles from the NEMA Learning Lab Series. Focus was disaster resilience and long term recovery. Our sponsors were @AECOM and @ICF #partnerships

Read our report on the reasons ppl return to jail w/o committing crime. tinyurl.com/qwzgnbx

Sen. Joan B. Lovely @SenJoanLovely • March 4, 2021

ISSUE 2 2021 | CSG CAPITOL IDEAS

Pleased to serve on @CSGovts 201920 Healthy States National Task Force to work w/state leaders on ways to improve healthcare systems & honored to be named to 2021-22 task force. Import quality healthcare is accessible so we can stay healthy during COVID19 https://senatorjoanlovely. com/media/senator-joan-lovelycompletes-work-on-two-year-csghealthy-states-national-task-force/

analysis for states:

The Coronavirus State and Local Fiscal Recovery Fund The American Rescue Plan Act of 2021, a $1.9 trillion economic relief package, was signed by the president on March 11. Part of this package includes the Coronavirus State and Local Fiscal Recov-

ery Fund, which provides approximately $350 billion in new federal fiscal assistance for states, territories, tribes, counties and municipalities. An additional $10 billion is available to states, territories and tribal governments for critical capital projects that directly enable work, education and health monitoring in response to COVID-19.

Usage

Restrictions

State and local governments may utilize funding from the Coronavirus State and Local Fiscal Recovery Fund as part of the American Rescue Plan Act of 2021 to:

The American Rescue Plan Act of 2021 outlines the following restrictions on usage of allocated funds:

Respond to the public health emergency with respect to COVID-19 or its negative economic impacts including assistance to households, small businesses and nonprofits or aid to impacted industries such as tourism, travel and hospitality *These examples are intended to clarify congressional intent. State and local spending is not limited to these activities.

ISSUE 2 2021 | CSG CAPITOL IDEAS

Respond to workers performing essential work during the COVID-19 public health emergency by providing premium pay to eligible workers of the county who are performing such essential work or by providing grants to eligible employers that have eligible workers who perform essential work

Provide government services to the extent of the reduction in revenue — such as online, property or income tax — due to the public health emergency relative to revenues collected in the most recent full fiscal year of the county prior to the emergency Make necessary investments in water, sewer or broadband infrastructure

States are not allowed to use funds to either directly or indirectly offset a reduction in the net tax revenue that results from a change in law, regulation or administrative interpretation during the covered period that reduces any tax *The covered period begins March 3, 2021 and ends on the last day of the year that a state receives funds from the U.S. Department of the Treasury. If a state violates this provision, it would be required to repay the amount of the applicable reduction to net tax revenue.

No funds are to be deposited into any pension fund

State and local governments are allowed to transfer to a private non-profit organization, a public benefit corporation involved in the transportation of passengers or cargo, or a special-purpose unit of the state or local government Any local government, including counties, that fails to comply with the federal law and related guidelines will be required to repay the federal Treasury

“Premium pay” is an additional amount of up to $13 per hour paid to an eligible worker during the COVID-19 pandemic; this legislation imposes a cap of $25,000 for any single eligible worker receiving premium pay

Estimated Coronavirus State and Local Fiscal Recovery Funds Allocated by State, Territory and Tribal Government ($ in thousands; Source: House Oversight and Reform Committee) State Government

Metropolitan Cities

Other Non-Counties

Counties

States (Capital Projects)

Total

$2,120,063 $1,019,259 $4,799,721 $1,650,382 $26,065,091 $3,953,676 $2,647,590 $913,411 $989,373 $754,862 $10,231,776 $4,654,502 $1,632,173 $1,188,431 $7,491,512 $3,060,414 $1,379,013 $1,585,853 $2,440,591 $3,208,887 $1,028,700 $3,869,861 $4,512,687 $5,654,660 $2,577,400 $1,804,500 $2,816,399 $910,085 $975,577 $2,946,870 $959,088 $6,433,992 $1,618,733 $12,569,201 $5,276,272 $1,010,881 $5,638,423 $2,174,309 $2,608,169 $7,293,483 $1,124,494 $2,095,191 $977,796 $3,820,754 $16,696,904 $1,516,673 $1,052,431 $3,766,101 $4,252,884 $1,249,449 $3,206,348 $1,075,105

$417,312 $45,345 $974,975 $202,335 $7,046,142 $549,315 $679,160 $62,179 $385,848 $0 $1,464,923 $551,780 $206,493 $125,148 $2,682,675 $852,739 $334,568 $251,634 $444,686 $571,879 $118,038 $638,217 $1,709,877 $1,781,571 $595,470 $97,204 $830,239 $50,931 $185,815 $285,427 $87,714 $1,167,892 $177,007 $6,140,905 $672,032 $41,164 $2,242,552 $303,644 $437,749 $2,370,848 $281,845 $144,803 $38,587 $513,184 $3,372,067 $280,590 $19,080 $628,133 $700,558 $175,816 $787,928 $11,734

$362,431 $43,517 $258,121 $210,146 $1,309,864 $277,500 $191,247 $85,554 $0 $0 $1,396,853 $856,599 $43,100 $103,548 $737,861 $434,592 $215,729 $172,405 $306,765 $322,437 $115,234 $505,621 $367,938 $686,365 $420,231 $258,415 $442,164 $81,702 $106,184 $150,718 $106,111 $572,622 $119,300 $824,518 $682,061 $50,158 $814,998 $237,103 $242,905 $935,645 $55,086 $442,262 $62,044 $431,314 $1,399,387 $188,622 $57,470 $603,973 $483,400 $153,213 $399,219 $50,914

$950,943 $141,879 $1,411,662 $585,285 $7,663,152 $1,116,871 $691,465 $188,856 $136,876 $0 $4,165,475 $2,071,269 $274,600 $346,590 $2,538,678 $1,305,672 $611,906 $565,019 $866,478 $901,605 $260,702 $1,172,522 $1,336,758 $1,936,889 $1,109,494 $577,206 $1,190,316 $207,283 $375,167 $597,377 $263,708 $1,822,916 $406,667 $3,907,436 $2,034,099 $147,797 $2,267,029 $767,430 $818,004 $2,842,751 $205,457 $998,561 $171,574 $1,324,476 $5,667,795 $621,776 $121,019 $1,655,411 $1,476,862 $347,576 $1,129,225 $112,247

$191,787 $112,259 $187,189 $157,785 $549,550 $170,706 $141,531 $112,116 $107,296 $0 $364,444 $261,682 $115,328 $126,361 $253,998 $202,264 $152,847 $142,825 $185,355 $179,788 $129,059 $169,002 $174,356 $249,813 $178,855 $166,066 $195,451 $119,283 $128,223 $134,660 $121,706 $190,496 $133,950 $353,347 $277,061 $112,474 $274,342 $166,719 $155,156 $278,903 $112,729 $187,984 $115,752 $216,850 $483,801 $135,986 $113,396 $221,739 $189,360 $137,947 $188,711 $109,612

$4,042,535 $1,362,259 $7,631,670 $2,805,933 $42,633,799 $6,068,068 $4,350,994 $1,362,116 $1,619,392 $754,862 $17,623,470 $8,395,831 $2,271,693 $1,890,078 $13,704,723 $5,855,681 $2,694,064 $2,717,737 $4,243,873 $5,184,596 $1,651,732 $6,355,222 $8,101,617 $10,309,298 $4,881,450 $2,903,392 $5,474,570 $1,369,283 $1,770,966 $4,115,053 $1,538,327 $10,187,918 $2,455,658 $23,795,406 $8,941,526 $1,362,474 $11,237,344 $3,649,205 $4,261,984 $13,721,631 $1,779,610 $3,868,800 $1,365,752 $6,306,578 $27,619,954 $2,743,646 $1,363,396 $6,875,359 $7,103,063 $2,064,001 $5,711,432 $1,359,612

puerto rico virgin islands american samoa guam northern mariana islands

$2,463,387 $517,247 $480,548 $556,005 $482,812

$832,244 $0 $0 $0 $0

$117,582 $10,546 $4,958 $16,630 $5,115

$619,397 $20,688 $9,398 $32,611 $10,094

$162,098 $18,411 $8,363 $29,022 $8,983

$4,194,709 $566,891 $503,267 $634,268 $507,005

$0 $0 $0 $20,000,000 $219,800,000

$0 $0 $0 $0 $45,570,000

$0 $0 $0 $0 $19,530,000

$0 $0 $0 $0 $65,100,000

$3,711 $13,448 $18,062 $100,000 $10,000,000

$3,711 $13,448 $18,062 $20,100,000 $359,999,999

palau marshall islands micronesia tribal governments TOTAL

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alabama alaska arizona arkansas california colorado connecticut delaware dc (regular) dc (cares plus up) florida georgia hawaii idaho illinois indiana iowa kansas kentucky louisiana maine maryland massachusetts michigan minnesota mississippi missouri montana nebraska nevada new hampshire new jersey new mexico new york north carolina north dakota ohio oklahoma oregon pennsylvania rhode island south carolina south dakota tennessee texas utah vermont virginia washington west virginia wisconsin wyoming

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TRACKING

S TAT E

BUDGETS

CSG continues to analyze ongoing fiscal impacts from COVID-19 by Sarah Needler and Bill Swinford COVID-19 impacted nearly every aspect of life inside and outside of state capitols in 2020, and state governments are dealing with the fallout of this ongoing public health crisis in 2021. State budgets have definitely been affected by the pandemic, and many of those impacts are still to come. In 2020, The Council of State Governments, with research and analysis support from accounting firm KPMG LLP, examined the near-term budget impact of the COVID-19 pandemic, the economic risk of ongoing effects and shutdowns, the resiliency of states’ ability to respond and strategies for fiscal recovery. CSG released its findings in July 2020 in the report, “COVID-19: Fiscal Impact to States and Strategies for Recovery.” This timely information not only helped states understand the continuing economic risks; it also armed states with data and analysis on how best to recover. As state leaders face challenges in 2021, CSG policy and research analysts are available to provide updates to the July 2020 report as well as other resources for states, including opportunities for states to learn from each other as they manage the fiscal impacts of COVID-19.

Since this report was published, COVID-19 has continued to affect state budgets. In fiscal year (FY) 2020, state tax revenues fell short of projections and states’ fiscal year 2021 operating budgets also face substantial projected decreases in tax revenues. Moody’s Investor Services expects states’ tax revenue will decline by as much as 5% in fiscal year 2021. These decreases in revenues reflect decreases in state and local tax collections caused by declines in taxable individual income, business closures and tax payment deferrals. For FY 2021, most states adjusted their revenue estimates in anticipation of continued decreases in revenues. However, budget shortfalls for many states are not as large as initially

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Based on the state-by-state estimates in the economic impact report, policymakers faced an estimated $169-253 billion shortfall due to declining general fund revenue receipts and increased Medicaid expenditures for the combined fiscal years ending (FYE) in 2020 and 2021. This estimation is based on revised state and general fund revenue forecasts released as of June 2020 compared to the last revenue forecast prior to the COVID-19 outbreak (+/20%). For those states that had not released revised revenue forecasts, the revenue impact was estimated based on the percentage of revenue decline for the region.

feared. On average, state tax revenues have not fallen as much as initially predicted and several economic forecasters have lowered their estimates of budget shortfalls. According to preliminary data collected by the Urban Institute’s State and Local Finance Initiative, 22 states currently are enjoying increased revenues. Virginia is one such state. In July 2020, CSG analysts found that fiscal risk and fiscal resiliency was medium in Virginia. This was reflected in Virginia’s estimated revenue shortfall of $2.7 billion for FY 2021. However, Virginia’s budget shortfall is smaller than initially expected. The state has revised its initially projected revenue shortfall of $2.7 billion upward by nearly $2 billion for FY 2021. This has allowed the state to provide raises for teachers and state workers, add funding for broadband and its free community college tuition program and allocate $900 million into its reserve fund. Even states that CSG analysts found to be in the highest overall risk category in July 2020 have found themselves in more favorable positions. In Colorado in July 2020, fiscal risk was found to be very high while fiscal resiliency was low. However, Colorado experienced a 5.7% increase in tax revenue from April to December 2020 due to an increase in job creation and higher online sales boosting the state’s economy. To offset initial budget shortfalls, states also have employed strategies such as employee furloughs and/or layoffs, hiring freezes, delaying discretionary spending and capital projects, general fund cuts to state agencies and drawing from reserves and rainy day funds. Most states have relied more heavily on drawing from reserves and rainy day funds and undertaking new borrowing than on strategies to cut spending in fiscal year 2021. This allows states to preserve funding priorities such as K-12 education but is also setting the stage for another challenging fiscal year in 2022. States will continue to face the impacts of the pandemic with higher fixed costs and lower reserves. State budgets could soon be further bolstered by direct pandemic assistance as part of the federal government’s recently enacted $1.9 trillion stimulus package. The bill is anticipated to provide $350 billion to state and local governments. In states that expect a budget surplus, policymakers are considering economic relief for businesses and families, tax changes intended to spark economic growth, and new investments in longtime priorities. Although many states are doing better than expected and more assistance is on the way, there still are fiscal challenges that states are experiencing and anticipating on the horizon.

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In Case You Missed It:

In July 2020, CSG, with research and analysis support from accounting firm KPMG LLP, examined the near-term budget impact of the COVID-19 pandemic, the economic risk of ongoing effects and shutdowns, the resiliency of states’ ability to respond and strategies for fiscal recovery. That report is available online at web.csg.org/covid19/fiscalimpact.

COVID-19: Fiscal Impact to States and Strategies for Recovery A Report by The Council of State Governments

July 2020

declines in taxable individual income

It is expected states’ tax revenue will decline by as much as 5% in fiscal year 2021 as a result of decreases in state and local tax collections caused by:

business closures tax payment deferrals. Source: Moddy’s Investor Services

On average, state tax revenues have not fallen as much as initially predicted.

In fact, 22 states are currently enjoying increased revenues. Source: Urban Institute’s State and Local Finance Initiative

A Mixed Revenue Picture In 28 states, tax revenue from April-December 2020 was lower than the same period in 2019. Revenue stayed flat or grew in 22 states.

WA 2.5% MT -5.6% OR -10.5%

CA 1.2%

ID 10.4%

NV* -11.8%

UT 8.0%

AZ 2.4%

ND -14.8%

ME 2.2%

MN -2.5% WI 0.5%

SD 6.3%

WY* -8.5%

IA -2.0%

NE 0.7% CO 5.7%

IL -2.0%

KS -2.7%

OK -4.0%

NM* 4.3%

TX -10.4%

PA -3.1%

OH -0.9%

IN -2.4%

MO -2.7%

AR -0.2%

NY -4.1%

MI 0.3%

KY 1.5%

WV -4.3%

NC 2.1%

TN -1.3% MS 0.3%

LA -7.5%

AL 3.7%

VA 1.2%

SC 1.7% GA 1.9%

FL -11.3%

HI -17.0%

≤-16%

-15% to -11%

-10% to -6%

-5% to -.01%

0% to -4%

≥5%

2.2%

-2.0%

-2.8%

0.8%

-2.5%

-2.4%

-7.3%

0.1%

ISSUE 2 2021 | CSG CAPITOL IDEAS

AK -42.5%

get to know:

SIMA MERICK

Executive Director, Ohio Emergency Management Agency

ISSUE 2 2021 | CSG CAPITOL IDEAS

President, National Emergency Management Association (NEMA), a CSG Affiliate

Your long career in emergency management and mitigation began with a job as a dispatcher for the Ohio State Highway Patrol. What drew you to this line of work? I grew up in a public service family. My family has been in law enforcement, fire, county government, so it just seemed like the track to take. I am very focused on first responders. My mom was clerk of courts, and I would spend summers with her at the courthouse. It’s sort of in my blood.

What aspects of emergency management are you most passionate about?

Junior staff seek you out as a mentor and sounding board. Why is it important to you to give back in this way? I think it’s important for me to pay it forward and to share my experiences and my knowledge. I’m a people person. If I’m going to talk to someone, I want to get to know them. It’s important to give people attention and to find out what motivates them and to help them understand that they’re good at what they do, or they could make these minor tweaks to be better. On the back side of all of that, at some point we all are going to promote, move on or retire, and I want to know, and I want to feel confident, that I’m leaving the agency and the state of Ohio, and the nation, for that matter, with capable people and junior who are staff coming up who can do the job just as well (and hopefully better) than I did and we won’t have any gaps.

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As a director, I’m passionate about all of them, because I now see every aspect of it, and that they tie together. I’m no longer in one channel. It’s critical for me to know that people are in the preparedness stages — identifying their plans and figuring out their strategies in the event of an event. What happens during that event? Are we ready to respond? So, I work hard and diligently with my staff not only on response out to people, but is our state Emergency Operations Center (EOC) equipped? Are we getting the right information in? Can we turn resource requests around fast? [ …] How do people get assistance, where do they go for shelter, what do they do to apply for financial assistance, and then how do they get the information, and who’s there to help them when they rebuild, and how do we mitigate against the next disaster? Because there’s always a next disaster.

“

How has NEMA helped emergency management directors collaborate during COVID? NEMA is a great association, and I feel blessed to be part of it. I also feel blessed to be the president and to be able to represent such an important and elite, but small, group of state directors that make such a difference in all of our states and in the country. NEMA’s that support for us — they are the cohesiveness. They provide this platform for us to all information share. We get together, we talk about the issue du jour, upcoming trends and how we blend with them. They keep us informed on partnerships with federal entities, they’re involved in other associations and are partners to them for information sharing which enhances our ability as state directors on decision making. NEMA is really good at pulling the relevant information together on learning issues or topics and encouraging discussion among stakeholders.

What has the COVID-19 crisis taught you personally about managing emergencies? 1 It’s made me think about how we’re really great at doing plans and engaging our stakeholders, but when that plan is done, a lot of times, it gets put on a shelf. In Ohio, I have a really strong planning section and strong training and exercise component. But I need to ensure these plans are being frequently practiced, tested and reviewed, and that they’re flexible. I need to ensure that those living documents align with any evolving operation we would have. Is it fresh for river flooding? Is it fresh for response to a tornado? How about the capabilities and plans for our operations center? We have to keep our plans up-to-date, fresh and tested or practiced. 2 It’s imperative for us to have effective communication and transparency. I really believe our leaders and our policymakers at the highest levels need to engage early and swiftly and develop a strong, unified response. We’re still fully engaged now with vaccination, and we have to communicate that. We have senior citizens, we have people in congregate care, we have underserved populations, and all of those folks have to go somewhere to get the information. It’s imperative that we’re transparent and we effectively communicate everything that our residents and citizens need to know to make it through this event.

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3 We have to continue to enhance and maintain our operational and support staff. Every agency, to include emergency management, needs to not only keep staff focused on normal daily operations but also to have that maintenance plan for the long-haul pattern. In government and in the private sector, people are COVID fatigued. They’re ready for it to be over. They’re ready for it to go back to normal, which isn’t going to be what we know as normal, it will be our new normal. We still have a lot of work to do, and we have to have the support and the freshness within the staff to be able to maintain the pace that we have to keep to get us through this.

Did You Know? Sima Merick has enjoyed an esteemed career in emergency management. She got her start as a dispatcher for the Ohio State Highway Patrol.

It’s critical for me to know that people are in the preparedness stages — identifying their plans and figuring out their strategies in the event of an event, what happens during that event, are we ready to respond? […] And how do we mitigate against the next disaster? Because there’s always a next disaster.”

So, what does Sima Merick do when there isn’t an emergency? “We do preparedness. What people don’t understand is all the work and strength of the response is driven by the planning, the training, the stakeholder engagement, the reviews of previous actions to strengthen them or avoid repeating some things that didn’t go well.”

What’s something you keep in your office, and why?

I keep a couple of personal belongings, all of which have meaning to me. I keep a family Bible, a picture of Progressive Field, which is the Cleveland baseball stadium, and a picture of the county courthouse where my mom worked and where I hung out with her as I grew up. On summer break, I’d pedal my bike up there and hang out. Who’s your biggest inspiration?

My mom. Both of my parents, but especially my mom. My roots and upbringing developed me into the person I am today. My mom gave to me and instilled in me my strength, my endurance and my charisma. She was just an amazing woman. She was born in 1920, the year women gained the right to vote, and she had three daughters (we were pretty far apart). Every year, she would say, “You need to vote, you need to pay attention to what’s out there. I will never tell you how to vote, but it’s your right. We worked hard for it.” What do you wish more people knew about emergency management?

A question I get a lot when there’s a shift in administration: “So, what do you do when there’s not an emergency?” We do preparedness. What people don’t understand is all the work and strength of the response is driven by the planning, the training, the stakeholder engagement, the reviews of previous actions to strengthen them or avoid repeating some things that didn’t go well. I just don’t think people completely understand all the work that has to happen to make responses successful. What’s the best piece of advice you’ve ever received?

Don’t ever make decisions when you’re angry. Wait a day before you make a decision or react. If you still feel the same the next day, it was important to take some kind of action, but chances are you’ve cooled down some so it’s not quite as tumultuous. What’s something most people don’t know about you?

That I love to watch PBA bowling on Sundays.

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faces

f r o m

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Across the country, state health officials and emergency managers helped lead response to COVID-19 while managing other public health dilemmas and record numbers of natural disasters by Mary Elizabeth Lonergan and Blair Hess

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The rapid spread of COVID-19 in 2020 brought unprecedented issues to our doorsteps, and state leaders had to take extraordinary measures to mitigate the spread of the virus while protecting communities, economies and public and private industries. It would be hard to identify an aspect of life inside or outside of state capitols that was left untouched. Health care, elections, education, employment security, corrections, taxation, drug development and discovery, long-term care, childcare, transportation and emergency response were just a few of the issue areas upended by the pandemic. As our states came to life to respond to the coronavirus, emergency managers and state health officials were some of the leading responders in managing this crisis.

Setting politics aside, these dedicated professionals stepped up, established data-driven plans and assembled cross-disciplinary, interagency teams to protect their communities and save lives. Often overlooked from their places among front-line workers, state health officials and emergency managers represent staffs of deeply committed public servants who work hard and rise to every challenge. The COVID-19 pandemic isn’t the only emergency — health or otherwise — they faced this year. Hear from these professionals as they discuss state response to COVID-19 against the backdrop of other health crises and natural disasters.

Dr. Lee Norman

Secretary, Kansas Department of Health and Environment

“

: In a time of peace, prepare for war. Find out

what your breakpoints are so that when something bad happens, you are prepared. Then ask a lot of ‘what if’ questions.”

hen Dr. Lee Norman set out to prepare for his most recent battle, he never thought it would be to protect millions of people in his own country against a virus.

“It wasn’t what I was signing up for, I’ll tell you that,” said Norman, who serves as secretary of the Kansas Department of Health and Environment. “I’m a colonel in the U.S. Army and now in the Army National Guard and the Army State Surgeon of Kansas. We set up incident command before the first case even arrived in the United States and we had enough concern about it.” Norman was aware of the new virus that was spreading through China and making its way internationally. He treated the threat of COVID-19 in the same manner as any of his military exercises: he and his team had 10 areas of concern in which they gathered data and tried to prepare as best as they could for the impending COVID-19 virus to reach the U.S. “We saw things coming before anyone else was really making a note of it,” he said. That was one of many successful steps Norman and his team made in fighting COVID-19 in his state. “First and foremost, my agency as the lead public health agency in the state was the lead agency in the Kansas Emergency Response plan,” he said. “We have a structure in place that brings all of our preparedness efforts together.” Norman cited the collaboration between his agency and the Kansas Division of Emergency Management in setting up an emergency operations center and determining next steps for Kansans in mitigating the crisis. “It’s kind of humorous in a sense that the person who heads up the emergency operations center and the Kansas Division of Emergency Management [Maj. Gen. David Weishaar] is a two-star Army General in the Army National Guard, so on the weekends, that person is my boss and during the week, I’m his boss,” he said. “It makes for a good working relationship.”

To date, the Kansas Department of Health and Environment has mitigated those needs and is currently working through properly vaccinating the state population. “I’m pleased with how we’ve navigated [these crises and vaccine distribution] despite the opportunity for lots of conflict,” he said. “The political division in the state of Kansas made it so we couldn’t get as much from our state delegations as we did from our federal delegations.” Norman said the difficulty working across the aisle might have slowed recovery efforts. “In a pandemic, even if you come from different ideologies, you have to team up together. There’s still lots of antagonism and impediments thrown in front of our effort.” Norman and his team have helped to lead Kansas into what they hope are better days, and he said there have been many lessons learned from the COVID-19 pandemic. “In Kansas, we have urban, suburban, rural and even frontier regions,” he said. “One of the weaknesses we found was the movement of critically ill people.” Norman said the needs for people in these communities to find proper care has caused Kansas to institute a mission control that will assist finding proper care and transportation as quickly as possible for future health emergencies. “In a time of peace, prepare for war,” he said. “Find out what your breakpoints are so that when something bad happens, you are prepared. Then ask a lot of ‘what if’ questions.”

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Norman said the pandemic has revealed several gaps in the system, calling it “a wave of many crises,” the biggest being the shortage of supplies.

Norman said the lack of personal protective gear, the lack of trained professionals to serve as contact tracers and the capacity of hospital beds created other problems that he and his team had to navigate through.

Dr. Joneigh Khaldun

Chief Medical Executive and Chief Deputy Director, Michigan Department of Health and Human Services

“

: I’m an ER doctor — when things get tough, I get

better. These are people’s lives, and we knew there were things we could do. It’s been an all-hands-ondeck team effort — so many people keeping this work going, so many behind the scenes. Everyone played a role, and it’s nice to see collaboration.”

Khaldun said in this process, she is proud of the work done in Michigan to help communities of color.

“As the chief deputy my overall role has been to guide [the Michigan state] government and my team on virus response, which included everything from what [COVID-19] is to how people were getting it and community migration, how we engaged on all things, isolation, masking and now on to vaccination,” Khaldun said.

Khaldun said one of her goals is to make sure Michigan is prepared to combat future public health emergencies.

hroughout Dr. Joneigh Khaldun’s career, she has navigated through many medical calamities. However, none has been as complex as her current role as the chief medical executive and chief deputy director for the Michigan Department of Health and Human Services.

Khaldun is a practicing emergency medical physician and previously worked on policy initiatives for former President Barack Obama’s administration. Today, she advises Michigan Gov. Gretchen Whitmer on all things related to public health. When COVID-19 first hit, many states had to scramble to learn as much as possible about this new virus in order to make plans to mitigate infection rates and help those individuals who were developing symptoms.

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“I’m very proud of the team in our state and local governments, particularly in public health,” Khaldun said. Michigan used data and built out a state public health lab that was able to test people for COVID-19.

“I’m proud of how we’ve been able to use data, build out our data systems,” she said. “I’m proud we are one of the first states to identify disparities we launched a racial disparity task force. We no longer have disparities in our [minority] communities. It has taken all of government.”

“We must strengthen our public health infrastructure,” she said. “As things have played out [with COVID-19], we’ve not only learned that we have to get upstream, but also that there is a disproportionate impact on [minorities], similar to the disproportionate impact we have in cancer and heart disease.” Khaldun credits the many teams and agencies involved, making the mitigation efforts in Michigan a success. “I’m an ER doctor — when things get tough, I get better. These are people’s lives, and we knew there were things we could do. It’s been an all-hands-on-deck team effort — so many people keeping this work going, so many behind the scenes. Everyone played a role, and it’s nice to see collaboration.”

Dr. Nirav Shah

Director, Maine Center for Disease Control and Prevention

hat has been your role as state health official as your state has navigated the COVID-19 pandemic? As director of the Maine Center for Disease Control and Prevention, my role in pandemic response has involved leadership across the full spectrum of preparation, planning, information, investigation and analysis. In that role, I have provided information based on public health best practices to Gov. Janet Mills to help her craft and adapt policy. What are some successes that you and/or your state have had this year? Throughout the pandemic, Maine’s per capita case rates and rates of death with COVID-19 have been among the lowest in the nation. After entering into an innovative agreement with IDEXX, a Maine company, our testing volume has been among the most robust in the nation. What are some lessons learned from this public health crisis in

terms of how you can now help your state and the U.S. better prepare for, respond to and recover from future health issues like this one? The importance of consistent funding for public health is a key lesson, as preparedness and planning position us all to be ready for pandemics or other demands on our public health systems. In many cases, states have been able to work together through this pandemic. Have you been able to work with your fellow state health officials? The Association of State and Territorial Health Officials (ASTHO) provides an excellent way for public health leaders to share ideas, test theories, and otherwise communicate on a near-daily basis. It has been an enormous asset. Through the past year, what has inspired you or kept you motivated during times when it has seemed as if all news was bad news? I have regularly been inspired by the fact that Maine people have largely embraced science in their approach to COVID-19. Even during deeply stressful times, people have followed the science and data. That has been encouraging and inspiring.

Dr. Kristina Box

State Health Commissioner, Indiana

i n h e r o w n w o r d s:

From the beginning of the pandemic, Indiana’s priorities were to prevent hospitalizations and save lives. We engaged an outside team of ethicists, pulmonologists, infectious disease experts and representatives from local health departments and health care systems to review Indiana’s data to determine who has been most impacted by COVID-19. This laid the groundwork for the rollout of our age-based vaccine allocation plan, because we determined that age was the number one contributor to severe illness and death in Indiana. At the same time, we expanded our centralized scheduling system to

also schedule and register vaccine administration. This system searches for the next available appointment by ZIP code and locations in the state. Hoosiers can go online to ourshot.in.gov to find an appointment that is convenient for them. The site also specifies which vaccine is available at each location. We also engaged our state 211 system, Area Agencies on Aging and local libraries to provide assistance with registration for Hoosiers who might need extra support, language translation or other help in finding an appointment. When new appointments open or we have expanded eligibility, the 211 team often reaches out proactively to individuals whose appointments were scheduled several weeks out to try to find them an earlier appointment. People who need to reschedule an appointment also can call 211 for assistance. This system has also been used to send out scheduling links for special populations with high-risk comorbidities like solid organ transplant, individuals with sickle cell disease, Down syndrome, those battling cancer, people with congenital heart disease and many other medical conditions increasing an individual’s risk for severe illness or death from COVID-19. The system has worked. Unlike other states, where people have stood in line for hours waiting for a vaccine, Indiana has received consistent praise for how efficient our process is. And we are seeing results — more than 70% of Hoosiers ages 70 and older have scheduled or received a vaccine and 60% of individuals in their 60s have done so. Our cases and deaths continue to decline.

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arly in the pandemic, it was critical that Indiana be able to quickly build testing capacity. We were quickly able to contract with an outside vendor to set up testing sites all over the state and to organize internal and external labs to actually analyze these tests for the state. These testing sites have persisted throughout this pandemic and have been a great addition to our hospital and local health department testing sites in every county. Another vendor set up a testing platform to schedule appointments, register individuals and report labs electronically back to the patients. This same platform is also scheduling our vaccination appointments across the state for everyone except for some pharmacies associated with the federal pharmacy program. Another vendor set up a centralized contact tracing program to augment our local public health efforts via text messages to positive cases and close contacts. This has been an efficient means for initial outreach, and the platform allows local public health interaction for documentation in each of these cases.

Samantha C. Phillips

Director, Massachusetts Emergency Management Agency

“

: Throughout the pandemic response, I have

been impressed by the willingness of people from all agencies and disciplines to step up, be helpful and raise their hands […] I am fortunate to work alongside an extremely talented and deeply committed group of public servants who seem to never tire, work extremely hard and rise to every challenge, and who have contributed to moments of real inspiration along the way.”

hat has been your role as an emergency management director as your state has navigated the COVID-19 pandemic?

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Early in the pandemic, Gov. Charlie Baker created the COVID Command Center under the leadership of the state secretary for Health and Human Services. The Massachusetts Emergency Management Agency (MEMA), along with many other agencies, is a key member of the COVID Command Center. As with most responses of this size and scope, the response partners can change based on the situation on the ground. What is notable about MEMA’s role is that we’ve been a constant and sustaining member of the command center structure as other agencies’ roles and participation have ebbed and flowed as their expertise was needed. As part of the overall response, we are a primary support entity to the command center leadership taking on significant roles related to the procurement and coordinating distribution of more than 44 million pieces of personal protective equipment (PPE), large-scale logistics operations, coordinating the build-out of field hospitals, coordinating

the state’s isolation and recovery hotel program, information sharing through a partnership with United Way’s 211 and recurring situational awareness statements, providing support to local municipalities, and coordinating the state’s disaster recovery programs. While I have final authority and responsibility for the agency’s mission areas, it’s just as important that I put in place the right team, empower those individuals and help to clear roadblocks so the programmatic, operational and tactical work can get done. Emergency management is rarely the lead agency, but we can plan, coordinate, organize and add depth and capacity in any response. What has the coronavirus pandemic uncovered about your state’s preparedness to deal with this sort of public health crisis? The pandemic required that we test and ground-truth our assumptions and interdependencies and put a spotlight on capacity. A vulnerability for many states, including ours, was our dependence on the global supply chain and federal government for support through programs such as the Strategic National Stockpile. Moving forward, our goal is to

be independently prepared and we’ve spent considerable time focusing on this work — responding to the current crisis and making strategic decisions to be best positioned for the next crisis. For example, Gov. Baker’s administration made investments as part of the pandemic response to create an infrastructure and ecosystem for local production and domestic supply of PPE that will continue to help us in the future. Secondly, the pandemic more so than any other crisis, tested our capacity, both at the state and local levels. An important focus moving forward will be on how to continue to build upon partnerships between state and local government to increase capacity and capability within emergency management and public health. What are some successes that you and/or your state have had this year? There are many success stories resulting from the COVID-19 response including MEMA’s partnerships with local communities, our role in addressing food insecurity, working with the Salvation Army and a network of food banks and food pantries to provide nearly 10 million meals to residents in need, the activation of multiple field hospitals, and our support in housing extremely vulnerable individuals as part of an isolation and recovery housing program. However, the two most significant milestones for MEMA include the development of a state logistics program and a major overhaul and expanded capacity of the state’s Disaster Recovery program. MEMA entered 2020 with goals to focus on logistics and disaster recovery coordination and COVID-19 forced us to meet these objectives ahead of schedule and on a much larger scale than we ever anticipated. These achievements will be lasting, permanent improvements that will enhance the Commonwealth’s crisis management capabilities. What are some lessons learned from this public health crisis in terms of how you can now help your state and the U.S. better prepare for, respond to and recover from this type of emergency? Leveraging data and being able to synthesize and analyze information are essential to effective disaster response. COVID-19 demonstrated this more than any crisis in recent memory. Data informs ongoing operations, helps the state pivot and shift its priorities, and prepared the state for ongoing recovery operations. A big focus on the heels of COVID-19 will be how we continue to gather and leverage data to inform our response operations across the spectrum of hazards.

Attention to the COVID-19 pandemic has been nearly allconsuming. What are some of the other emergencies you have had to face this year, and what successes have you been able to celebrate? We’ve managed a steady clip of smaller-scale, “routine” emergencies in addition to COVID-19. These include snowstorms, a tropical storm, high wind events resulting in power outages, supporting law enforcement partners with responses to civil unrest and working alongside local partners as they’ve have managed larger-scale localized crises such as apartment building fires. We spent significant time adapting our response plans for a COVID-19 environment and instead of tabling things, we leveraged the pandemic-environment to help us advance key planning and operational initiatives. We adopted the philosophy of not letting our foot off the gas and capitalizing on every opportunity to continue to expand and improve. In many cases, states have been able to work together through this pandemic. Have you been able to work with your fellow emergency managers as well? The field of emergency management is known for working collaboratively and sharing information. This is particularly true within the New England states (Massachusetts, Connecticut, Vermont, Rhode Island, New Hampshire and Maine). The six state directors communicate routinely to share successes, talk through challenges and seek advice. The collaboration and camaraderie are invaluable as we navigate uncharted territory. Through the past year, what has inspired you or kept you motivated during times when it has seemed as if all news was bad news? Throughout the pandemic response, I have been impressed by the willingness of people from all agencies and disciplines to step up, be helpful and raise their hands. This is true across state and local government, but especially within MEMA. I am fortunate to work alongside an extremely talented and deeply committed group of public servants who seem to never tire, work extremely hard and rise to every challenge and who have contributed to moments of real inspiration along the way.

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Andrew Phelps

Director, Oregon Office of Emergency Management

“

: This is why we get into this business. It isn’t

necessarily for those blue-sky days when things are easy. It’s to help our communities navigate the bad days and to make those bad days a little better and less frequent. As a former firefighter, I’ve never wanted bad things to happen, but when they did, I wanted to be in a position to help.”

What has been your role as an emergency management director as your state has navigated the COVID-19 pandemic?

My focus, and the focus of our agency, has been on three areas that are relatively consistent across most disasters. One of our priorities has been to facilitate interagency coordination and ensuring connectivity among local governments, state agencies, our federal partners and the private sector in support of the Oregon Health Authority as the lead agency for pandemic response. We also continue to view the response through the lens of what needs to be done: providing timely and accurate information to the public to help them make decisions to protect themselves and their families by leading the state’s Joint Information Center and supporting the Oregon Health Authority’s Health Information Center and the logistical needs of a disaster of this scope, scale and complexity, like with our state-wide personal protective equipment procurement and distribution mission.

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I also needed to ensure we were managing the impacts of COVID-19 on our day-to-day operations and any impacts to other disasters, like our flooding disaster in Eastern Oregon in February 2020 and our catastrophic 2020 Labor Day fires.

What has the coronavirus pandemic uncovered about your state’s preparedness to deal with this sort of public health crisis? Like many states across the nation, we found gaps in our existing stockpiles of public health response supplies and our dependence on international supply chains for things like N95 respirators. As we’ve prepared as a state for a Cascadia Subduction Zone earthquake we’ve spent a lot of time working on continuity plans, and much of that work benefited us as we pivoted to telework while identifying areas where we need some more work in that area. Much of our planning around a Cascadia earthquake scenario has focused on implementing interstate mutual aid through the Emergency Management Assistance Compact (EMAC) but in a nationwide disaster like COVID-19, the cavalry isn’t necessarily coming, so we had to leverage the in-state resources we had with limited outside help. We’ve also learned additional work is needed in establishing a baseline across state government for understanding emergency management processes and response structures.

What are some successes that you and/or your state have had this year? Partnering with our state fire partners in the Oregon State Fire Marshal’s Office and the Oregon Department of Forestry with guidance from the Oregon Health Authority in advance of our fire season had an incredibly positive impact on our state’s ability to protect our wildland firefighters and limiting the spread of COVID-19 while these folks were working in close proximity to each other during our difficult fire season. We were also able to get most of our folks set up to telework fairly early in our COVID-19 response, which was especially important for those on our team who suddenly found themselves with kids home from school or daycare and those who were more susceptible to the virus. A largescale shift to remote working was not perfect, but the team’s flexibility and willingness to identify challenges, communicate needs and problem-solve were exemplary. What are some lessons learned from this public health crisis in terms of how you can now help your state and the U.S. better prepare for, respond to and recover from this type of emergency? It’s important to view any response through the lens of what needs to get done and establish measurable goals and objectives early. Otherwise it is possible to become overwhelmed by the scope and complexity. When you view a disaster as a logistics mission, or a public information mission, it becomes much more manageable and the resource and planning needs for your response become a little clearer. This disaster also highlighted the importance of accuracy, consistency and clarity with public communications. With a novel virus and so many unknowns early on, being up front about what is known, what is unknown and that the situation will change. I would also note that during a large, complex incident nearly every state agency in Oregon became, to some degree, an emergency management agency. Ensuring alignment of mission and connectivity among partners and across all levels of government, volunteer organizations and health care partners is something that needs constant care and feeding, and the ability to course-correct to ensure alignment and connectivity cannot be overlooked. Attention to the COVID-19 pandemic has been nearly allconsuming. What are some of the other emergencies you have had to face this year, and what successes have you been able to celebrate?

In many cases, states have been able to work together through this pandemic. Have you been able to work with your fellow emergency managers as well? Physically sharing resources during COVID-19 was challenging, especially as each state was being pushed to the limit with responding to this disaster. Every state was impacted, and continues to be impacted, by this pandemic. I was proud of Gov. Kate Brown’s decision early on in our response to redirect dozens of our state’s supply of ventilators to New York while they were experiencing much higher rates of infection than we were in Oregon. A quick phone call to my counterpart in New York put this offer of assistance in motion and within hours we had a plan to get those resources packaged and shipped across the country. I’ve mentioned how helpful EMAC was as we responded to our wildfires, and we were glad to return the favor to or friends in California when they needed help with their response. Regardless of what else is happening, emergency management as a community seemingly always finds a way to help. Each of us has been impacted and continue to be impacted by COVID-19, personally and professionally. I’ve drawn tremendous inspiration from my colleagues in Oregon and across the nation and their willingness to find innovative solutions to wicked problems and when the physical sharing of resources is not possible, hopping on a conference call or sending an email with suggestions, recommendations or simply words of encouragement to lift each other up during a difficult time has made an incredibly positive difference for me. Through the past year, what has inspired you or kept you motivated during times when it has seemed as if all news was bad news? This is why we get into this business. It isn’t necessarily for those blue-sky days when things are easy. It’s to help our communities navigate the bad days and to make those bad days a little better and less frequent. As a former firefighter, I’ve never wanted bad things to happen, but when they did, I wanted to be in a position to help. So, during these long days, time spent away from family and the stress associated with managing multiple disasters in addition to day-to-day agency operations, I remind myself how fortunate I am to be in a position to do the work that I do, with the tremendous team that shows up to work with me each day. All of us who serve in positions like mine are in these positions for a finite amount of time, and I know I want to have as positive an impact as possible while I have this opportunity to serve. That is what puts wind in my sails when things get hard.

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As devastating as our wildfire season was, it was also remarkable to see my partners who lead other state emergency management agencies across the nation offer their assistance to help us respond and initiate what will be the most complex disaster recovery operation our state has ever seen. The willingness of other states like Washington, California, Michigan and Wyoming to send their staff to Oregon during a pandemic to help us out was a ray of sunshine during a very difficult time. We also found tremendous success partnering with the American Red Cross to safely shelter thousands of wildfire evacuees in non-congregate settings. It was a Herculean effort from our Red Cross partners, their volunteers and our state’s mass care lead agency, Oregon Department of Human Services.

Until 2020, we had experienced two federal disaster declarations over the previous 25 years that were so devastating that they required the Federal Emergency Management Agency to authorize Individual Assistance grants to individuals, families and households, but we’ve had two Individual Assistance disasters in 2020 alone. I am incredibly proud of our team’s ability to prioritize and adjust workloads and to integrate new, temporary staff into our team to support disaster survivors who were impacted by disasters in our state.

Erica Bornemann

Director, Vermont Emergency Management

hat has been your role as an emergency management director as your state has navigated the COVID-19 pandemic? As with most disasters, my role as state emergency management director has been to lead the State Emergency Operations Center in coordinating resource support, public information and ensuring the response is as efficient as possible. Our primary function is to support our public health partners by ensuring they have the resources and support they need. Because of the many sectors this event has impacted we must coordinate with entities across state and local government as well as non-profits and non-governmental organizations that we may or may not have worked with in the past.

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What has the coronavirus pandemic uncovered about your state’s preparedness to deal with this sort of public health crisis? No matter how much planning we have collectively done for a pandemic, I don’t believe there was any amount of training or prep that could have adequately prepared us for the challenges this pandemic has presented us with. The extended and all-encompassing nature of this event, coupled with the impacts on our family and home lives of ourselves and our staff, are not characteristics one can adequately exercise. The sheer complexity and number of entities that must be involved challenges emergency management as a profession to “up our game” as it relates to catastrophic incident planning. While we have actively worked with our senior leadership in the past to ensure preparedness to incidents, this event underscores the importance of increasing that interaction for all hazards in the future. Vermont has celebrated many successes throughout this pandemic and our last and final success will be to reconcile lessons learned to be more prepared for the next disasters regardless of type.

What are some successes that you and/or your state have had this year? Vermont has consistently had one of the lowest case positivity rates in the country which correlates tightly with hospitalization rates that have not significantly exceeded our health care system. Vermonters have sacrificed much throughout the pandemic but it’s clear we banded together to protect our health care system. Additionally many of our response partners have stepped up in a big way to resolve some of the most significant challenges of this pandemic. Whether it was creating a registration system that moved seamlessly from testing to vaccination, standing up a PPE warehouse, feeding the hungry for months on end, leveraging a volunteer base that was larger than ever before, or any of the countless other areas in which solutions where needed, innovation and creativity were the central tenets. What are some lessons learned from this public health crisis in terms of how you can now help your state and the U.S. better prepare for, respond to and recover from this type of emergency? One of the biggest lessons learned is related to catastrophic incident planning, training and overall preparedness. We exercise and train extensively for many hazards and pandemics are among them. But this pandemic has changed the underlying planning assumptions for all catastrophic nationwide disasters, and we have a lot of work to do to ensure we are prepared for the next event that shares the same characteristics as the COVID-19 pandemic. Those characteristics include

an event that lasts longer then several weeks, requires all partner and emergency support function participation, requires constant and continuing federal involvement at all levels of leadership, taxes or eliminates critical supply chains and overlays an economic impact that is felt from coast to coast. Vermont’s emergency planning will need to evolve to adequately account for events of this magnitude because now we know where the bar is set. We have to raise the bar in preparedness. Attention to the COVID-19 pandemic has been nearly allconsuming. What are some of the other emergencies you have had to face this year, and what successes have you been able to celebrate? In November 2020, just as vaccine were set to be disseminated to the states our largest health system suffered a cyberattack that brought down its electronic medical records system. We supported them by activating the National Guard cyber response team in Vermont which assisted with reconstitution. This could not have come at a worse time as it was also when case counts were beginning to rise through the holidays. The primary success was the first in-state mobilization of this critical resources from the National Guard which was able to assist on the network of a non-governmental entity with relative speed and efficiency. We are very proud of the work they have done to develop this resource and we are lucky to have it right here in Vermont. In many cases, states have been able to work together through this pandemic. Have you been able to work with your fellow emergency managers as well? The New England emergency management directors have leaned on each other to share information as well as resources throughout the pandemic. While Vermont has not received or been able to send personnel or other resources to states, we have worked closely with other states to seek answers and solve problems which are often in common with other states. The emergency management director network throughout the country is a tight community that is supported by the National Emergency Management Association (NEMA). The partnerships we develop with our counterparts across the country are invaluable for resources, information sharing or just another shoulder to lean on in a bad day. Through the past year, what has inspired you or kept you motivated during times when it has seemed as if all news was bad news? It hasn’t been easy! This year has been the most challenging in my career and I know many of my counterparts would say the same. A lesson I personally learned before this pandemic that I have shared with my staff throughout this year is that growth only comes after we have been challenged. It is uncomfortable and sometimes downright painful. I have asked them to reflect on who they were as emergency managers and people before this pandemic and recognize how far they have come. For better or worse, this pandemic has made them better at what they do and hopefully will make them stronger people. My staff at Vermont Emergency Management have made my heart swell with pride over and over throughout this event because of the way they rise to a new challenge again and again. They put themselves outside their comfort zones and play an important part in shaping this piece of our history. It’s really inspiring to watch and even more inspiring to be a part of. We have to remember that on the hard days, weeks and months of this pandemic.

A Year of

RECOVERY T H U R S D A Y , M A Y 6 | 2 : 3 0 - 4 : 3 0 P. M . E T The rapid spread of COVID-19 in 2020 brought with it unprecedented issues, and states had to take extraordinary steps to mitigate the spread of the virus while protecting communities, economies and public and private industries. It would be hard to identify an aspect of life inside or outside of state capitols that was left untouched. Health care, elections, education, employment security, corrections, taxation, drug development and discovery, long-term care, childcare, transportation and emergency response were just a few of the issue areas upended by the pandemic. As our states came to life to respond to the coronavirus, emergency managers and state health officials were some of the leading responders in managing this crisis. In the second edition of CSG Capitol Ideas Presents, join the National Emergency Management Association (NEMA) and the Association of State and Territorial Health Officials (ASTHO) in conversation with emergency managers and state health officials as they discuss state response to COVID-19, lessons learned and how their industries are more important than ever. Register at web.csg.org/capitol-ideas/capitol-ideas-presents ISSUE 2 2021 | CSG CAPITOL IDEAS

when disaster strikes

From COVID-19 to wildfires, emergency management professionals serve on the front lines of crisis

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by Trina Sheets, Executive Director, National Emergency Management Association (NEMA)

By now it seems impossible to overstate the impact of the COVID-19 pandemic on people’s lives. More than 500,000 Americans have died and virtually everyone has undergone significant changes to employment and daily routines. Emergency management professionals are no exception.

Since the early warning signs of a public health crisis appeared pointing to a potential outbreak, emergency managers have remained connected to their elected leadership at all levels of government. State emergency management agencies provide situational awareness to the governor while simultaneously serving as the conduit between local jurisdictions and applicable federal support in a disaster. The response to COVID-19 has provided unique challenges as the virus affected every state and required the coordination of such disparate activities as supply chain management and procurement of personal protective equipment (PPE), public information and messaging, vaccination logistics and navigating the process to access federal funding programs that support COVID-19 response activities. The frequent changes in guidance and rapid pace of change in the early months of the pandemic highlighted a need for proactive and solution-oriented information flow. The National Emergency Management Association (NEMA), an affiliate of The Council of State Governments, participated in that effort by developing a weekly report providing information on states’ actions to mitigate coronavirus spread. The report was disseminated broadly among state, federal and relevant private sector partners to help form a common operating picture. NEMA also

Against the backdrop of the ongoing response to COVID-19, emergency managers dealt with

22 separate disasters in 2020 resulting in damages exceeding $1 billion, the most ever in a single year according to the National Oceanic and Atmospheric Administration.

continues to provide a platform for states to share their promising practices, and serves as a coordinator for states to communicate with the relevant federal agencies about challenges they are experiencing as the response evolves.

When events like this occur, states lean on one another for support and leverage the Emergency Management Assistance Compact (EMAC), the nation’s mutual aid system, which allows states to request and send resources and personnel to assist with response and recovery efforts. This system, too, was challenged in new ways last year as shortages of medical personnel and PPE and requisite quarantine periods limited states’ abilities to provide the usual levels of rapid support during infection spikes. Even at reduced capacity, EMAC, which is administered by NEMA, facilitated the deployment of more than 3,500 personnel and many resource commodities last year.

We also know that the climate is changing. Disasters are becoming more frequent and larger in scale, scope and complexity. To limit the effects of these changes and work to embed equity in disaster planning and recovery, states and the federal government are investing in the new Building Resilient Infrastructure and Communities (BRIC) program. The program aims to reduce risks through pre-disaster mitigation projects and community resilience investments. This and other mitigation investments at all levels of government will be critical as we build toward a more resilient future. Disasters have long provided honest evaluations of our strengths and vulnerabilities. As states lead the charge on COVID-19 vaccination and we collectively work to overcome the pandemic, emergency management continues to incorporate lessons learned from 2020 around equity in disasters, mitigation planning and responding to concurrent disasters to prepare for future events. While last year presented challenges unlike any experienced in our lifetimes, building on these experiences will allow the United States to be more prepared when the next disaster strikes.

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Against the backdrop of this complex ongoing response, emergency managers dealt with 22 separate disasters in 2020 resulting in damages exceeding $1 billion, the most ever in a single year, according to the National Oceanic and Atmospheric Administration. These events ran the gamut of natural hazards from hurricanes to derechos to wildland fires. Indeed, more than 10 million acres of the American West burned last year alone, with the August Complex burning over a million acres before full containment. The 2020 Atlantic hurricane season was also the most active on record with six different hurricanes reaching that billion-dollar-plus impact status.

As devastating and all-encompassing as these disasters were, they still do not fully portray the impacts of disasters that occurred across the United States last year. For many smaller communities, events that incur just a few million dollars in damage can be enough to overwhelm their ability to respond and recover. Many of these under-resourced communities are also home to communities of color and located in areas more vulnerable to repetitive natural hazard events such as flooding. These events may not generate the same national headlines but should not and cannot be ignored if we want to ensure that all communities have access to the appropriate resources to recover following a disaster.

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Restoring Trust in Public Health STATE HEALTH OFFICIALS HOPE TO REESTABLISH CONFIDENCE IN THE PUBLIC HEALTH SYSTEM FOR FUTURE GENERATIONS

by Michael Fraser, Chief Executive Officer, Association of State and Territorial Health Officials (ASTHO)

The COVID-19 pandemic brought much devastation and loss to our nation. Far too many people perished and far too many lives were altered — damages that have forever changed the landscape of our nation and our world. The pandemic has been unprecedented in terms of its scope, magnitude and impact on our way of life and — perhaps most revealing — the vulnerability of our public health system. COVID-19 has tested our nation’s public health and health care capacity, and many early challenges were a result of a fragile public health infrastructure that has been crippled by years of neglect and underfunding. While Congress has appropriated historic investments in our public health system to help governmental public health “build back better,” they have limited capacity to address even more alarming trends that have been the result of COVID-19: the politicization of public health decision-making and the public harassment many public health leaders experienced after recommending mitigation measures such as mandatory mask wearing and other public health protections. These new investments in public health capacity building will need to be complemented by new initiatives to restore trust in public health leaders who have been stifled, disrespected, disregarded and left out of critical discussions and decision-making.

Harassment of Public Health Officials Unfortunately, many public health practitioners became scapegoats for people who were angry at having their daily lives curtailed to slow COVID-19 transmission, and they experienced pushback for recommending that people wear masks and practice social distance or for suggesting that we follow the science. Protestors, including some who were armed, gathered at the private residence of Dr. Amy Acton, Ohio’s former health director. Another state health official had to have police protection when she left her house, even just to walk her dog. Public health leaders received death threats, were harassed at public meetings and have been recipients of hate speech about their gender, religion, and other identities. As a result, there have been significant turnovers in public health leadership nationwide.

For example, since the start of the pandemic, 18 of the collective 59 state and territorial health officials have left office, with at least 33% of this turnover attributable to conflicts with elected officials and/or threats of physical harm/harassment from the public. Similarly, at the local level, 30% of the 37 county/city health officials who have left office during the pandemic did so because of COVID-19 response conflicts with local politicians or the public. This means that many public health agencies responsible for protecting the public's health are experiencing disruptions in leadership during the most challenging public health event of our lifetime.

Building Back Better As we reflect on the scope of these transitions and the open harassment of public health leaders, we must ask: How do we restore respect for public health decision-making and how can we rebuild public trust in public health for the next generation of Americans? Millions of people depend on our governmental public health system, an invisible web of protections that keep us all healthy every day. COVID-19 made that invisible web much more visible: few people even knew who their state health officers were prior to the pandemic, and now they are featured prominently in local, state and national news. Fewer knew the critical state of our public health infrastructure until now. Unfortunately, over the last year, we have all witnessed a public health system that was overwhelmed by the global pandemic. Despite the challenge, public health and health care workers all served essential roles in the battle against COVID-19, often sacrificing their own health in order to protect the health of others. To honor the sacrifices of these professionals, we must rebuild our public health system with a renewed commitment to innovation and collaboration. We must work as partners to provide effective vaccines, drugs and diagnostics and invest in the systems to distribute them while simultaneously protecting and promoting the health of all Americans. We must intentionally remove the pervasive and systemic health inequities that keep many from enjoying optimal health and wellness. And we must prioritize key functions and resources that every local and state public health system must have to be effective and create resiliency. There is much more work to be done, and we must all actively engage in addressing these challenges to end the pandemic and begin the process of restoring confidence in our public health system. Together, we can use the pandemic as a catalyst for transformation of our public health system and work to change public policies, attitudes and behaviors. By doing so, we can build a more trusted and robust public health system that is prepared to handle the next public health crises.

At least 33% of this turnover results from conflicts between the health official and elected officials or threats of physical harm and/or harassment from the public.

At the local level, 37 county/ city health officials have left office during the pandemic. 30% of those did so as a result of COVID-19 response conflicts with local politicians or the public.

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Since the start of the COVID-19 pandemic, 18 of the collective 59 state and territorial health officials have left office.

Interstate compacts helped states temporarily modify health care licensing during the pandemic and can provide long-term solutions

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by Andrew Bates

As states faced the spreading COVID-19 pandemic in early 2020, they were met with strains on health care systems that threatened their ability to take care of communities impacted by the virus. Mobilizing health care workers was an important aspect in addressing these problems and getting help to those who needed it most.

“[The compact] has enabled nurses to respond at short notice and avoid any delays due to licensing,” he said. “Hospitals throughout the 34 compact states have appreciated the NLC [...] because the multistate license significantly decreased the onboarding time of nurses needed to supplement nurse staffing.”

To facilitate health care worker mobility, 42 states implemented some form of temporary licensure or license waiver for out-of-state workers.

“States in the compact were easier to work with,” said Dr. Henry ‘Hank’ Drummond, a senior vice president and chief clinical officer for the staffing firm Cross Country Healthcare, in a National Council of State Boards of Nursing interview. “[The executive orders] were very confusing. We would read them and say, ‘What does this really mean?’ We would get on the phone with the governor’s office and ask very pointed questions, and they would still not be able to answer them. We called the boards of nursing and asked them, and they said they were trying to get clarity too. We would reach out to the client and get the same response.”

The majority of these measures relate to physicians, nurses and other professions engaged in virus treatment. Many states also have implemented emergency licensure policies for equally important mental health professions and for specialties like audiology and speech-language pathology that face care delivery challenges. Since the pandemic began, The Council of State Governments has identified more than 400 occupational licensing and telehealth actions by state legislatures, governors and regulatory bodies. The CSG report, “Assessing COVID-19 Occupational Licensing Policy Actions,” reveals the significant strain on state health care workforces and highlights the inadequacy of traditional systems of licensure in confronting a national crisis. To read the report, visit: licensing.csg.org/wp-content/ uploads/2020/12/Assessing-COVID-19-Occupational-Licensing-Policy-Actions-20202.pdf Interstate occupational licensure compacts preclude this complicated patchwork of emergency orders and waivers. Compacts allow professionals who meet a uniform set of licensure requirements to practice in any member state, including via telehealth. A licensee’s good stand-

Drummond sees the pandemic as a potential motivator for the nursing profession to standardize its licensure system, creating greater resilience for the next crisis. “If the pandemic has shown us anything, it has revealed the need for standardization across the board. [The compact] allows us to be agile, it allows us to be fluid and it allows us to be quick. If you think of it from the health care professional’s point of view, do we really need to put them through all of these steps every time they go to a new assignment?” States are getting the message. Puente said the pandemic has played a “huge role” in the introduction of NLC legislation in 13 states and territories.

“That this is the highest number of states to introduce an NLC bill in one legislative session in the 21-year history of the NLC is no coincidence,” he said.

Nurse Licensure Compact (NLC) administrator Jim Puente said his compact’s multistate license has supported professional mobility for thousands of nurses during the pandemic.

Dan Logsdon, director of the CSG National Center for Interstate Compacts (NCIC), notes the NLC is not the only licensure compact attracting attention from states due to COVID-19.

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ing is verified instantly through a shared licensure database. During a public health crisis, licensure compact states have a distinct advantage in confronting health care workforce challenges.

“In our recent conversations with state legislators and regulators, NCIC is hearing a lot of concerns about barriers to interstate practice. The pandemic has certainly highlighted licensure compacts in general as powerful, state-driven solutions to these barriers.” In addition to the five compacts operating at the start of the pandemic (for nurses, physicians, EMS personnel, physical therapists and psychologists), new compacts for occupational therapists, professional counselors, and audiologists and speech language pathologists are under legislative consideration. Under an agreement with the Department of Defense, CSG will facilitate the development of additional licensure compacts for professions to be determined. The Pentagon identifies compacts as the most effective solution to interstate licensure challenges facing military spouses. Compacts maximize their value through maximum state participation. Until a compact has representation from all states, additional licensure recognition policies may be needed, including bilateral reciprocity agreements and universal licensure recognition laws. Nonetheless, compacts are the most powerful tool available to states to bolster the resilience of essential workforces by removing barriers to interstate practice.

[The compact] has enabled nurses to respond at short notice and avoid any delays due to licensing. Hospitals throughout the 34 compact states have appreciated the Nurse Licensure Compact [...] because the multistate license significantly decreased the onboarding time of nurses needed to supplement nurse staffing.” — J IM PUENTE Nurse Licensure Compact administrator

Since the pandemic began, The Council of State Governments has identified more than 400 occupational licensing and telehealth actions by state legislatures, governors and regulatory bodies. WHAT IS AN INTERSTATE COMPACT? Interstate compacts are agreements between states. Often, these compacts create reciprocal professional licensing practices between states while ensuring the quality and safety of services and safeguarding state sovereignty. The benefits of interstate compacts include: S treamlined relicensing process between member States of the compact for all practitioners in the occupation S upport for military spouses of relocating active duty military personnel through provisions recognizing unique requirements of military life

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Creation of streamlined pathways for interstate practice

Increased public access to care or services E nhanced ability for member states to protect the public’s health and safety I ncreased cooperation of compact member states in regulating multistate practice E nhanced exchange of licensure, investigative and disciplinary information

LEARN MORE ABOUT OCCUPATIONAL LICENSURE: Occupational licensure compacts create reciprocity between states while maintaining the quality and safety of services and protecting state sovereignty. Compacts result in a more efficient distribution of licensed workers by supporting practitioner mobility. The CSG National Center for Interstate Compacts leads the development of interstate compacts for physicians, nurses, emergency medical services personnel, physical therapists, psychologists, occupational therapists, licensed professional counselors and audiologists/speech-language pathologists. More than 40 states and territories have adopted at least one of the compacts and over half have adopted three or more. The CSG report, “Assessing COVID-19 Occupational Licensing Policy Actions,” reveals the significant strain on state health care workforces and highlights the inadequacy of traditional systems of licensure in confronting a national crisis. To read the report, visit: licensing.csg.org/wp-content/ uploads/2020/12/Assessing-COVID-19-Occupational-Licensing-Policy-Actions-20202.pdf Learn more at csg.org/NCIC

When COVID-19 hit, 34 states were prepared and ready to act Join the Nurse Licensure Compact (NLC) to: ; Protect the health and welfare of the citizens of your state ; Ensure that your state has access to nurses who hold a multistate license and have been vetted and federally background checked ; Mobilize a workforce of more than 2 million nurses Sponsor the NLC model legislation (www.ncsbn.org/NLC_Final_050415.pdf) and join 34 states (www.ncsbn.org/nurse-licensure-compact) in a compact that will expand your state’s nursing workforce before the next disaster occurs.

For more information, contact NCSBN Legislative Affairs at rfotsch@ncsbn.org.

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Unite to create a #NurseCompactNation where all nurses with a multistate license can practice in all 50 states!

by Mary Elizabeth Lonergan

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s state legislators work to better combat COVID-19 with vaccine rollouts, some focus is shifting toward healing the mental health toll the pandemic created.

“To me, it’s been something that was ignored,” said Delaware state Rep. David Bentz. “Now we’ve seen, luckily, a real change in people’s thought process. Mental health is part of complete health and we need to get the message out that it is OK to seek help.” Nationally, Americans have struggled with their mental health since before the arrival of COVID-19, but in many cases the virus exacerbated their suffering. Pew Research Center found that 33% of Americans have experienced high levels of psychological distress at some point during the extended period of social distancing and isolation in the effort to slow the spread of COVID-19. That same survey found that 55% of adults who describe their financial situation as poor have experienced high levels of distress, as have half of those who report having a disability that keeps them from fully participating in activities.

The American Psychological Association Stress in America 2020 survey found 78% of adults count the coronavirus pandemic as a major source of stress in their life; 49% say their behavior has been negatively affected. Seventy-one percent of those surveyed say the pandemic is the lowest point in our nation’s history. “Increasingly we referred to it as a society in despair,” said Dr. Wayne Lindstrom, vice president of Business Development and Consulting at RI International, an organization delivering mental health and substance use solutions and care. “We had the opioid crisis, increasing suicide rates, people feeling isolated and cut off, and that was all before COVID. If that’s the context before COVID, it wouldn’t be much of a leap to think COVID has exacerbated this — and it has.” Vermont state Rep. Anne Donahue, a mental health survivor and advocate, agrees. “The most significant issues are anxiety and depression stemming from the degree of isolation that people are experiencing,” she said. “People need people: it’s true for recovery, which comes about most significantly through support of peers, but the reverse is true when we are cut off

MENTAL H E A LT H In the wake of COVID-19, mental health tops the list of concerns for several legislators across the country

from our direct, usual social interactions and supports.” Some worry about those who are not reaching out for help they may need.

In 2019, The Society for Human Resource Management said that less than 10% of Employee Assistance Programs designed to improve mental health are utilized by employees. As a physician, Oregon state Sen. Elizabeth Steiner Hayward has a keen awareness of the mental health impact of the virus as well as the impact felt by the states and constituents. “We need to understand and promote evidence-based standards, practices and evidence-based treatment, and do what

“

— VERMONT REP. ANNE DONAHUE MENTAL HEALTH SURVIVOR AND ADVOCATE

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“The pandemic has exposed cracks in our system,” said Bentz. “We need to make sure we treat mental health the same way we do all health care […] making sure mental health is prioritized as it should be. […] I am worried a lot more is happening in secret under the radar. There’s a much larger toll on people’s health than just the COVID virus.”

The most significant issues are anxiety and depression stemming from the degree of isolation that people are experiencing. People need people: it’s true for recovery, which comes about most significantly through support of peers, but the reverse is true when we are cut off from our direct, usual social interactions and supports.”

we can to inform an adequate workforce,” Steiner Hayward said. “Every person who has mental health issues doesn’t need a psychiatrist. On the other hand, they may need culturally competent people, culturally specific treatment options and evidence-based [strategies].”

“I spoke to our speaker about creating a task force on suicide prevention. He agreed, and it’s 13 bipartisan members, with a focus on youth, farmers, veterans and first responders,” Ballweg said. “We tailored our meetings to target these groups.”

Young people are paying possibly the greatest price in the mental health fallout.

Ballweg said that youth, farmers, veterans and first responders struggle with suicide and need support systems they can rely on.

“What I’m hearing about the most is kids and the social isolation of kids and elderly. We are seeing kids with depression and anxiety,” said Steiner Hayward. “If you think of the middle school crowd and you take kids who lost a year of their life, you’ve lost this important social and development time.”

“Behavioral health is so difficult to get your head around,” she said. “There is still quite a stigma when it comes to confronting individual struggling and those around them when it comes to that realization all of these things.”

Wisconsin Senator and CSG National Chair Joan Ballweg has worked within the legislature to create solutions for teens struggling with mental health issues.

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33%

of Americans have experienced high levels of psychological distress since COVID-19

Both Ballweg and Lindstrom shared the new national number for suicide prevention and help. By dialing 988, callers will be connected with the National Suicide Prevention Lifeline. Mental health crisis counselors staff the line and are able to provide support and help for callers.

78%

count the coronavirus pandemic as a major source of stress in their life

Despite the COVID-19 mental health outcome, 71% of American adults still feel hopeful about the future, according to the American Psychological Association. Still, the government must continue to work to find solutions, according to Donahue. “Mental health is a crucial component of public health; our public health departments must be reaching out to address population health in all arenas, which includes mental wellness,” she said. “There needs to be state leadership in ensuring fully equitable access and integrated care from insurers and providers, barring discrimination based upon disability status and confronting stigma.”

49%

Source: American Psychological Association Stress in America 2020 survey

1-800-662-4357

72%

of those surveyed say the pandemic is the lowest point in our nation’s history

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say their behavior has been negatively affected

If you or someone you know is struggling with mental health on account of COVID-19 or for any other reason, please seek help at the Substance Abuse and Mental Health Services Administration’s National Helpline:

C S G Pa r tn e rsh ip wit h Th e Co m m o nwe a l th Fu n d Hi gh l i ghts So c i a l Isolat io n , O th e r Me nta l He a l th Issu es

by Sean Slone A year of quarantines and social distancing prompted by the coronavirus pandemic compounded a growing concern in the mental health field — an epidemic of social isolation and loneliness.

and older adults are at increased risk for loneliness and social isolation because they are more likely to live alone and experience the loss of family and friends, chronic illness and hearing loss.

Social isolation is one of four mental health topics that are a focus this year for a partnership between The Council of State Governments and The Commonwealth Fund, a New York-based foundation that promotes “a high performing health care system.” Other topic areas highlighted are maternal mental health, social determinants of mental health and mental health insurance parity.

For the general population, health researchers are concerned about short- and long-term public health and behavioral complications from prolonged isolation, including substance abuse, domestic violence, obesity and suicide. A growing body of evidence indicates social isolation significantly increases the risk of premature death. A 2015 analysis by Brigham Young University psychology and neuroscience expert Julianne Holt-Lunstad and others found the risk for untimely death increased by 26% for those experiencing loneliness, 29% for those experiencing social isolation and 32% for those living alone.

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CSG has convened a 20-member advisory group of state legislators and executive branch health officials from across the country and four subject matter experts.

“

This crisis will continue well beyond the public health emergency and well after safety measures like social distancing are lifted.”

The group will guide, shape and contribute to research into each focus area, highlighting innovative legislation, successful state programs and departmental initiatives and clinic-level interventions. That research will inform a new CSG resource guide for policymakers, providing a roadmap for addressing some of the most pressing mental health challenges, including one that is likely to receive renewed attention even as the pandemic recedes. Many populations already at high risk for social isolation and loneliness have been among those disproportionately impacted by COVID-19, including older adults, people of color, low-income earners and those in nursing homes and prisons. According to a 2020 report from the National Academies of Science, Engineering, and Medicine, nearly one-fourth of adults 65 and older are considered to be socially isolated,

The Coalition to End Social Isolation and Loneliness is a Washington, D.C.-based membership organization that disseminates research findings, advocates for federal and state legislative and regulatory policy interventions and builds public awareness. Andrew MacPherson, the group’s founder and co-director, will serve on the 20-member advisory group convened by CSG. “This crisis will continue well beyond the public health emergency and well after safety measures like social distancing are lifted,” said MacPherson. “It is critical that states act now to support individuals who are experiencing isolation and loneliness in order to protect their mental health today and the worsening of associated negative health care impacts well into the future.”

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Working Together Throughout the COVID-19 pandemic, the country’s private sector has played a key role in helping communities fight the virus, in developing innovative technologies to assist state leaders and in promoting science and collaboration. The following articles were submitted by CSG private sector partners.

Working Together Toward One Goal Can Help Communities Fight COVID-19 by Melissa Schulman | Senior Vice President, Government and Public Affairs at CVS Health As we hit the one-year mark of the COVID-19 pandemic, I had the opportunity to reflect on our efforts at CVS Health to immediately and continuously respond to the needs of the communities we serve across the country. As a diverse health care services company with nearly 10,000 locations nationwide, we have utilized our local presence to help meet those needs during COVID-19. In the early days of the pandemic, meeting the needs of consumers and patients meant helping them safely stay home as much as possible as we were restocking our shelves, filling 90-day scripts, offering free prescription delivery, waiving copays and securing personal protective equipment, among other things. Shortly thereafter, it quickly evolved to providing greater access to COVID-19 tests and that meant opening and operating large-scale and retail drive up testing sites.

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In addition to drive up COVID-19 testing sites, CVS Health stood up community-based testing sites focused on meeting the needs of under-served neighborhoods. These community testing sites located across the country, from Baltimore to Los Angeles, have helped to ensure greater access and convenience to testing services. To date, CVS Health has administered more than 15 million tests at more than 4,800 sites across the country, which represents 70% of the testing in a retail setting in the United States.

As the promise of the vaccine became increasingly real in late 2020, CVS Health was more than ready, having begun our preparations months ago. In October 2020, we were selected by the U.S. Department of Health and Human Services to provide COVID-19 vaccines in long-term care and assisted living facilities nationwide. More than 40,000 long-term care facilities across 49 states and Puerto Rico selected CVS Pharmacy to provide COVID-19 vaccines to residents and staff. We were also selected, along with other pharmacy chains, to administer vaccinations in our retail pharmacies as they became available to the general public as part of the Federal Pharmacy Partnership program. To date, CVS Health has administered well over four million COVID-19 vaccine doses to residents and staff in over 40,000 long-term care facili-

ties across the country. COVID-19 cases have declined in nursing homes which indicates that the vaccine is working, and we are delivering on the company’s commitment to help protect a population disproportionately impacted by the pandemic. Additionally, CVS Health is administering COVID-19 vaccines in over 20 states as part of the federal pharmacy partnership program and has built out a community-based strategy to address COVID-19 vaccine education and equity with a particular focus on Black and Hispanic populations. The strategy includes proactive patient outreach, community-based partnerships and vaccine clinics, and robust, education-focused marketing, all aimed at increasing COVID-19 vaccination rates. As our new President and CEO Karen Lynch said so well recently, “We are committed to reaching people of color and under-served communities to ensure health equity as we work to vaccinate all Americans. Our presence in communities across the country uniquely positions CVS Health to educate vulnerable populations and connect them with vaccine administration services.” As more supply becomes available through the federal program, we plan to expand to additional states while increasing the number of stores offering vaccinations. CVS Pharmacy has the capacity to administer 20 to 25 million shots per month. The last 12 months have brought incredible challenges and for many of us, me included, it has brought personal loss. I have learned a lot personally and professionally. Through my work at CVS Health, one of the greatest lessons I have learned during the pandemic is that working together towards one goal in public-private partnerships can make an incredible difference in the lives of millions of people. What we’ve been able to accomplish so far through the pandemic is a direct reflection of the tireless efforts of our 300,000 CVS Health employees across the United States, and I am extremely grateful.

CVS Health is administering COVID-19 vaccines in over 20 states as part of the federal pharmacy partnership program and has built out a community-based strategy to address COVID-19 vaccine education and equity with a particular focus on Black and Hispanic populations.

How Collaboration and Science Are Helping Us Restore America’s Health by Lori M. Reilly | Chief Operating Officer, PhRMA The COVID-19 pandemic has affected every area of American life. Public health policies have changed how we work and learn. Grocery shopping, sports competitions and even legislative hearings look different today than they did prior to the pandemic. And financial strains have affected budgets in households and for your state operations. As of this writing, there is hope that we are turning the corner on this crisis, as the U.S. Food and Drug Administration (FDA) has approved one COVID-19 treatment and issued emergency use authorizations (EUAs) for three vaccines and multiple treatments. Additional candidates under investigation have also been making incredible progress. America’s biopharmaceutical researchers have been working tirelessly, relying on science to help us get back to normal. Concurrently, companies have maintained close collaboration with federal and state governments to assist with COVID-19 testing, support and, more recently, treatment and vaccine distribution. We’re thankful for your dedication and leadership in getting many vaccines and treatments to residents of your states. Biopharmaceutical research companies built on their decades of experience with similar viruses and billions of dollars in investments to advance our understanding of infectious diseases. Throughout the process to develop COVID-19 treatments and vaccines, extensive safety and effectiveness data have been collected from rigorous, large clinical trials and then reviewed by FDA. To further help instill confidence in vaccines, the leading companies working on vaccines for COVID-19 issued a pledge “to make the safety and well-being of vaccinated individuals the top priority in development of the first COVID-19 vaccines.” This commitment to safety isn’t new — it’s what the industry does every day.

As a result of these efforts, Americans have access to multiple treatments, like monoclonal antibodies, antivirals, anticoagulants and anti-inflammatories. With viral variants surging in the U.S. and around the world, the need for treatments to keep COVID-19 patients out of the hospital is critical. Because viruses are constantly changing, which can lead to genetic variations (commonly referred to as variants or mutations), public health officials and biopharmaceutical companies closely monitor them to learn more about how they might affect public health, whether they impact the efficacy of vaccines and how treatments may respond. Armed with this knowledge, vaccine makers are developing modifications to their vaccines to fight back. Companies are also investigating booster vaccines, which could be given following original vaccines, and developing new vaccines that target the common viral strain and new variants. Meanwhile, companies are working to address capacity challenges by entering into agreements and partnerships with other manufacturers to expand manufacturing facility capabilities and to relieve pinch points such as fill/finish. They’re also working to bring more vaccine and treatment manufacturing facilities into play through internal expansions and by partnering with other companies who have capacity to help produce these vaccines and treatments. We remain committed to supporting our health care system at the state and federal level as we work to treat and vaccinate as many people as possible. Through these efforts and partnerships, we can help restore America’s public health and economy.

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Because viruses are constantly changing, which can lead to genetic variations (commonly referred to as variants or mutations), public health officials and biopharmaceutical companies closely monitor them to learn more about how they might affect public health, whether they impact the efficacy of vaccines and how treatments may respond.

To help reduce delays in getting these medicines to Americans who need them, manufacturers are completing some development steps simultaneously, such as preparing for Phase 2 clinical trials during Phase 1 and preparing for manufacturing during Phase 3. Many companies began manufacturing vaccines and treatments before they were authorized to ensure sufficient capacity to meet demand once authorized.

Technology Such As Broadband is Key to Closing the Digital Divide by Brad Hall | Vice President, External Affairs, Appalachian Power The COVID-19 pandemic has changed daily routines for millions of Americans. The sudden transition to working and learning from home not only has reinforced the value of electricity, but also highlighted the importance of access to affordable, reliable broadband. By leveraging their existing infrastructure, electric companies can provide middle mile broadband and are positioned to help close the digital divide. One such company is Appalachian Power. Prior to the pandemic, Appalachian had already identified improved broadband access as a key to economic growth in its mostly rural service territory in southern West Virginia and southwestern Virginia. The pandemic exposed just how critical that need was. A quickly applied Band-Aid helped students trying to learn from home last spring. The AEP Foundation donated $73,000 to create about 50 free WiFi hotspots at schools and community centers across Appalachian Power’s service area. The hotspots allowed students to easily access education materials and classroom assignments from their laptops, iPads or phones if they didn’t have internet access at home. Meanwhile, pilot broadband projects in both states gained momentum. In Grayson County, Virginia, the project achieved a milestone when crews installed the first fiber optic cable on Appalachian Power’s poles in December 2020. To date, about 40 miles of cable have been installed. After the lines are up, internet service provider GigaBeam Networks of Bluefield, Virginia, will offer “last-mile” connectivity to customers. Appalachian Power gained approval for the pilot project from the Virginia State Corporation Commission about a year ago, which authorized the company to invest $25 million to install up to 238 miles of 96-strand fiber optic cable on its utility poles in the rural county. It is expected to take 18 to 24 months to reach all 6,000 county residents identified in the project area.

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In Logan and Mingo counties in West Virginia, the company plans to invest $61 million to install 430 miles of middle-mile fiber optic cable. As with the Grayson project, the plan calls for GigaBeam Networks to own, install and operate the last-mile infrastructure needed to deliver broadband services to customers in the project area. Appalachian Power

The sudden transition to working and learning from home not only has reinforced the value of electricity, but also highlighted the importance of access to affordable, reliable broadband. By leveraging their existing infrastructure, electric companies can provide middle mile broadband and are positioned to help close the digital divide.

submitted its project plan and cost recovery application to the Public Service Commission of West Virginia in January, and a ruling is expected later this year. Project construction is expected to begin within 180 days after Commission approval and be complete approximately 24 months after the start of construction. With both projects, GigaBeam will have access to the middle-mile facilities in phases as construction progresses. The phased-in approach will allow GigaBeam to coordinate its equipment installations with middle-mile construction and connect new broadband service customers on a rolling basis throughout the construction process. Appalachian Power has significant experience building and maintaining fiber optic cable, with more than 2,000 miles already in place for system operations. Chris Beam, the company’s president and chief operating officer, says the company’s fiber experience and extensive reach into rural areas make middle-mile fiber deployment a good fit for the company. “With utility poles already in place near homes and businesses, even in the most rugged and mountainous areas, we are well-positioned to help expand broadband access in rural parts of our service area,” Beam said.

Digital Skilling and the Post-COVID Economy by Allyson Knox | Senior Director, Education Policy, Microsoft Philanthropies The COVID-19 pandemic and global economic recession has underscored inequities in our society. One of the keys to a genuinely inclusive economic recovery is expanded access to digital skills to ensure job seekers, employees and students have the skills they need to fill the new jobs available. As the senior director, Education Policy at Microsoft Philanthropies, I have spent the last year working with colleagues to develop a deeper understanding of how our existing programs can help meet the needs of local communities and what more we can do to help. Microsoft’s TechSpark initiative has played a key role in this work and has provided us with a lens to look at the importance of skilling for postCOVID economic recovery. TechSpark fosters economic opportunity and job creation in partnership with communities through funding, technology, expertise and partnerships. TechSpark operates in six regions: Wyoming, Wisconsin, North Dakota, Virginia, Washington and two border cities in Texas and Mexico. Over the last year, we’ve continued to work towards achieving TechSpark’s mission to help everyone succeed in the digital economy. I’d like to shine a spotlight on important work going on in one of TechSpark regions, Northeast Wisconsin, led by my colleague Michelle Schuler, and how the lessons learned can inform work elsewhere in the United States. Our data shows that two years’ worth of digital transformation was concentrated into two months in 2020. The pandemic has shined a harsh light on what was already a widening skills gap – a gap that will need to be closed with even greater urgency to accelerate economic recovery. Closing the skills gap will require a renewed partnership between stakeholders across the public, private and nonprofit sectors. In Wisconsin, the TechSpark program worked to address this issue through a new partnership with the regional economic development nonprofit, The New North, and a social entrepreneurial platform, gener8tor. Together, we launched gener8tor Upskilling to provide training to unemployed and underemployed individuals and help them to secure new jobs. So far, the program has 107 graduates who have earned more than 450 LinkedIn Learning certificates. Thirty-six percent of graduates found full-time work upon graduating. We learned that wrap-around services, which help job seekers gain skills and place into jobs, are essential and require coordinated investment. Through our work with the University of Wisconsin Green Bay, we recognized that people in higher education are struggling in the digital economy. In the fall of 2020, we launched an initiative with the Chancellor of the University of Wisconsin Green Bay to ensure its faculty

and students took advantage of LinkedIn Learning—a resource they had already had access to use. As a result, the entire campus is now aware of this resource and staff, faculty and students are using LinkedIn to help digitally transform the campus by expanding technology knowledge beyond the IT Department. By helping leaders across departments better utilize technology platforms and services, we can help drive social impact in the broader community. Digital skilling needs to start before individuals enter the workforce, which is why we have been working with leaders in Wisconsin’s Cooperative Education Service Agency 7 (CESA 7) to help ensure all students gain access to at least one rigorous computer science course before graduating from high school. CESA 7, which represents 37 local school districts, now leads the Computer Science Talent Ecosystem for Youth Framework and leverages resources from national non-profits such as CSforAll, Code. org, Computer Science Teachers Association and Microsoft resources including Imagine Academy and TEALS. They incorporated the Wisconsin Department of Workforce Development’s IT Youth Apprenticeship program and secured funding from American Family Insurance, New North, Wisconsin Economic Development Corporation and Community Foundation of the Fox Valley. Collaboration can help inspire educational organizations to champion efforts that increase access to computer science education. As a result, we can help K-12 students better prepare to enter the digital economy. We recognize that this important work is going on in communities across the country, and we look forward to continued collaboration to help everyone succeed in the fast-growing digital economy.

Our data shows that two years’ worth of digital transformation was concentrated into two months in 2020. The pandemic has shined a harsh light on what was already a widening skills gap — a gap that will need to be closed with even greater urgency to accelerate economic recovery.

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THANK YOU!

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CSG LE ADERSHIP CIRCLE

To learn more about the CSG Associates Program and Leadership Circle, please contact: Maggie Mick, chief advancement officer p. 859.244.8113 | e. mmick@csg.org

by Sierra Hatfield

The Council of State Governments Shared State Legislation (SSL) program gives novel state legislation the opportunity to be featured as a cutting-edge solution to regional or national issues that other legislatures may consult when drafting their own answers to today’s policy challenges. ISSUE 2 2021 | CSG CAPITOL IDEAS

Annual member-driven committee selects bills to help answer shared policy challenges

SSL is a year-long, member-driven program that highlights innovative legislation and presents included bills as a resource to state legislatures across the nation. The process begins with the compilation and research of bills submitted anonymously to the SSL Bill Docket. Then the SSL Committee, composed of elected and appointed state leaders, meets at least once a year in conjunction with the CSG National Conference to review legislation on the docket using a combination of SSL criteria and member experience with state action in that area. After deliberation, accepted bills are transferred to the SSL Database, a new host element for innovative legislation that will debut during the program’s 80th anniversary in 2021. The SSL Committee decides whether to include or reject a bill, to defer it to the next docket so CSG staff can conduct additional research or to include it as a “Note” (indicating the committee found the bill to be worthy of inclusion but needing context provided by other states or issues.) The docket usually consists of roughly 100 bills, with less than a quarter normally chosen for inclusion in the database, making the process highly selective and an example of CSG’s commitment to its members’ top policy priorities. To participate in the SSL process, two avenues are available. Policy leaders and other stakeholders may (1) submit bills via the online form at csg.org/ssl for inclusion on the docket, and (2) watch and participate in SSL Committee meetings to advocate for or against bills on the docket.

In December 2020, the committee included 22 bills to highlight as innovative legislation: GA HB 879

Alcohol Home Delivery Law (Note)

WA SB 5975 Relating to Paid Family and Medical Leave

NY SB 8427

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Relates to Establishing a Coronavirus Disease 2019 (COVID-19) Public Employee Death Benefit

IA SB 2310

SSL Committee members, other state officials and their staffs, CSG Associates and CSG staff may submit legislation directly to the SSL program. Legislation from other sources is allowed but must be submitted through a state official. The committee currently categorizes submitted bills in 10 topic areas, however more categories can be added as trends in submissions become clearer. The original topics are Health, Agriculture, Commerce & Labor, Education, Energy, Environment, Government, Justice, Technology and Transportation. When considering submitting a bill to the program, it should be noted the committee will judge the bill using an extensive set of pre-determined criteria. Bills with the best chance of inclusion have the following characteristics:

Enacted Not available in similar forms in more than 10 states No more than two years old

LA SB 426 (2020) COVID Testing

Revised Uniform Law on Notarial Acts (2018)

Uniform Electronic Bills Act (2019)

TX SB 751 (2019) Deepfakes and Election Security

OK SB 661 (2020)

Learning Online Initiative

Oklahoma Open Meeting Act (Note)

UT S 5011

MN HF 3100 (2020)

High Risk Population Protection Amendments

Emergency Insulin Assistance Program

CA AB 824 (2019)

CO HB 1039 (2019)

Prescription Drug Supply Chain – Pay for Delay

Identity Documents for Transgender Persons

FL HB 23 (2019)

CT HB 6004 (2020)

Telemedicine

An Act Concerning Police Accountability (Note)

KY SB 133 (2018)

LA HB 826 (2020)

An Act Relating to Crimes and Punishments

IN SB 99 (2018)

COVID-19 Limitation of Liability

LA SB 491 (2020)

Limits Liability of Persons who Provide Relief or Recovery Equipment or Services During a Declared State Emergency

IN SB 243 (2019)

LA SB 508 (2020), Limits Liability of

Nonconsensual Pornography

IN SB 192 (2019) Nonconsensual Pornography

Restaurants During the COVID-19 Epidemic

For more information and to see past and current dockets, please visit csg.org/ssl.

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Civil Forfeiture (Note)

Essential Workers Are Needed. But Some Are Shut Out. by Megan Quattlebaum

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When the first COVID-19 wave hit the U.S. last year, state officials worried they wouldn’t have the right equipment to meet patient demand. Today, it’s not the ventilators that are in short supply. It’s the people operating the ventilators who are needed to save lives.

In November, The New York Times reported that a number of states were seeking respiratory therapists willing to temporarily relocate, but hospital officials said most of their pleas went unanswered as COVID-19 deaths surged nationwide. Many who aspire to hold this now-crucial position never had a chance to answer the calls for help because of an unexpected barrier they face: a criminal record. Respiratory therapists are required by most states to have licenses, certifications or other credentials. But statutes in Alabama, Hawaii, Idaho, Louisiana, Massachusetts, Oregon, Pennsylvania and Wyoming either restrict or deter people who have criminal records — even decades-old misdemeanors in some states — from being licensed as respiratory therapists. And it doesn’t stop there. In some states, a misdemeanor could prevent someone from becoming an EMT. Other state laws limit access to public works jobs for certain felonies or misdemeanors. And an embalming license can be denied in some

People recently released from prison

People with criminal records suffered from a

(within two years)

unemployment rate in 2008, almost five times higher than the unemployment rate for the general public at that time.

states for an ambiguous “crime involving moral turpitude.” The federal government recently labeled all of these professions essential to meet the demands of the COVID-19 economy. Whatever the justification for these barriers in ordinary times, they now seem ripe for reconsideration. In the best of circumstances, people with criminal records have a difficult time accessing jobs. One study from the Prison Policy Initiative showed that people with records suffered from an alarmingly high 27% unemployment rate in 2008 — almost five times higher than the unemployment rate for the general public at that time. People recently released from prison were the most likely to be unemployed or underemployed, with a 32% unemployment rate among people released in the prior two years. These hurdles particularly impact people of color: whereas white job applicants with criminal records have a callback rate of 17%, Black applicants with criminal records receive callbacks at a rate of only 5%.

And these laws don’t just affect a small fragment of the population. Millions of Americans have a criminal record of some kind, and we know that having a job is a key factor in reducing one’s chances of committing a crime in the future. To shut such workers out of the few areas of our economy that are growing is to trap even more of them in unemployment, a result that not only hurts them and the people they support

32% unemployment rate.

financially, but also deprives the rest of us of the chance to benefit from a group of highly motivated workers. COVID-19 has left state and federal policymakers with painfully long to-do lists. But it also provides them with a unique chance to rebuild their workforce and create an inclusive economy — one that affords opportunities to all, gives businesses access to untapped talent and helps make our communities safer. The Council of State Governments Justice Center has developed customized playbooks for each state to help policymakers map out actions that will break down these barriers to opportunity. View the playbook for each state at: csgjusticecenter.org/publications/ removing-structural-barriers/state-playbooks. If COVID-19 has any bright spot, it is that it has forced many of us to reflect on what matters most. In such moments, the health of our families looms large. It’s painful to think about the moment when someone I love might need acute respiratory care; even more so to imagine that we could miss out on such care because we’ve denied a group of our fellow Americans the opportunity to help.

Megan Quattlebaum is the director of The Council of State Governments Justice Center, a nonpartisan, nonprofit membership organization that provides criminal justice guidance to state officials in all three branches of government. To learn more, visit csgjusticecenter.org

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Many factors make the job market harder for people with records, including limited access to education and the pervasive stigma surrounding criminal records. And legal barriers to employment are another significant driver of the problem. There are more than 29,000 state and federal regulations that impede access to employment, professional licensing and entrepreneurship on the basis of a criminal conviction. Health care employment and licensure is more affected by collateral consequences than any other industry, with nearly 7,500 regulatory barriers.

were the most likely to be unemployed, with a

2020: Advancing Justice in a Year of Crisis The outbreak of COVID-19 and the public outcry over George Floyd’s killing presented overlapping crises for state and local justice systems in 2020. The CSG Justice Center responded by directing its resources to meet the rapidly evolving needs of its stakeholders. The result was a challenging but productive year filled with successes in the midst of hardship and consensus despite conflict. Below are 10 highlights from the Justice Center work in 2020.

ince the start of the pandemic, S Justice Center staff has been in contact with hundreds of policymakers and practitioners across all 50 states

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to identify critical questions and share response strategies. It has amplified challenges, tracked cases of COVID19 in prisons and jails, compiled resource opportunities for struggling community nonprofit organizations and developed new tools for corrections officials. The CSG Justice Center has also worked to encourage the federal Small Business Administration to allow business owners with criminal records access to COVID-19 relief funds.

Two states passed legislation taking action to reduce recidivism. The Justice Reinvestment initiative delivered key improvements that will help stop the cycle of incarceration. Wyoming passed a bill that strengthened its behavioral health programming for people in the criminal justice system by standardizing its treatment services and creating more interaction between health and corrections professionals. Vermont approved legislation that restructures its community supervision approach and launches an examination of racial disparities in state sentencing practices and prisons.

The Justice Center connected eight new governors personally to people impacted by their corrections systems.

Counties were pushed to take the next step toward reducing the number of people with mental illness in their jails.

In 2019, a historic number of new governors took office. Soon after, they faced unprecedented challenges, particularly for people who live and work in prisons, amid the COVID-19 pandemic. Before and after the virus struck, the Justice Center’s Face to Face initiative created opportunities for governors to learn about the criminal justice system through the eyes of the people who have experienced it.

With more than 515 counties committed to the Stepping Up initiative, a new effort — Set, Measure, Achieve — was launched to get each of the counties to establish and reach measurable goals that demonstrate a reduction of the number of people struggling with mental illness in their jails.

The CSG Justice Center created real-time data tools to help states better understand their supervision trends. The Lantern initiative delivered corrections leaders in Missouri and Pennsylvania new automated tools that calculate more than 200 million metrics each week to better track probation and parole revocations and identify solutions that can more effectively prevent unnecessary prison admissions.

The largest, most comprehensive effort to get all policymakers actionable criminal justice data they can count on was launched. Critical criminal justice data is often collected but not analyzed, analyzed but not shared or shared but not acted upon. In such unpredictable times, policymakers need data that is timely and easily digestible to make tough decisions. Justice Counts — powered by more than 20 organizations and guided by public officials from every corner of the criminal justice system — is a national, consensus-building effort to inform policymakers’ decisions by making data more timely, less disjointed and as useful as possible.

An agreement on policy options was secured to help two states make smarter decisions when dealing with troubled kids. Connecticut and North Dakota agreed to policy options proposed by the CSG Justice Center as part of its Improving Outcomes for Youth (IOYouth) initiative that, among other things, decriminalize adolescent behaviors that are not best addressed by the justice system and divert kids from the system if they are at low risk of reoffending.

he impact that the T justice system has on people at different stages of education was examined and guidance on how to address these systemic issues was provided. Reports showed how punitive juvenile justice responses such as probation not only have little impact on school attendance but made matters worse in South Carolina. An additional study delivered a state-by-state look at what states are doing when it comes to offering currently and formerly incarcerated people educational opportunities beyond a high school degree.

A national database of funding opportunities was built to help state and local leaders sustain their criminal justice system improvements. State and local leaders often face challenges sustaining their efforts to reduce the number of people in jails who have mental illnesses or substance use disorders. And while plenty of federal funding exists, it can be daunting to sort through the opportunities, deadlines and application processes. Financing the Future of Local Initiatives is a new set of tools that provides a jumping off point for local criminal justice leaders to identify measurable goals and align funding opportunities to achieve them.

Two new national support centers were launched to help law enforcement and practitioners address the behavioral health needs of people in contact with the criminal justice system. The Law Enforcement and Mental Health Support Center and the Center for Justice and Mental Health Partnerships will both serve as unique clearinghouses for free training and resources.

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Protecting Voter Rights

White House Offers Infrastructure Report Cards for Every State In April, the White House released fact sheets detailing the infrastructure needs of every state and how these needs would be addressed through the investments proposed under the president’s $2.3 trillion American Jobs Plan. The plan, released on March 31, calls for new federal spending on public infrastructure, research and development, workforce training, affordable housing and caregiving.

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The fact sheets assign a grade to each state based on an assessment of 12 infrastructure categories, including the number of bridges and miles of road that are in poor condition, the percentage of households without access to broadband, the money required for resilient infrastructure and clean drinking water and the availability of affordable housing, childcare and veterans’ health services.

In the Northeast, where no state scored higher than a C, under investment in transportation has led to increased commute times, higher costs and a lack of resiliency to severe weather events. Drivers in New Jersey, which received a D+ grade, pay an average $713 annually in costs stemming from driving on roads in need of repair. In Maine, which received a C- grade, 49% of trains and other transit vehicles are past their useful life. CSG East’s Transportation Policy Committee has consistently supported long-term sustainable funding for the nation’s aging and overburdened transportation system. Learn more about the White House report cards and CSG East programming at csg-erc.org.

For more on CSG East, visit csg-erc.org. 212.482.2320 • info@csg-erc.org

As the 2021 legislative session unfolds, conversations around voting rights are front and center in state legislatures across the nation. Some 253 bills have been introduced in 44 states that would make changes to voting rights, representing a 600% increase compared to this time last year. The CSG East Council on Communities of Color held a virtual panel discussion in late March with state officials and voting rights advocates to explore the potential impact of these proposals on minority voters in communities across the country. The panel was the first of the Council on Communities of Color’s 2021 “Movement Summit Series,” which convenes state and local policymakers and experts working on equitable governing solutions.

International Business Development The Eastern Trade Council organized an informational session on business opportunities in African for U.S. companies in preparation for a Virtual Trade Mission to Africa scheduled for May 2021. The Eastern Trade Council is a nonpartisan, not-for-profit organization dedicated to strengthening state and regional economic competitiveness in the global marketplace. This council promotes cooperative approaches among the 10 northeastern states and assists northeastern companies in exporting goods and services through a variety of regionally oriented projects.

Tapping Maple Trees As a tradition, New Hampshire Gov. Chris Sununu tapped the first maple tree to officially kick off Maple Week in the state. The governor spoke before tapping two trees at Connolly Brothers Dairy Farm in Temple, New Hampshire, honoring the 75th anniversary of the state association of conservation districts.

Renewable Energy The U.S. Department of Energy’s Lawrence Berkley National Laboratory published its annual update of state Renewable Portfolio Standards — policies that have been a major force behind the development of solar, wind and other forms of emissions-free energy in the U.S. for more

than two decades. The report offers a glimpse into recent trends associated with the standards, which require that retail suppliers in a state provide a specific portion of their power from certain renewable sources over time. New York and Virginia both have 100% zero-carbon electricity mandates (New York by 2040 and Virginia by 2050) and Connecticut, Maine, New Jersey and Rhode Island have 100% zero-carbon electricity goals (Connecticut, Maine and New Jersey by 2050 and Rhode Island by 2030).

Seeking Solutions for Transportation When governors began enacting stay-athome orders in March 2020 amid the coronavirus pandemic, state transportation officials saw a crisis unfolding before their eyes. Ridership plummeted on the region’s public trains and buses and highway traffic volumes declined, leading to a steep drop in revenue from tolls, motor fuel taxes, general sales taxes and other sources that help fund highways and transit systems. The CSG East Transportation Committee hosted a roundtable to offer committee members an opportunity to share strategies for addressing the funding gaps and to encourage a federal plan to provide stable funding to maintain the nation’s aging highways, bridges and public transit systems. Officials warned that without an immediate infusion of federal aid, state and local projects would stall, leading to less safe roadways and massive layoffs.

IA / IL / IN / KS / MI / MN / ND / NE / OH / SD / WI / AB / MB / ON / SK

Midwest Annual Meeting The Council of State Governments Midwestern Legislative Conference will mark a milestone anniversary this summer in a region steeped in U.S. history. The 75th Annual Meeting of the MLC will be held July 11-14 in Rapid City — South Dakota’s “gateway to Mount Rushmore.” Registration can be completed at csgmidwest. org. Discounted registration is available through May 4. Designed by and for Midwestern state and provincial legislators, the family friendly MLC Annual Meeting includes a mix of public policy sessions, professional development workshops, featured speakers, special evening events, and separate programming for the adult and youth guests of attendees.

Improving Mental Health The one-two punch of the opioid crisis and COVID-19 has propelled mental and behavioral health to the top of state legislatures’ agendas, so much so that new standing committees have been created in 2021 in the Illinois Senate and Ohio House. They join extant committees in the Illinois House (Mental Health & Addiction) and Wisconsin Assembly (Mental Health), as well as the Minnesota House’s Behavioral Health Policy Division. Proponents of separate mental/ behavioral health committees say pushing that specific issue out of broader health committees gives legislators enough time for “deep dives” into a complex subject that defies quick and easy answers.

Michigan Mining Tax

Pay for Public Defenders A new law in Wisconsin will allow for a boost in pay for the state’s public defenders. Between March 2020 and the beginning of this year, 78 people had left Wisconsin’s Office of the State Public Defender — the state-funded entity that ensures the right to counsel. Among the factors causing this spike in turnover: in-person visits to jail and court proceedings during a pandemic, higher workloads and career opportunities in the private sector and other government offices. Under SB 62, signed into law in March, merit pay for a public defender can exceed 10% of his or her base bay for the remainder of this fiscal year.

Licensing for Health Workers South Dakota is hoping to boost its health care workforce and be prepared for future public health emergencies with a new law that recognizes out-of-state professional licenses. HB 1077, which took just a month to go from introduction to Gov. Kristi Noem’s desk, directs state licensing boards to “issue a license, certificate, registration or permit” to someone as long as the qualifications for their out-of-state license are “substantially equivalent to or exceed” those in South Dakota. The new law also authorizes a provisional license if the person has to satisfy additional requirements to qualify.

Protest to Progress States including Illinois, Kansas and Minnesota have taken deep dives into issues of race and equality resulting in a mix of new laws and legislative proposals. The death of George Floyd at the hands of police brought people across the country to the streets in protest. Some of those included state legislators including Sen. Kimberly Lightford, Illinois Senate majority leader and chair of the state’s Legislative Black Caucus. She saw a real chance to “move from protest to progress” with the Illinois General Assembly helping lead the way. In only a few months’ time, after many hours of legislative hearings and subsequent negotiations, major policy changes in areas such as criminal justice, education and economic development went from the study stage to the desk of Illinois Gov. J.B. Pritzker for signing. “We all learned together,” Lightford says. “I think that is why it was so successful, because of the inclusion, because of the collaboration with our colleagues, because we worked from a place of research and data and best practices. And we had the support of our governor, Senate president and House speaker.” Policymakers in other Midwestern states, such as Kansas and Minnesota, also have taken this kind of comprehensive approach. Leaders in all three of these states report notable, though varying, progress since the summer.

For more on CSG Midwest, visit csgmidwest.org. 630.925.1922 • csgm@csg.org

ISSUE 2 2021 | CSG CAPITOL IDEAS

In Michigan, a portion of a tax on mining now helps fund rural development in many sectors. Across the Midwest, income levels among rural residents tend to lag those of their urban counterparts. Since 2010, inflation-adjusted income rose 14.5% in metropolitan areas as opposed to 9.7% in rural areas. In Michigan, one approach to address this is to use money from one of the state’s oldest economic sectors to improve the sustainability and viability of other land-based industries.

The legislature created a Rural Development Fund with a dedicated revenue source, a portion of a 2.75% severance tax on mining activities. Under the legislative statue, land-based industries include tourism, food, agriculture, forestry, mining and oil and gas production.

AL / AR / FL / GA / KY / LA / MO / MS / NC / OK / SC / TN / TX / VA / WV

Funding for Flooding and Sea-Level Rise

Law Enforcement Training Reform A new plan approved by South Carolina’s Law Enforcement Training Council allows law enforcement recruits to complete the first part of training at state technical colleges. Under the new plan, recruits will attend a 14-week certification course, followed by the final eight weeks of training at the S.C. Criminal Justice Academy. The move, considered a step forward for the state’s law enforcement community, comes as state officials struggle with a pressing need for more officers and limited availability at the training academy.

ISSUE 2 2021 | CSG CAPITOL IDEAS

The 14-week program is comprised of courses covering criminal law; courts, crimes and procedures; basic patrol operations; domestic violence; report writing; drug enforcement; and basic collision investigation. Extending the program to 14 weeks, equivalent to one semester, allows recruits to access tuition assistance and scholarships while also earning credits toward an associate’s or bachelor’s degree. The program is expected to begin in the fall of 2021.

This is the first time law enforcement training has been conducted on a large scale at South Carolina’s technical colleges. Some hope the program eventually will be extended to cover additional topics for recruits, including cultural awareness and de-escalation training.

For more on CSG South, visit slcatlanta.org. 404.633.1866

The Florida Legislature is working on a bipartisan bill that would allocate up to $100 million annually on projects to address flooding and sea-level rise for coastal communities, as well as create a grant program for local governments to cover the cost of community resilience planning. The bill, backed by House Speaker Chris Sprowls, also establishes a three-year statewide flooding and sea-level resiliency plan that would be overseen by the Department of Environment Protection. The legislation calls for spending $25 million next fiscal year on the program, with the amount jumping to $100 million a year starting in the 2022-2023 fiscal year.

State Agency Diversity A new plan in Virginia requires every state agency to promote equity, diversity and inclusion to better reflect the state’s diverse population. Under the new plan, known as ONE Virginia, each agency will be asked to recruit and retain a diverse workforce; create and sustain a culture that affirms and respects diversity and inclusion; educate workers on diversity and inclusion; create infrastructure within the agency to track progress on equity goals; and ensure that agencies’ work benefits all of Virginia’s communities. State agencies will be required to submit an annual report to the governor highlighting progress made under the new plan.

Historic Education Budget The Alabama Senate passed a $7.6 billion education budget for 2022, the largest in the state’s history. The proposed budget, more than $450 million higher than the current year’s spending plan, includes a 2% cost of living pay increase for K-12 and community college employees; $95 million for a “Teacher Stabilization Program” to help K-12 systems keep teachers next year; and increased pay for middle and high school math and science teachers who meet certain qualifications. In all, the budget includes about $5.3 billion

for K-12 and nearly $2 billion for higher education. The bill must be signed by the House before it heads to the governor’s desk.

Improving Education Workforce The Tennessee Department of Education announced that more than 2,000 educators have been connected to jobs through the TN Teacher Jobs Connection Portal, a newly launched program that began in May 2020. The portal, which is open to licensed teachers, recent graduates and out-of-state job seekers, includes a form through which candidates can specify preferred grade levels, subjects and prior experience. According to the department, the portal has connected prospective educators from more than 40 states and seven countries with school districts looking for applicants. It has been particularly helpful during the pandemic due to the challenges of traditional recruitment, according to the department.

Increased Tax Credits for Foster Parents A bill increasing tax credits for foster parents in Georgia to incentivize more adoptions passed unanimously through both chambers of the General Assembly, advancing one of Governor Brian Kemp’s legislative priorities this year. The bill boosts annual tax credits for new foster parents from $2,000 to $6,000 annually for the first five years after adoption. The credit ends after five years and when a foster child turns 18 years old. According to the Division of Family and Children Services, the state has more than 11,000 children in foster care, down from about 15,000 in 2018.

AK / AZ / CA / CO / HI / ID / MT / NM / NV / OR / UT / WA / WY / AB / AS / BC / CNMI / GU

Industrial Hemp

Second Amendment

Colorado — in a joint effort between Gov. Jared Polis, Colorado State University, the Colorado Department of Agriculture, the Colorado Department of Public Health and Environment, the Colorado Division of Regulatory Agencies and the Colorado Office of Economic Development and International Trade — released the Colorado Hemp Advancement Management Plan report, which will serve as a tool to standardize hemp production across the country and to advance and manage this new leading industry. From this blueprint, state and local agencies in partnership with higher education and industry will be able to promote research and development in seed genetics and cultivation, develop and advocate for increased industrial processing and uses and increase access to financial insurance resources, among other benefits.

Wyoming passed House Bill 236/House Enrolled Act 87 in early April, prohibiting financial institutions and payment processors in the state from discriminating against firearms businesses that support or are “engaged in the lawful commerce of firearms, firearm accessories or ammunition products.” This followed Gov. Mark Gordon’s signing to other pieces of firearms-related legislation in April ensuring that during emergencies, the government cannot impose improper restrictions on Wyoming citizens’ lawful access to firearms. Additional legislation extended permit-less carry in Wyoming.

Depression Treatment Options Oregon, as required under Ballot Measure 109, assembled the Oregon Psilocybin Advisory Board made up of top doctors and researchers from Oregon Health and Science University, fungi experts from Oregon State University, therapists, health experts and community-oriented licensed clinical social workers. This board will be charged with following the best available science and data to create Oregon’s regulatory framework for the supervised, therapeutic use of psilocybin products, which have shown promising results in treatment methods for people suffering from anxiety, depression and PTSD.

Clean Water

New Mexico formally enacted adultuse cannabis legalization in April. Gov. Michelle Lujan Grisham signed the historic measure following a special legislative session. New Mexico estimates the sales of adult-use recreational cannabis could amount to $318 million in the first year, creating over several years what could be more than 11,000 new jobs. Preliminary estimates are that the excise tax will raise at least $20 million for the general fund in the first full fiscal year, with significant growth in subsequent years. Local governments will also benefit from the added revenue.

Ahead of peak fire season, California Gov. Gavin Newsom signed a $536 million wildfire package enabling the state to take urgent action on projects that support wildfire suppression, improve forest health and build resilience in communities to help protect residents and property from catastrophic wildfires in diverse landscapes across the state. SB85 builds on the governor’s funding for wildfire resilience that was proposed in his 2021-22 state budget. It funds projects to restore the ecological health of forests and watersheds, fuel breaks around vulnerable communities, statewide fire prevention grants targeting projects to advance community hardening and improvements to defensible space to mitigate wildfire damage. The state is investigating sustainable approaches to thinning its vulnerable landscapes, half of which will be funded under the early action legislation. One of these approaches is to develop a comprehensive framework to expand the wood products market in California to create economic opportunities for the use of forest materials that store carbon, reduce emissions and contribute to sustainable local economies.  In March, California authorized $80.74 million in emergency funds for 1,399 additional firefighters with CAL FIRE to bolster fuels management and wildfire response efforts. In early April, Newsom announced that he is expanding and refocusing the Forest Management Task Force to deliver on key commitments in the Wildfire and Forest Resilience Action Plan issued in January, including the $1 billion in investments. The Wildfire and Forest Resilience Task Force of federal, local and tribal leaders builds on the state’s collaborative effort to improve the health of forests and reduce wildfire risk to communities. For more on CSG West, visit csgwest.org. 916.553.4423 • csgw@csg.org

ISSUE 2 2021 | CSG CAPITOL IDEAS

Idaho Gov. Brad Little signed Senate Bill 1121 into law in late March, the fourth “Building Idaho’s Future” bills that aim to make strategic investments in critical state priorities. This latest legislation directs $50 million to projects that promote clean, plentiful supplies of water for generations to come. Little plans to use Idaho’s record budget surplus to make strategic investments in transportation, education, broadband, water, capital construction and other critical areas.

Recreational Adult-Use Cannabis

California Passes Landmark Wildfire Package

Chariots of Fire

And Other Essential Service Vehicles CSG would like to extend its sincerest thanks to all the essential workers who have kept our ambulances running, mail delivered and utilities working during the COVID-19 pandemic. In honor of these personnel, we leave you with a few fun facts about the vehicles our everyday heroes use to keep the trains on the tracks.

NATIONAL SCHOOL BUS GLOSSY YELLOW

The f irst POLICE PATROL CAR was an electric wagon that protected the streets of Akron, Ohio, in 1899. It reached speeds of 16 mph.

is the official color of all school buses in North America and has been since 1939.

Most semi-tractor trailer vehicles have

10 FORWARD GEARS AND TWO REVERSE GEARS, BUCKET TRUCKS,

ISSUE 2 2021 | CSG CAPITOL IDEAS

used by utility, forestry and construction crews, are often known as “cherry-pickers” because the first models in the 1900s were used to pick fruit.

In 1947, Schaefer Air Service began the first FAA-CERTIFIED AIR AMBULANCE service in the United States.

but some vehicles can have UP TO 18 DIFFERENT GEARS.

The TALLEST FIRE TRUCK ladder in North America reaches 137 FEET high and reaches 13 STORIES.

THE U.S. POSTAL SERVICE boasts one of the largest civilian fleets in the world with OVER 288,000 VEHICLES.

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Capitol Ideas | Issue 2 | 2021 | The Pandemic: One Year Later

Articles inside

Focusing on Mental Health

Strength in Numbers

Working Together

Reliable Responders

Restoring Trust in