Although not expressly written as part of the U.S. Constitution, from the earliest days of the republic, strong presidents have issued proclamations, instructions, and statements that eventually evolved into executive orders (EOs) carrying the weight of the federal government on new directives meant to change policy. George Washington issued his first presidential edicts to have his Cabinet report on departmental activities.
Initially, EOs were operationally task oriented, but they later became more substantive and often politically jarring. As they’ve evolved through different White Houses and some famous U.S. Supreme Court cases, EOs now influence four areas:
- Deliver direct orders or interpretations of law.
- Give guidance for future regulatory action.
- Structure governmental institutions or processes.
- Make a political statement.
The first few presidents used EOs sparingly: Washington made eight in eight years, Lincoln 12 in six years. But by the early 1900s, others took more liberty: Woodrow Wilson had 1,803 in eight years and Franklin Delano Roosevelt (FDR) 3,721 in 12 years. Since Ronald Reagan, the average has been about 50 annually. Throughout U.S. history, a total of 14,013 presidential EOs have been issued (as of February 2021).
EOs That Changed History
A few notable EOs have stood out, including:
Lincoln’s emancipation proclamation (number 95) declared “that all persons held as slaves” within the rebellious states “are, and henceforward, shall be free.”
FDR invoked many during the Great Depression, establishing the Civil Works Administration (number 6423B) that created four million new government jobs.
Harry Truman desegregated the military (number 9981) with his order that “there shall be equality of treatment and opportunity for all persons in the armed services without regard to race, color, religion or national origin.”
New Administrations Make Policy Changes
President Joe Biden issued a large number of EOs in the first 100 days of office since his January 2021 inauguration. Most were campaign promises, reversals of former administration policies, and directives on implementing COVID-19 relief efforts, and several affected health care, providers, and patients:
Letter to His Excellency António Guterres, World Health Organization (WHO) Director: Rejoining WHO reestablishes the United States’ crucial role in the worldwide war on cancer, the COVID-19 pandemic, and other threats to global health and health security. It positions the country as a full participant and leader in confronting health threats and advancing health and health security.
Executive Order on Strengthening Medicaid and the Affordable Care Act (ACA): Protecting and advancing Medicaid and the ACA improves the accessibility and affordability of high-quality health care for every American.
Memorandum on Restoring Trust in Government Through Scientific Integrity and Evidence-Based Policymaking: A task force is developing a framework for regularly assessing and improving scientific-integrity policies and practices at government agencies, ensuring that they adhere to the principles of scientific integrity.
Executive Order on a Sustainable Public Health Supply Chain: By creating a system to review the availability of critical healthcare materials, treatments, and supplies for COVID-19, including personal protective equipment and the resources to effectively produce and distribute tests and vaccines at scale, the United States can assess whether industry is prepared to meet demand increases.
Executive Order on Establishing the COVID-19 Pandemic Testing Board and Ensuring a Sustainable Public Health Workforce for COVID-19 and Other Biological Threats: Establishing a public health workforce program will address pandemic response efforts, including challenges in recruiting and training sufficient personnel to ensure adequate and equitable community-based and high-risk testing and vaccination. It also supports other urgent public health workforce needs connected to ONS priorities, such as increasing health worker training and combating opioid misuse.
Executive Order on Improving and Expanding Access to Care and Treatments for COVID-19: Developing a plan to fund large-scale randomized trials, identify optimal clinical management strategies, and support the most promising treatments for COVID-19 improves the United States’ preparation for future high-consequence public health threats, both domestically and internationally.
Politics and policy are often intrinsically intertwined and diametrically opposed. EOs have the full authority of the federal government behind them; only the U.S. Congress can override the laws with a two-thirds majority vote, but that rarely happens. If a divided Congress won’t act, then a decisive president often does. Power abhors a vacuum.
Public health professionals—including nurses—are working to better understand how to implement awareness campaigns and healthcare procedures to address both COVID-19 and other health concerns—like cancer—both now and in the future. Through ONS advocacy, trusted nurses bring those issues to elected officials, policy leaders, and decision makers.
The role of the nurse in health care has never been more important. Learn how you can join ONS advocacy efforts and lend your voice to the cause.