Falling Behind on Telemedicine

Posted on by Elias Tsapelas

Not long ago, Missouri was a national leader in telemedicine. Governor Parson was among the first to waive unnecessary restrictions on telemedicine as part of the state’s response to COVID-19, and those waivers played a key role in allowing the service to flourish. But the waivers have since expired, and our elected officials have yet to take the action necessary to ensure continued easy access to telemedicine. Missouri is falling behind, as numerous states and even the federal government are recognizing the important role telemedicine should play in health care going forward.

As I’ve written repeatedly, the growth in telemedicine services was one of the few silver linings of the pandemic, and all it took was the government getting out of the way. Prior to 2020, most forms of health coverage, including Medicare and Medicaid, covered telemedicine services only in some circumstances. Various laws and regulations restricted where telemedicine services could be accessed and who could provide them, which drastically limited their benefits. But once the COVID-19 public health emergencies were declared, many of these restrictions were waived, and millions of people nationally tried remote health care for the very first time.

At the end of 2022, as Missouri turned the corner on the pandemic, Governor Parson allowed the telemedicine waivers to expire. Though telemedicine usage was lower at that time than it was during its 2020 peak, it was still far more popular than it was before the pandemic. There is no doubt that some medical services could be better in person, and there are some potential risks for fraud and abuse with remotely offered services. But after multiple years of telemedicine proving its place as a reliable health care option, bringing back old barriers that were shown to drastically limit health care access should have been out of the question.

All things considered, I was optimistic last year that Missouri’s legislature would at least make the waivers permanent, if only because that would maintain a level of access to health care that Missourians had grown accustomed to. But, as with many other priorities this past legislative session, telemedicine reform failed to make it across the finish line.

As this year’s legislative session gets underway, our elected officials have a fresh opportunity to make things right on telemedicine. Giving Missourians the increased options and access they had in the very recent past seems like a perfect place to start.

What Does Missouri’s Teacher Shortage Really Look Like

Posted on by James V. Shuls

A version of this commentary was published in the Columbia Daily Tribune.

Over the past few years, Missourians have gotten a better understanding of the term “shortage.” Whether it was soup or toilet paper, we can all remember those empty shelves at the grocery store at the beginning of the COVID-19 pandemic. Maybe that’s why the term “teacher shortage” has many policymakers on edge these days. There’s just one problem: in education, the term “shortage” doesn’t mean what you think it means.

Take the “shortage” of elementary school teachers in Missouri for example. In 2021, the Springfield School District wanted to hire 55 elementary school teachers. They received 2,155 applications from individuals with the appropriate certification. Yet, for one reason or another, they left six positions vacant. This is a teacher shortage.

The problem is the misleading way in which the Missouri Department of Elementary and Secondary Education presents the data. In the “Teacher Shortage Report for Missouri,” released in December 2022, DESE defines shortage areas as “those content areas within the state for which positions were filled with inappropriately certified teachers(s) or left vacant due to the absence of certified candidates.”

This is possibly the broadest definition of what it means to have a shortage. If a school district hires a private school teacher with 10 years of experience and a bachelor’s degree in elementary education? Shortage. They hire an individual with an MBA to teach high school business, but he does not have certification? Shortage. Let’s say they hire someone with a high school mathematics certification to teach elementary or middle school mathematics. Shortage. Keep in mind, the state has dozens of teacher certification areas, and being certified in one does not qualify you to teach another. With this broad definition, DESE suggests Missouri was short 532 elementary school teachers (Grades 1–6) in 2022, making this the highest shortage area.

Let’s put that into perspective using raw, unweighted data provided by request from DESE. In 2022, there were 2,015 job openings for elementary school teaching positions. Districts received over 21,000 applications, more than 18,000 of which had the appropriate certification. Of course, teachers may apply for more than one job.  In all, 32 elementary positions were left vacant. Thirteen of those vacancies were in the Riverview Gardens School District alone.

There is a teacher shortage—it’s just not as widespread as most believe. In total, across all certification areas, Missouri had 258 positions left vacant in 2022. These vacancies were spread across 74 of the state’s 550+ school districts, but nearly half of all vacancies were in just five school districts: Hickman Mills (17), Kansas City (17), St. Louis Special School District (19), Hazelwood (27), and Riverview Gardens (47).

Aside from the Special School District, which is a unique district that serves special-needs students in St. Louis County, the other four districts have a lot in common. They tend to serve students who come from low-income families who are black. For example, more than 97 percent of Riverview Gardens students are black.

The shortage narrative has been used to push for an increase to the starting teacher salary in Missouri. According to data obtained from the Missouri State Teachers Association, the average starting salary in these four districts is $40,075. That is well above the current state minimum of $25,000 and even above the proposed minimum of $38,000 that is currently before the Missouri legislature. Estimates suggest this increase would cost the state $21 million.

Such an increase could actually exacerbate the problems facing high-poverty, majority-minority school districts. If all the districts that currently pay less are forced to offer higher wages, Riverview Gardens, Hickman Mills, and other districts that struggle with teacher recruitment will lose the competitive advantage of higher salaries. Imagine: the state could spend $21 million and fail to even address the real shortage problem in Missouri’s most disadvantaged school districts.

Missouri’s teacher shortage is not equally felt throughout the state; it is most pronounced in high-poverty, majority-minority school districts. Accordingly, strategies to address the shortage should provide targeted support for the affected districts. This could include salary supplements for teachers in hard-to-staff schools, or it could mean intense marketing, recruitment, and human-resource support for these schools. An across-the-board increase in minimum teacher salary is not what Missouri needs, and it could very well do more harm than good.

Teacher Pay, Child Care Costs, and Unemployment Insurance

Posted on by Aaron Hedlund

James Shuls, Aaron Hedlund and David Stokes join Zach Lawhorn to discuss teacher pay in Missouri, the case for and against reforming child care policies, and a new report on modernizing the state’s unemployment insurance system.

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Produced by Show-Me Opportunity

Release: Show-Me Institute Names Two New Directors

Posted on by Zach Lawhorn

Show-Me Institute Names Two New Directors

Dr. James V. Shuls will serve as Director of Research and a Senior Fellow and Elias Tsapelas as Director of State Budget and Fiscal Policy

 St. Louis, MO – Dr. James V. Shuls has been named the new director of research and senior fellow and Elias Tsapelas the director of state budget and fiscal policy at the Show-Me Institute. Previously, Dr. Shuls held the title of distinguished fellow of education policy at the Institute and Tsapelas was a senior analyst.

“I am honored to serve the Institute in this new role,” Shuls said. “While the opportunity to focus on policy areas beyond education is new to me, the goal remains the same—to provide high-quality research that helps promote free markets and individual liberty for all Missourians.”

“Research is at the center of everything we do at the institute,” Show-Me Institute CEO Brenda Talent said. “James and Elias bring knowledge and experience to their respective roles that will be invaluable as we continue to address the challenges facing our state.”

James V. Shuls is an assistant professor of educational leadership and policy studies at the University of Missouri–St. Louis. He earned his Ph.D. in education policy from the University of Arkansas. He holds a bachelor’s degree from Missouri Southern State University and a master’s degree from Missouri State University, both in elementary education. Prior to pursuing his doctorate, James taught first grade and fifth grade in southwest Missouri.

Elias Tsapelas earned his master of arts degree in economics from the University of Missouri in 2016. Before joining the Institute he worked for the State of Missouri’s Department of Economic Development and Office of Administration, Division of Budget & Planning.

Dr. Susan Pendergrass, who previously served as director of research, has returned to the role of director of education policy in order to focus on education research.

Tsapelas is the institute’s first director of state budget and fiscal policy.

Media Contact: Zach Lawhorn

[email protected]

End in Sight for Runaway Enrollment?

Posted on by Elias Tsapelas

Late last year, Congress approved a bill that will have major implications for Missouri in 2023. After nearly three years of being barred from removing ineligible Medicaid enrollees from the program, Missouri will be allowed to resume eligibility checks starting April 1st.

Though this change may not seem like a big deal, the prohibition on checking whether participants are eligible to continue receiving services has been the primary driver of unsustainable Medicaid growth in Missouri since 2020. When the pandemic began, and the federal government started doling out relief funds, Missouri’s enrollment was well below 900,000. But as a result of the federal government conditioning relief funding for Medicaid on states no longer removing enrollees that were found to be ineligible, Missouri’s rolls have since grown by more than 575,000. Today, there are more than 1.4 million Missourians enrolled in the program; more than 720,000 are children.

Initially, the prohibition on disenrollment was supposed to continue until the federal public health emergency for COVID-19 expired. It was not necessarily surprising that once enrollment checks were stopped that program enrollment would skyrocket. Welfare programs typically experience a lot of what is called “enrollment churn,” as participant circumstances move people in and out of eligibility. What was surprising to many (myself included) was the continued extensions of the federal public health emergency.

Missouri’s emergency declaration for COVID-19 response ended more than a year ago. While it’s certainly true that COVID-19 remains present in our society, it’s also true that emergencies aren’t meant to last forever. Policymakers seem to understand this, as there was bipartisan congressional support for allowing states to resume eligibility checks, regardless of the status of the federal public health emergency.

The coming year will likely be a consequential one for Missouri’s government, as billions in federal covid relief funds that have been propping up the state’s budget begin to dry up. There is perhaps no issue with bigger financial implications than reinstating eligibility checks for Missouri’s Medicaid program. As long as the state’s Medicaid agency is equipped to quickly and accurately process the long-awaited enrollment checks without issue, the program should begin to right-size quickly. And if the agency isn’t prepared, Missouri’s elected officials should be prepared to step in and provide the necessary support, because there are far too many state tax dollars on the line.

Medicaid, Electric Cars, and Short-Term Rentals

Posted on by David Stokes

David Stokes, Elias Tsapelas, and Avery Frank join Zach Lawhorn to discuss the future of MIssouri’s Medicaid rolls, who should pay for mandated electric car charging stations, should anyone be able to turn their property into a short-term rental, and more.

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Produced by Show-Me Opportunity

Short-term Rentals, Long-term Questions

Posted on by David Stokes

Turning primary or secondary homes into assets by renting them out via AirBNB or VRBO has become very popular. It also often conflicts with local zoning regulations banning or limiting such practices. When a similar debate—technological changes versus old laws—emerged with Uber and Lyft a decade ago, I unambiguously took the side of Uber and Lyft because the existing regulations were rank protectionism for the taxi companies. The short-term rental question is trickier.

The debate over municipal limits on renting out your own property is happening all over Missouri, but most immediately in Lake Ozark and the City of St. Louis. In Lake Ozark, which currently bans short-term rentals in much of the city, the city council is voting Tuesday night on amending the zoning laws and allowing short-term rentals in certain parts of the city. I am opposed to municipalities having a comprehensive ban on short-term rentals. In a tourism-driven area like the Lake, it makes even less sense to have an outright ban.

The arguments for allowing short-term rentals are that: (a) you have right to rent out your own property if you wish to (b) allowing more rental options is good for the tourism industry and local economy; and (c) complaints about the rentals are often overblown, and police or regulators can handle such problems as they arise.

I agree with all of that—but even if you believe with all your heart that zoning violates property rights, the courts have decided that zoning is legal. So, if zoning regulations where you live say you can’t rent out your property, you may need a better argument. Point (b) is hard to dispute, and while point (c) is also true in my opinion, I understand why homeowners next door to the property that is the exception—with lots of parties, noise, crime, etc.—may want their city to take more proactive action.

The legitimate arguments against allowing short-term rentals are also straightforward. Too many of them do involve large parties and general mayhem. More importantly, one has to have sympathy for the property rights of the people who bought a home or condo under existing zoning laws that limited or prohibited such rentals, and are now seeing people trying to change (or governments ignoring) those laws. I support allowing short-term rentals, but I won’t be cavalier about the property investments people made with the understanding such things are not allowed.

It’s a tough issue. I think short-term rentals should be allowed in a tourist area like Lake Ozark (and the entire Lake region), but I understand that limits and rules may be necessary. In more residential locations, tighter limits may be appropriate. However you look at it, this issue isn’t going away in Missouri anytime soon.

I’ll be writing more soon on the role homeowners associations can play in this issue and how short-term rentals should be taxed.

Breaking: The Actual Starting Teacher Salary According to DESE

Posted on by James V. Shuls

The St. Louis Post-Dispatch, and other major media outlets in Missouri, continually claim that Missouri teachers are, on average, the lowest-paid in America. That claim is false. As the data clearly show in the National Education Association’s report, which the Post-Dispatch cites for its claim, Missouri ranks 50th. That’s 50 out of 51 because Washington, D.C. is included. Montana ranks lower than Missouri.

You may ask, “So what? Isn’t this just splitting hairs?”

Undoubtedly, being second to last is hardly better than being dead last. But this correction is not simply about making Missouri teacher salaries look marginally better. It is about calling for clarity when it comes to this important policy discussion.

Right now, the Missouri Legislature is debating measures that could cost taxpayers hundreds of millions of dollars to increase teacher pay. To date, no lawmaker has been provided accurate information regarding Missouri teacher pay. That’s the problem.

Take, for example, this NEA report in which Missouri ranks 50th. The figures from this report are being described as the average starting “teacher” salary. But the numbers are actually the average starting “district” salary.

“So what?”

But this distinction matters! Each year, Missouri hires thousands of new teachers. An actual calculation of the average starting teacher salary would use the data from each of these teachers. A district that pays well and hires a bunch of teachers would pull the average up.

The NEA report calculates the average starting salary of Missouri’s more than 500 districts. It counts small, low-paying school districts the same as it counts large, higher-paying school districts.

If the Middle Grove School District, which according to the Missouri State Teachers Association is the only district to start teachers at the state minimum of $25,000 and has just 35 students, were to hire one teacher, and the Parkway School District, with more than 17,000 students, were to hire 20 teachers at the starting salary of $44,250, the NEA report would count each district once and say the average starting salary was just $34,625. In reality, the average of those 21 new teachers would be $43,333. This is a difference of more than $8,700.

If you haven’t noticed, Missouri has a lot of school districts Our state has more than 550 school districts, which ranks 11th in terms of total number of districts. Meanwhile, Missouri is 21st in the number of students. Florida, which has about two million more students, has just 75 school districts. All of these figures come directly from NEA reports. Taken together, these facts mean the NEA calculation of district averages leads to lower averages and lower rankings for Missouri teacher pay.

The NEA reports Missouri’s starting salary as $33,234. But what is Missouri’s actual average starting teacher salary?

According to data I have obtained from DESE, the average regular term salary for a first-year teacher in Missouri was $38,367.33 in 2022. This figure was provided directly by DESE after my request. The increase of more than $5,000 would move Missouri up to 37th on the NEA report.

While we’re at it, I’d like to note some other relevant data. Missouri ranks 43rd in average salaries for instructional staff. Meanwhile, Missouri ranks 48th in student-to-teacher ratio, with 11.3 students per teacher. In comparison, Illinois’s ratio is 14.3 to 1, ranking the state 28th. In 2021, revenues for Missouri’s public schools were $15,809 per student, which is 31st overall nationwide. These data suggest that part of the reason Missouri’s teacher salaries are relatively low is due to staffing choices made by school districts themselves.

Missourians deserve an honest discussion about Missouri’s teacher salaries. For that, we must have all the facts.

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