This mixed-methods comparative public policy study examined the restrictiveness of the stay-at-home executive orders issued by U.S governors and the effect those restrictions had on COVID-19 health outcomes. The author extracted 2,789 restrictive phrases from 121 executive orders issued by 46 states to develop a novel Restrictive Measure Index (RMI). The RMI, along with other predictive factors, were compared to COVID-19 case and death rates. The study findings indicate that while COVID-19 policy restrictiveness varied among states, the level of restrictiveness did not appear to have a significant influence on COVID-19 case and death rates. Since COVID-19 responses differed across the U.S., this research also included a case study of two divergent states, California and Florida, to examine the practical application of the concepts outlined in the study. Key findings of the case study indicate that California had a statistically significant lower COVID-19 death rate and a lower case rate than Florida. Public health experts typically lead the response during health emergencies, yet many governors took a more active role during the COVID-19 pandemic by issuing numerous health related executive orders, which created challenges for local public health administrators. These administrators faced intense pressure and had to continuously adapt to a rapidly changing environment. The findings of this study contribute to understanding crisis management policies in the U.S. federalist system during public health emergencies and enrich discourse on intergovernmental relations in pandemic response. Future research into the role of public health experts and effective collaboration models during COVID-19 could benefit responses to future health crises.