American Royal Crosses the Line

Posted on by Michael Austin

Once again, the economic border war between Kansas and Missouri has heated up. This time, the American Royal, a Kansas City Institution, will be moving from the West Bottoms in Kansas City, Missouri, to Wyandotte County, Kansas. In an op-ed appearing in today’s Wichita Eagle, I argue that the financing behind this move is questionable. Here’s an excerpt:

Kansas’ $80 million contribution to the project is about double what American Royal was publicly trying to get out of Kansas City, Mo., officials just two years ago to keep the Royal in the city’s West Bottoms.

But did Kansas even have to “build it” with taxpayer money to entice the American Royal to move?

Read more at: http://www.kansas.com/opinion/opn-columns-blogs/article112668553.html#storylink=cpy

Is Expanding Pre-K a Good Idea? The Jury Is Still Out.

Posted on by Emily Stahly

Missouri can learn a lot from the successes and failures of other states—and this applies to Amendment 3, too. Before voters weigh whether or not to approve a massive expansion to pre-K funding on November 8, they might want to examine the research done on state-funded pre-K programs in states like New York, Oklahoma, Tennessee, and Georgia.

Or, better yet, they may consider how little research there is on the matter. According to a recent article by Haley Glatter in the Atlantic, there are very few studies that thoroughly examine state-run and state-funded pre-K programs. Moreover, these studies are inconclusive on whether or not pre-K offers lasting benefits.

In Georgia and Oklahoma—states with universal pre-K programs—there is evidence that pre-K has reduced achievement gaps. The jury is still out in New York, which established universal pre-K only two years ago. Tennessee, on the other hand, implemented targeted pre-K for low-income children. Positive results were evident when these children entered kindergarten, but the benefits began to fade by first grade. By third grade, these students were performing worse than other students on statewide assessments.

Here are a few things we can take away from these states’ experiences:

  • The quality of the pre-K programs offered matters immensely—not all pre-K is created equal.
  • Good pre-K programs will not make up for the deficits of a failing K-12 system.
  • There are only a handful of programs operating at a state-wide scale which makes it difficult to draw firm conclusions on pre-K.                                                                                                 

One of the lingering questions about Amendment 3 is what exactly the pre-K program it creates will look like. In his recent analysis of Amendment 3, the Show-Me Institute’s Michael McShane writes:

To date, it simply isn’t clear what the regulations for participating schools will be. In one sense, this uncertainty means we should probably reserve judgment, but in another it makes it hard to support a program when we don’t know what that program will ultimately look like.

On the one hand, it makes sense for us to gather as much information as we can about the effectiveness of pre-K programs before Missouri designs a program of its own. But then, does it also make sense to wait until we have a well-researched plan in place before amending the constitution and investing such a significant amount in early childhood education?

Diversity of Viewpoints? Not at Mizzou

Posted on by Michael Q. McShane

Last week, Heterodox Academy released a ranking of the top 150 universities in America in terms of commitment to viewpoint diversity. Mizzou finished tied for dead last.

Heterodox Academy is a collection of university professors committed to supporting intellectual diversity and free speech on campus. Its ringleader is Jonathan Haidt, a social psychologist and professor at New York University. Haidt’s work focuses primarily on business ethics, but increasingly he has become known for his efforts to promote civil debate and ideological diversity in the academy.

Heterodox Academy’s ranking relies on four main metrics. First, it grades schools on whether they have endorsed the University of Chicago’s principles on free expression. Second, it adds the Foundation for Individual Rights in Education’s rating of the school’s speech code. Third, it uses the Intercollegiate Studies Institute’s rating of openness to conservative and libertarian students from its guide Choosing the Right College. Finally, it notes any relevant events related to free speech on campus since 2014.

The top five schools in the ranking are the University of Chicago, Purdue, Carnegie Mellon, William and Mary, and George Mason.

The bottom five are the University of Oregon, Mizzou, Rutgers, Northwestern, and (ironically, given Haidt’s employment there) NYU.

Mizzou was dinged for not adopting the University of Chicago’s speech code, for being rated red (the lowest possible distinction) by FIRE, and red (the lowest possible distinction from ISI). It also lost points for University of Missouri police asking individuals who witness incidents of hateful and/or hurtful speech to call the campus police station (or 911), banning student protests, the censorship of students, and for efforts to limit press access on campus.

Debate on college campuses is healthy. As Haidt and his colleagues have demonstrated, ideological diversity leads to more interesting and useful research and helps guard against errors driven by groupthink. Mizzou's spot at the bottom of this list is an embarrassment. The university should take the criticism seriously and work to make campus a more welcoming place to people of different viewpoints.

And Now Anthem Floats Possibility of Leaving the Exchanges

Posted on by Patrick Ishmael

In the last few months Americans found out that several insurers, including major players Aetna and United, would largely exit the Obamacare exchanges in the coming year. In most Missouri counties, that leaves only one insurer providing any kind of exchange coverage at all. As I pointed out in Forbes, Missouri has been more or less divvied up among Blue Cross Blue Shield insurers, with effective exchange monopolies for both in many regions of the state.

Well, it's not even 2017 yet, and one of the BCBS companies is giving Missouri health insurance customers something to dread in 2018.

Another insurance giant has signaled that it could exit state Obamacare exchanges if health plans don't become more profitable in the coming year.
 
Anthem Inc. executives said during an earnings call Wednesday that they will evaluate the company's performance in marketplaces across the U.S., including in Indiana, where it offers insurance under the Affordable Care Act. If conditions don't improve, executives said, Anthem could pull out of some or all states where the company offers insurance.
 
As I've noted, while there are technically four insurers in Missouri's exchange, the vast majority of counties have only one insurer. The insurance provider in most of those one-insurer counties: Anthem. 
 
First tab shows where there's only one insurer; second tab shows where Anthem does business.

In other words, Missouri insurance customers are already at risk today… and may be at even greater risk in the very near future, especially if Anthem exits as it's contemplating.

There are ways to make health care in this country more affordable and accessible, but unfortunately, Obamacare isn't that solution. It's time to try something different.

ER Visits Spike With Obamacare’s Medicaid Expansion

Posted on by Patrick Ishmael

I’ve written at length about the negative effects of expanding a broken Medicaid program under Obamacare. Poor health outcomes and limited care access rank high among the reasons to be wary of throwing more money at the program, but consider also this broken promise of the law: that by expanding the program, supposedly wasteful emergency room visits would fall, because more people would be “covered” by a government health plan. But fresh research from the New England Journal of Medicine shows that those ER claims have not been justified: rather than decrease unnecessary ER visits, Medicaid expansion actually appears to increase them.

The new study resulted from the Oregon Medicaid experiment, in which Oregon expanded Medicaid to a limited number of lower-income, non-disabled adults using a lottery. The expansion’s design, which involved random assignment, allowed researchers to draw more reliable conclusions about the impact of Medicaid eligibility than observational studies.

. . . Of crucial importance, the study also found that “[a]cross a variety of alternative specifications, we consistently find that Medicaid’s value to recipients is lower than the government’s costs of the program, and usually substantially below.” They estimated that the “benefit to recipients from Medicaid per dollar of government spending range from about $.2 to $.4.”

Cato director of health policy studies Michael Cannon has said that the Oregon Health Insurance Experiment (OHIE) “may be the most important study ever conducted on health insurance,” precisely because researchers were able to isolate the health effects of Medicaid coverage in ways that, under normal research circumstances, is very difficult to do. These findings, then, represent a gold standard by which claims about the Medicaid program can be fact checked in key respects, including emergency room usage.

In our direct primary care paper, published last year, we looked at emergency room usage and Medicaid as well, and we found plenty of evidence to support the OHIE research team’s findings.

Perhaps most startling is recent news from a survey of emergency room doctors, taken this year by the American College of Emergency Physicians [ACEP], suggesting that the expansion of Medicaid has actually increased—not decreased or kept flat—emergency room usage. As explained by Dr. Howard Mell of the ACEP in the Wall Street Journal, “Visits are going up despite the ACA, and in a lot of cases because of it.”

ACEP’s 2015 report was not the product of a once-off survey, either. In 2014, one-third of emergency departments reported seeing more Medicaid patients; in 2015, over half reported an increase.

With the failures of the Obamacare exchanges, it is more important than ever to ensure that Missourians are not exposed to more of the Obamacare disaster. That means continuing to reject a broken Medicaid expansion that doubles down on bad policy. Without reform, the Medicaid program will continue to imperil both the health of patients and the money of taxpayers, and unfortunately, expanding Medicaid would serve to aggravate the program’s long-standing problems.

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