Embracing Telemedicine Requires Permanent Change

Posted on by Elias Tsapelas

COVID-19 may be changing America’s health care industry forever. As hospitals and providers search for ways to safely treat patients in our new landscape, telemedicine is poised to assume a larger role.

For the past few months, Americans have been asked to stay at home, even in situations where they’d normally go to a doctor. Telemedicine was proposed as a solution to this problem—patients could access the benefits of an in-person medical visit without potentially exposing themselves to the virus. So far, consumers are responding.  Just last week, Blue Cross Blue Shield of Massachusetts reported the demand for telemedicine has skyrocketed, with a 190-fold increase in daily claims and most patients indicating a willingness to use the service again.

Now that consumers and coverage providers recognize the value of telemedicine, the government needs to get out of the way in Missouri. Prior to COVID-19, Missourians faced various barriers to receiving telemedicine services. First, it was limited to doctors already licensed in the state. And second, the doctor was required to physically see the patient in person before they could treat them using telemedicine.

In response to COVID-19, Governor Parson quickly waived those telemedicine requirements. By removing these requirements, Missourians were ensured greater access to care. This move also implicitly acknowledges the negative effects of current law. This past legislative session, Missouri’s policymakers took the strong step of granting license reciprocity to doctors from other states, but hurdles still remain for telemedicine professionals who wish to provide care in our state. Without further action, the currently waived regulations will return once the governor’s emergency declaration expires.

States across the country and health coverage providers alike are warming to telemedicine. Even though our state’s businesses are beginning to reopen, a return to normalcy may not be achieved by many for quite some time. It’s important that those who need to limit their potential exposure to the virus can maintain access to health care services. One of the best ways to do that is to embrace telemedicine and remove the current barriers permanently.

 

Kansas City Auditor to Investigate Oversight of Community Improvement Districts

Posted on by Patrick Tuohey

Kansas City’s Auditor, Doug Jones, announced recently that his office was going to look into whether the city is properly overseeing community improvement districts (CIDs). This is a good start. And while this is a process audit and not a financial audit of the CIDs themselves, any attempt to rein in these special taxing districts (SDs) and increase transparency is welcome.

SDs are political subdivisions of the state established to provide very specific services and improvements, such as sewer infrastructure, fire protection, and neighborhood security. Their narrow, singular purpose is why they are known as “special.” In Missouri, SDs can be established to impose and collect tax revenue for a wide variety of purposes. In addition to CIDs there are drainage and levee districts, sewer districts, port improvement districts, nursing home districts, and fire protection districts, to name just a few.

As the auditor notes in his announcement, there are currently 74 CIDs in Kansas City and their use “is growing, and our past audits noted CIDs did not consistently submit required reports to the city, and also identified accountability and transparency issues.”

One problem with CIDs is that they may be created and impose taxes without a vote of the people. CIDs may be formed by nonresidential voters such as commercial landowners and developers. These districts need only a single constituent to be created. As a result, a single landowner can (1) propose a district, (2) cast the single vote to establish the district and approve its revenue sources and projects, and (3) appoint or elect the district’s board of directors, which oversees district business. In short, CID laws allow a single landowner or developer to completely control all aspects of the district.

Given the huge opportunity for abuse, it is important that Kansas City ensure that this important power to tax is respected. In our 2019 paper on these districts, Graham Renz and I suggested a number of reforms for the state legislature—one recommendation requiring the approval of the voters of the entire municipality was passed out of this legislative session. Municipalities may not be able to enact many restrictions on these districts, but they are required to approve their creation in the first place. This effort in Kansas City to shed light on city oversight is welcome and necessary, even if not sufficient by itself.

 

It’s All About the Tax Credits, Baby

Posted on by Jakob Puckett

We’re often told that renewable energy will power the future. But a new study reveals that wind energy—America’s largest renewable source—is far more reliant on subsidies than advocates may care to admit.

A groundbreaking new study by the Lawrence Berkley National Laboratory found that wind power plants significantly reduced their output once their eligibility for federal subsidies expired. Wind energy is subsidized through the Production Tax Credit (PTC), which reimburses wind power plants between $15 and $24 for each megawatt hour generated over a period of ten years once the plant is operational.

The study examined pre-2008 “old” plants that have operated during and after their PTC eligibility, as well as post-2008 “new” plants that do not have post-PTC data available yet. The study found that production dropped roughly 10 percent in the years after PTC reimbursements ended, and 13 percent overall after 17 years.

PTC graph

The authors note that this coincidental timing

suggests that maintenance and operating strategies change when projects lose access to the sizable tax benefits afforded by the PTC…After the window of PTC eligibility has passed, operating profitability declines and, therefore, so does the operational rigor.

Overall, the study found

clear evidence that operators are carefully adjusting behavior based on the PTC status to maximize profitability, which provides an additional level of plausibility to the idea that operators would also change maintenance regimes based on the PTC status.

This study adds to the growing evidence that wind plants are quite reliant on subsidies. The federal Energy Information Administration forecasts that new wind plants will face a steep drop in construction after PTC eligibility expires in 2020. While the tax credits will continue for ten years for plants that are deemed eligible before PTC expires, new plants won’t be eligible after 2020.

Show-Me Institute analysts have often written about how subsidies affect markets in any industry, and energy production is no different. Markets should not be designed so that companies chase after subsidies and change their behavior to maximize handouts. Energy subsidies distort markets, alter industry behavior, and rack up large taxpayer bills.

More wind power plants are being built in Missouri to qualify for the PTC before eligibility ends in 2020. Given the perverse effects of wind power subsidies, Congress should not extend the PTC as it has several times before and Missouri should not consider a state-level replacement once PTC eligibility expires.

Tax revenue will be hard enough to come by in the coming years. It should not be given away to prop up favored private industries.

 

School Start-Date Flexibility: A Short-Term Win for Local Control

Posted on by Abigail Burrola

The Department of Elementary and Secondary Education (DESE) has provided school districts an opportunity to take back some autonomy over their school calendar. A few weeks ago, I wrote that school districts should have the flexibility to set their own start date this fall, but a 2019 bill mandates the start date be no earlier than 14 calendar days before the first Monday in September.

The good news is that school districts will have that flexibility this year. DESE recently announced that “The Missouri State Board of Education voted to grant exemptions to the school start date law that goes into effect for the 2020–2021 school year, given the unusual and extenuating circumstances COVID 19 has presented.”

This waiver is good news for districts. The start date law, however, is an unnecessary restriction aimed at supporting tourism at the cost of education. A mandated start date makes even less sense this year, given the chaos created by COVID-19.

To acquire a waiver, districts must apply to the State Board of Education. Requirements for waiver eligibility (listed under the “Calendars, Finance and Funding” tab) include showing local support for moving the start date (DESE is vague about exactly what this means), holding a public hearing on moving the start date, demonstrating how this exemption will benefit students and their learning, and explaining how this exemption will minimize the transmission of COVID-19.

If a district’s waiver is granted, districts can create a school calendar based on student needs. However, the waiver is only good for the upcoming school year. Next year and beyond districts will have to follow the start date law. The coronavirus is an extreme example of how this law can create problems for schools, but there are many other potential situations where adjusting the school calendar could be necessary.

While it’s welcome news that districts won’t be mandated to start school on a fixed date this year, the underlying problem remains. The school start date law harms kids and schools in Missouri, and lawmakers should just get rid of it.

 

Three Cheers for the Kansas City Council

Posted on by Patrick Tuohey

The Kansas City Missouri City Council adopted three new ordinances to help restaurants during the pandemic. The ordinances make it easier for restaurants to serve patrons on sidewalks and parking lots, and also renew permission for restaurants to serve mixed drinks for take-out and delivery. While these measures are temporary and require the issuance of city permits, they are a positive sign that city leaders are willing to support the businesses that support the city.

  • Ordinance 200376 refers to the temporary expansion of sidewalk cafés, parklets and street cafés.
  • Ordinance 200377 temporarily suspends parking requirements for restaurants and bars.
  • Ordinance 200378 temporarily suspends the prohibition against delivering alcoholic beverages to or by vehicles.

Kansas City, like municipalities across the country, is going to take a significant hit to the bottom line as a result of efforts to curtail the spread of COVID-19. City leaders have an opportunity to demonstrate that they are willing—even eager—partners with the men and women whose entrepreneurship drives the city economy. The regulations being waived likely caused more heartache than they were worth even in good economic times.

The permitting process should not be used to show favor to certain businesses or parts of the city—but favoritism that has marked more than a decade of city spending and regulation. If sidewalk cafes are good for downtown, they are good for midtown and the northland. Treat everyone equally. And if these policies are good temporarily, they are likely good permanently.

The city’s 10-10-10 plan was a debacle, not least of which is because it demonstrated that regulators had not talked to the businesses they were regulating. These ordinances are more promising. The council should be congratulated for setting aside rules and regulations that hamper growth and drive up costs without improving public safety, and should be encouraged to do so permanently. There is much more to do along these lines, but this is a good start. Slainte!

 

Don’t Repeat Mistakes from the 2009 Stimulus

Posted on by Jakob Puckett

Missouri has a rocky history when it comes to transparency and federal relief. A 2011 audit of how Missouri spent 2009 stimulus dollars found poor documentation of how federal funds were spent and state agencies resistant to more stringent measures of transparency.

Ignoring the debatable merits of the bill, the 2009 American Recovery and Reinvestment Act (President Obama’s stimulus package), required reporting on every project down to the subcontractor level and taxpayers were supposed to have near-real-time ability to see how funds were being spent. This act spurred many states to enact increased transparency measures. It is disappointing to learn that Missouri took a step backward at a time when much of the country was moving forward. The auditor noted, “When there’s inadequate documentation, you don’t know if there’s waste, fraud or abuse.”

Has Missouri learned from its mistakes? Some governmental bodies appear to be transparent, if not exercising fiscal restraint, with their emergency spending. The State Treasurer’s Office is publishing CARES Act state government relief fund spending down to the vendor and item purchased. St. Louis County and City both have websites publishing their emergency spending, showing when, where, and on what the money was spent. The county also publishes future committed spending. Close-fisted spending habits have led some to question their emergency priorities, but it’s the transparency portals that inform such questioning. Franklin and Jackson Counties plan to release spending details in the future. However, no other major county or city has yet published such coronavirus-specific spending.

Some state agencies have published the amount of federal money they received but did not specify how they spent or will spend it. A few identified potential categories of expenses—such as the Department of Higher Education, Department of Elementary and Secondary Education, and the Department of Transportation—but did not provide details.

Why aren’t all state agencies and political subdivisions willing to show how they are spending taxpayer funds? Shouldn’t agencies receiving relief funds, i.e., taxpayer money, want to demonstrate that the money is being put to good use? With today’s technology, they can make such data easily accessible, complete, and accurate. If a county or agency is unable to publish this information on its own, it can send the data to the state for publication.

Show-Me Institute analysts have called for government transparency since the first relief funds rolled in. While some appear to be acting transparently, not all are. Isn’t it time for the rest to catch up and show us the money?

 

A Taxing-District Win for Taxpayers

Posted on by Corianna Baier

Though this year’s legislative session was a little different than most, Missourians did get some legislative wins. A provision in House Bill 1854 is one of those wins. Amongst various other things (some good and some not so good), the bill includes important reforms for community improvement districts (CIDs) and transportation development districts (TDDs).

Show-Me Institute researchers have pointed out numerous problems with these small taxing districts. One big problem is that many of these taxing districts were not subject to a broad-based, representative vote for approval. Previously, these districts could impose a tax on purchases within the district if the tax were approved by voters within the district. However, these districts can be so small that they sometimes only contain one commercial building, which means that a tax could be approved by one commercial landowner’s vote. It’s sometimes the case that these taxing districts are enacted through private interest and increase costs for taxpayers without their permission.

The new legislation attempts to fix that problem, adopting a policy solution that Show-Me researchers have previously suggested. The bill requires that new taxes created by CIDs or TDDs be approved by the majority of the voters within the municipality that contains the taxing district, not just the voters within the taxing district.

This legislation gives voters more of a say when it comes to tax increases and could also increase transparency by bringing tax increases to the attention of the public. If the costs of projects funded by CIDs and TDDs are going to be externalized to taxpayers, it’s only fair that taxpayers get a say in the process. This law gives taxpayers more representation and could help slow the growth of special-taxing districts in Missouri—and that’s a clear win for taxpayers.

 

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