Judge Strikes Down Medicaid Expansion

Last week, Cole County Circuit Judge Jon Beetem struck down Medicaid expansion, ruling that the initiative approved by voters last August violated Missouri’s constitution.

Beetem’s decision was in response to a lawsuit from the initiative’s supporters, which was filed after Missouri’s legislature decided against appropriating funding for Medicaid expansion. Governor Parson then halted all state implementation efforts.

As I explained last month, Missouri’s constitution gives the state legislature the responsibility of appropriating all state spending. It also provides that amendments cannot impose new costs without providing a mechanism to pay for them. Yesterday’s ruling holds that the expansion initiative failed to include a funding mechanism, and that growing the state’s Medicaid program by an estimated 275,000 enrollees will cost the state money. (The decision mentions that expansion would cost $1.8 million per year which is almost surely a typo; it should be $1.8 billion, as projections from Missouri’s Medicaid agency show.)

Prior to last August’s election, a different lawsuit challenged the constitutionality of the expansion petition on the same legal grounds. As Beetem’s decision explains, the courts at the time decided against removing the initiative from the ballot in part because the fiscal estimates showed a wide range of potential outcomes, from enormous savings to extraordinary costs. If the amendment did end up saving the state money, it wouldn’t need a funding mechanism. As I wrote repeatedly last year, the promise of savings was always illusory Once the true cost of expansion was presented to the legislature, legislators refused to appropriate funding citing their sole constitutional authority on the issue.

The plaintiffs certainly disagree with the circuit court’s ruling and have already filed their appeal. While it may be weeks or months until this issue is ultimately resolved, Judge Beetem’s decision is an important one with implications beyond this particular fight. If a petition to amend our state’s constitution violates the constitutionally defined rules for amending the constitution, it should not stand. It’s really that simple. Time will tell if the Missouri Supreme Court agrees as well.

A Rising Tide of Mediocrity

If Spanish philosopher George Santayana is correct that those who cannot remember history are doomed to repeat it, then he may be disappointed in Missouri high school students. In 2017, the latest year for which data are available, only half of Missouri students scored Proficient or higher on the state’s American history exam. That’s not great, but on top of that, the quality of the exam is questionable.

A recent analysis by the Fordham Institute of state civics and U.S. history standards granted Missouri C’s in both. Once again, Missouri holds firm to its spot in the middle of the pack. Overly broad language and incoherent organization are two of the reasons cited for our mediocrity. The recommendations for improving the standards include:

  • Reorganizing the American government course so that it is chronological rather than in “strands” or themes
  • Including specific examples, such as Supreme Court cases or acts of Congress, wherever possible
  • Providing deeper and more specific guidance for teachers

Making sure that our students leave school with a solid grasp of the history of this nation and what it means to be a citizen are two of the more important roles of our public education system. Missouri needs solid and coherent standards, along with assessments that are well aligned to those standards. We need a better framework for schools and districts to graduate students ready to join civil society as knowledgeable citizens.

Medicaid Expansion Ruling, Special Session and the Cost of Tax Subsides

This week, David Stokes, Patrick Ishmael, Susan Pendergrass and Elias Tsapelas join Zach Lawhorn to discuss the recent ruling on Medicaid expansion, the kickoff of a special session with high stakes and what tax giveaways can really cost a city like St. Louis.

Listen on Apple Podcasts 

Listen on Sticher 

Listen on SoundCloud 

Overland Park Considers Adding Tolled Lanes to Expand Highway

Drivers on U.S. Highway 69 in Overland Park near Kansas City are about to see some market-based transportation policy in action, and Missouri policymakers should take note.

A proposal approved by the Overland Park City Council and the Kansas Department of Transportation to add two tolled lanes to U.S. Highway 69—one in each direction—will go before the Kansas Turnpike Authority for final approval. Local officials cited increased traffic from an expanding population, which is only expected to continue growing, as the need for such an expansion. Rather than paying for the project directly out of the city’s budget, officials want to use tolling to pay for the construction.

The lanes would be tolled electronically, with drivers either being billed from a K-Tag transponder or by having their license plate scanned. The prices to use these lanes will vary, with prices highest when road usage—the “demand” for roads—is highest. The original four lanes on the highway will continue to be toll-free, so drivers concerned about the cost won’t have to pay for a lane they don’t end up using.

Missouri policymakers also should consider using tolling to finance new highway lanes, particularly in areas where traffic is expected to increase beyond what the current system can handle. Congestion pricing, as this policy is also called, reduces travel times and can also help reduce local air pollution as fewer vehicles are idling on the road.

I hope the benefits of Overland Park’s tolled lanes won’t go unnoticed in Missouri. There are a lot of reasons why tolling is a policy that deserves to be explored in the Show-Me State as well.

First Results of Our Request for Critical Race Theory Curricula

Earlier this week, we began a new transparency project focused on whether schools in Missouri are teaching critical race theory (CRT) concepts in the classroom. Similar to the Show-Me Checkbook and Show-Me CBA projects, the Show-Me Curricula Project seeks to find out from Missouri schools what Missouri tax dollars are buying Missouri parents.

Most schools that have replied so far have told us that they do not have documents that are responsive to our request, meaning they claim they have not incorporated CRT into their curricula and have not talked publicly about it. I trust those representations are true. Readers can follow what we’re receiving from schools and districts, as we receive them, by clicking here. We appreciate the promptness of the responses of districts that have already gotten back to us.

Notably, the Hazelwood School District sent four documents responsive to our request for CRT-related materials: three curricula and one public statement. Some of the CRT materials are incorporated by reference; there are instructions in the curricula to review and discuss content in a linked website but the content is not necessarily fully articulated in the curricula. Some examples of what I found:

Content from the New York Times1619 Project dealing with early European explorers is prescribed for fourth-graders, and ninth-graders are told that the 1776 Commission, established by former President Donald Trump, was an exercise in “identity politics”—a charge it did not also level against the 1619 Project.

The curricula for fourth-graders and eighth-graders also direct teachers, by a link, to materials provided free of charge by the Southern Poverty Law Center (SPLC) and marketed variously as “Teaching Tolerance” and “Learning for Justice.” Readers will find substantial CRT content at this SPLC website.

To be sure, it is difficult to know the full extent to which CRT concepts will be taught in Hazelwood schools; curricula doesn’t always translate directly to the classroom. But it is fair to believe that these materials represent the baseline of the school’s CRT instruction.

Our Sunshine Law request also returned a Hazelwood School Board public statement. Per the statement, the district is engaged in ongoing, unspecified racist practices—a remarkable admission, given taxpayers are being forced to subsidize the district through their taxes. In a long list of action items, Hazelwood’s school board says it will:

[e]mpower the superintendent and charge her with boldly addressing and correcting institutionalized racist practices that have survived because of a “wall of silence and denial,” against our students and in our schools much like that in police departments. The Board will hold itself and all staff, accountable for the same. [Emphasis mine]

I did not know about Hazelwood’s “institutionalized racist practices,” and therefore I did not request documents relating to it. It may be the subject of a follow-up Sunshine Law request.

I encourage the public and parents especially to read for themselves the materials that are being provided, and to do their own due diligence with their own schools as classes return later this year. Transparency is a fundamental part of good governance. Likewise, transparency is the bare minimum that districts and schools should be offering taxpayers when it comes to problematic curricula.

Time Running Out to Protect Telemedicine

One of the few bright spots from the past year was the removal of various barriers that were needlessly restricting access to telemedicine services. Unfortunately for Missouri, unless there’s action before August 31, those barriers will be going back up.

At the outset of the pandemic there were serious concerns that an influx of patients would overwhelm our state’s hospitals and clinics, and expanding telemedicine usage offered a timely solution. Allowing patients to access their health care providers remotely helped relieve the strain on an area’s hospitals while also allowing those at risk of being exposed to the virus to receive care from the comfort of their own homes. That’s why back in March of 2020, after Governor Parson declared a state of emergency to help the state respond to COVID-19, he then waived various regulations that were making it harder for Missourians to receive care via telemedicine. (See more here about the specific regulations that were waived.)

But as our communities turn the corner on the pandemic, it’s likely Missouri’s state of emergency declaration will be allowed to expire on August 31. And with its expiration, the various regulations that were waived to fight the pandemic will return, which includes those that restrict access to telemedicine. My colleagues and I have been writing for the past year about the importance of making these and other regulatory waivers permanent, and while there was some optimism toward the end of the legislative session, none of the bills including those provisions made it across the finish line.

It’s important that our elected officials remember what was learned during the pandemic. So much has changed over the past year, including the dramatic rise in telemedicine usage, and there’s no reason to return to the old status quo when we now know that things can be better. Too many Missourians still struggle to access the health care they need when they need it; why would Missouri bring back old barriers that only make receiving care more difficult?

Going into next year, improving health care access for Missourians should be a priority for our elected officials. The easiest way to move forward is the policy of making permanent the regulation waivers that have been so helpful over the past year.

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