Overall, the responses we’ve received so far in 2022 look generally like what we saw in 2021. Most schools either have not responded to our request for information or have denied teaching CRT. Some schools have opted to try and charge the Institute hundreds of thousands of dollars to get access to school curriculum, and many more wanted to charge smaller fees. What has been rare, however, is schools openly providing documents that include CRT-type material. Last year, the most prominent example of this was the Kansas City Public School District.

But another notable example from last year was the Hazelwood School District. Hazelwood was one district that provided CRT-related materials when the Institute sent requests last year, and at that time its curriculum included excerpts of the 1619 project being taught to fourth graders and materials provided by the Southern Poverty Law Center about “Teaching for Tolerance.” When Hazelwood responded to this year’s request, the district sent basically the same documents it did last year, though this time without any fourth-grade curriculum, indicating that content was removed from the curricula.

Our director of government accountability, Patrick Ishmael, has been critical of CRT concepts. But it’s important to remember that regardless of the content of the instruction, the public has a right to see it and districts have an obligation to provide it.

Hazelwood should be commended for its honesty and forthrightness in response to our inquiries, both last year and this year. Through two iterations of the project, it is the only district that to date has twice released the pertinent curriculum without any fees, delays, or complaints.

The point here is that if school districts are going to spend taxpayer money to educate students regarding a subject, including CRT, they should make the information available to parents. Ideally, all districts would be transparent with curriculum and would post it on their website or send it to parents before the start of a school year. After all, sunlight is the best disinfectant, and if government transparency can improve curricula, our schools and our kids will be better off for it.

The post At Least Hazelwood’s Honest appeared first on Show-Me Institute.

But as it turned out, some of the smallest cities I worked with were the most responsive and welcoming of our checkbook inquiries. The Village of Huntsdale, Missouri, is an example. Located 20 minutes west of Columbia, Huntsdale has a population of only 25 people. All of its government officials are unpaid and work part time in addition to their full-time jobs. Considering these factors, one might expect that the city would just ignore our request, as many small towns have. However, that wasn’t the case.

Ana Lopez, a Huntsdale city official, replied to us within a week of our request. She acknowledged that the village has very few expenses due to its size, and only has a single monthly bill (totaling a little less than $800) for landscaping work. She provided us with a digital copy of this bill, showing the exact cost, who the amount was paid to, and the date. Of the over 600 requests that the Show-Me Institute sent, Huntsdale is the smallest city to respond thus far. As it turns out, being a smaller city may mean fewer resources for officials to marshal, but it also means fewer stones to turn over when asked about its operations.

This isn’t to say that Huntsdale’s response would be the exact format for what we would want a submission to the state to look like someday, when a statewide mandatory checkbook reform comes to pass. We have talked before about the importance of reporting spending in a standardized format, and that format when submitted to the state would probably look (to enter the weeds briefly) like an Accounts Payable report or some equivalent. In that scenario, the state would need more than a lonely bill from Huntsdale for it to be in compliance. Of course, that isn’t the circumstance today.

Moreover and as with every city, receipt of a city’s documents is not itself a confirmation of their contents. Our presumption in our Sunshine Law requests is that the responses we receive will be in good faith. Lacking an independent basis to affirm the truth of a document we receive; however, we can only observe how well respondents adhere to the transparency process and the nature of the documents we got. The state, empowered by a mandatory checkbook reporting system, will be far better positioned to confirm the truth of local spending documents, and we will leave those determinations to when that time comes—as we always have. With that in mind, Huntsdale’s response was nonetheless sufficient for our purposes now.

It has now been over three weeks since we sent requests for spending information out, including many to middle-sized and large municipalities. But if Huntsdale, a town of 25 with zero paid officials, can respond promptly, so can larger cities with one or more full-time staff. Government transparency requires officials to use their power in a responsible manner, with an eye toward stewardship, and that’s something that can happen in small towns and sprawling cities alike.

Municipal transparency doesn’t really depend on city size at all.It depends on city culture. Fortunately, it seems Huntsdale’s culture of transparency is a good one.

The post Small but Mighty Huntsdale, Population 25 appeared first on Show-Me Institute.

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The post Election Results, Health Care Prices, and Spending Your Taxes appeared first on Show-Me Institute.

To boost hospital compliance, Missouri’s policymakers should consider reforms that would work in conjunction with existing federal rules. As Show-Me Institute researchers recommended in last year’s blueprint, establishing state level requirements for health care price transparency (including non-hospital providers) to publish charges for hundreds of shoppable services in a way that most Missourians can understand would represent a significant step forward.

Additionally, no price transparency requirement is effective if the providers charging those prices won’t comply and there is no effective enforcement mechanism. Under current federal rules, hospitals that fail to disclose prices in a comprehensible way can be fined from $300 to $5,500 a day. It doesn’t appear, however, that fines are being imposed. Missouri policymakers may need to consider noncompliance penalties with teeth for providers if they continue withholding pricing information from patients.

Policymakers should also consider ways to make it easier for patients to access and use these prices. States including Florida, and nine others, have taken the issue into their own hands and created online tools that help patients shop for various procedures. Something similar could be done in Missouri.

While greater transparency in health care will not single-handedly fix all the health care problems in Missouri, the hope is that it will take some of the uncertainty and confusion out of the process. Patients deserve clarity, not mystery, when making decisions related to their health. And until patients can be informed consumers of the care they purchase, we can’t expect to keep the cost of medical services under control.

The post Health Care Price Transparency in Missouri: Part Three appeared first on Show-Me Institute.

I decided to try the same thing out at the flagship hospital for four of St. Louis’s major hospital systems. I found that the price without insurance for a knee replacement was $26,122 at Barnes Jewish and $18,766 at St. Luke’s. Using that search term in the pricing websites for both Mercy St. Louis and SSM Saint Louis University turned up no matches. I then decided to broaden my search to every hospital in Missouri.

I used the rules outlined by the Centers for Medicare and Medicaid Services (CMS) to evaluate how “transparent” each hospital’s pricing was. The rules state that each hospital needs to have a consumer-friendly way to shop for common services, as well as a comprehensive list of all services and charges in a digital file. I found that of Missouri’s 164 hospitals, only 47 fulfilled both requirements. That is a compliance rate of just 29%, which, considering the federal rule is a year and a half old, is pretty terrible.

Many of the 47 “compliant” hospitals, such as Mercy, had some sort of online form to estimate prices but, in my opinion, did not make the system all that easy or intuitive to use. Many of these sites would not accept a general term for a procedure, like “knee replacement”, but instead required a technical procedure name or hospital code. Requiring the average patient to have such specific information is not “user friendly.” Likewise, the digital files many hospitals provided are difficult to read unless you have extensive computer software and coding knowledge. The digital file Mercy provided was one of these difficult file types. After spending approximately 45 minutes using code to read Mercy’s file, I found that it was still missing key information CMS requires about negotiated rates between the hospital and insurers.

The bottom line is that Missouri hospitals, by and large, are not following the plain intent of the rules, which makes it difficult for patients to know how much their care will cost and to effectively compare prices. If you would like to try to research the prices of procedures for yourself, I have included an Excel file at the bottom of this post that has URLs for every hospital’s pricing information.

The post Health Care Price Transparency in Missouri: Part Two appeared first on Show-Me Institute.

That’s right. Last week, the Show-Me institute began an updated municipal checkbook project, which entailed obtaining the spending records of every city in Missouri. Every city that had available contact information was sent a request under Missouri’s Sunshine Law. Many cities had data already organized and were happy to share, all of which is available here. Some cities, especially those without already-digitized records, requested a fee before they would gather their data. This is allowed under law, but fees are supposed to reflect only the cost of labor and copying involved, and usually did not amount to more than $100. Arbyrd’s fee was a little more than that. According to the response I received from the Arbyrd City Clerk, our request would “require a significant amount of time and resources to complete and therefore we charge $40 per page with a minimum of 500 pages. This amounts to $20,000.”

Twenty thousand dollars! With no details explaining how a single page of paper could cost $40, Arbyd was prepared to charge us tens of thousands of dollars for information about where the city is spending taxpayer money. This clearly goes against both the letter and the spirit of the sunshine law and was met with a swift reply from Institute staff.

Unsurprisingly, days after our reply explaining that what they were doing violated the Sunshine law and that we would be contacting the Attorney General’s office, Arbyrd backed down. The mayor sent a revised offer, promising a digital copy of their spending information at no charge (we received their information on July 19). As it turns out, Arbyrd’s spending data was available in digital form, but for whatever reason their response to our initial request was to decline to provide it.

The bottom line is that all citizens, not just the most dedicated or persistent, should be able to see how their tax dollars are being spent. Cities should strive to make this information easy to access, without the need to resort to state law. Taxpayers should not have to fight for a $20,000 discount to have transparency in government.

The post The $20,000 Discount: Municipal Checkbook Hall of Shame appeared first on Show-Me Institute.

Health care price transparency was added to the Show-Me Institute’s 2022 blueprint because of its potential to dramatically improve the lives of Missourians. Price transparency arms the health care consumer with greater knowledge about what exactly procedures will cost, what prices insurers negotiate with hospitals, and how the cost of a procedure differs from hospital to hospital. This information should be easily accessible so that someone could do accurate research before ever scheduling a hospital visit.

The main benefit of price transparency is that more information is available to patients, insurers, and employers to aid in decision making. Insurers can use the information to better negotiate prices with hospitals, while patients and employers can use the information to make more informed decisions when purchasing health plans. A price tag attached to a procedure makes it much easier to weigh the costs and benefits of a service, so you know exactly what you are putting in your healthcare shopping cart.

In Missouri, the strictest price transparency rules come at the federal level. Under the guidelines of a Trump administration 2019 executive order, hospitals are required to publish a list of standard charges for 300 common procedures in a user-friendly, shoppable display. In addition, hospitals must publish a complete list of charges in a machine-readable format. “Machine readable” simply means the information can be downloaded off the hospital website into a file format that your computer could understand—like a Microsoft Excel file, as one example. The files need to include the gross charge, a discounted cash price, any payer-specific negotiated charges, and both the highest and lowest negotiated charge for any given service.

While price transparency reforms such as this one are potentially very beneficial for patients all across the nation, there are problems with compliance. The Wall Street Journal reported that, as of last December, many of the nation’s largest hospital systems were not complying with the 2019 rule, without any penalty from the Centers for Medicare and Medicaid Services. In the next post, I take a deep dive into Missouri hospitals and their compliance (or lack thereof) with price transparency rules.

The post Health Care Price Transparency in Missouri: Part One appeared first on Show-Me Institute.

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The post Tax Rebate Veto, KC Bus Issues, And The Osage Beach Outlet Mall appeared first on Show-Me Institute.

The proposed route received some tweaks earlier this month, and now is set to run from Natural Bridge Road at Grand Boulevard in north city down Jefferson Avenue past the National Geospatial-Intelligence Agency (NGA) headquarters and the site of the new MLS stadium. This new plan has an estimated price tag of between $600 and $800 million and would be financed primarily through federal funds. However, like the ill-advised KC Streetcar expansion, expanding MetroLink would be a waste.

The first and most obvious problem with the proposal is ridership. The project is touting the ability to connect impoverished areas of North Saint Louis with centers of commerce in places such as downtown and the Central West End. However, project leaders have yet to put out research supporting this claim. Considering that fewer and fewer people are commuting downtown for work, there are reasons to be skeptical of this assertion.

As a longtime Saint Louis sports fan, I understand that MetroLink can be a convenient way to get downtown and avoid the stress and costs of parking. However, building an additional stop and line to service the new MLS stadium is completely unnecessary, considering its proximity to Union Station­­­–it is only 0.2 miles away, or a five-minute walk. Instead of changing lines to access the dedicated stadium stop, soccer fans taking the train downtown would be better off exiting at Union Station and making the short walk over.

As with the KC Streetcar expansion I wrote about in a recent blog post, spending hundreds of millions of dollars on a questionable MetroLink expansion comes at the expense of bus systems.  Saint Louis Metro has been forced to cut lines amid staffing shortages, an issue which is predicted to persist into next year. Metro Bus is the primary means of transportation for roughly 22,000 St. Louis commuters, compared to only 4,000 commuters who primarily use MetroLink.

If St. Louis wishes to use federal money to improve public transit, it should improve the bus system and invest in more efficient types of public transportation, like Bus Rapid Transit (BRT). Unfortunately, policymakers’ tendency to chase shiny objects will likely leave Saint Louis with a defunct trolley, an oversized light rail system, and thousands of unhappy bus riders.

The post Even with an Updated Route, MetroLink Expansion is a Waste appeared first on Show-Me Institute.

Meanwhile, the KC Streetcar Authority has broken ground on a 351 million-dollar expansion, financed by $171 million in federal funds, with the rest coming from a new transportation development district (TDD). This special taxing district will levy a 1% sales tax on areas around Main Street, generating millions in revenue to maintain the streetcar’s “free” admission status.

As Show-Me Institute analysts have argued in the past, the KC Streetcar has failed to generate economic growth and raise property values and does not improve Kansas City’s transit system as a whole. Throwing hundreds of millions of dollars at expanding the streetcar not only continues to grow a poor transit system but also neglects the more valuable bus system. Between 2016 and 2020, buses were the primary form of transportation for about 8,500 commuters in the Kansas City metro area. In contrast, there were only about 250 commuters in the entire metro area who got to work using the streetcar. In addition, the KCATA has an annual operating budget of $57.6 million, which is only about a fifth of what is being spent to expand the streetcar.

Kansas City’s MAX bus system is supposed to be a form of Bus Rapid Transit (BRT), but with buses only coming every half hour on two of the three MAX routes, it fails in this respect. These routes need more frequent service, which means more buses and more drivers. Instead of continuing to pour money into an overpriced, ineffective streetcar system, Kansas City should consider diverting funds to its buses, which could be improved at only a fraction of the cost of current streetcar spending.

Politicians like grandiose plans, shiny new objects, ribbon-cutting ceremonies, and spending exorbitant amounts of other people’s money. What their constituents need is a bus system that runs effectively so that they can schedule their day properly. Politicians seek the former at the expense of the latter, and it ends up hurting the very people they most often claim to be helping.

The post As Kansas City’s Streetcar Expands, Its Buses Suffer appeared first on Show-Me Institute.