Wyoming Joins the Direct Primary Care Party

Over the last couple years I’ve talked a lot about direct primary care (DPC), a doctor practice model that largely cuts insurance out of the patient care equation. By assigning clear prices to care rather than “coverage” and guaranteeing access to patients, DPC doctors offer a market-based reform to our health care system that benefits doctors and patients alike.

The good news is that such arrangements are arguably promoted under the Affordable Care Act; the bad news is that many states could try to regulate these practices as insurance providers when they’re clearly not. Missouri fixed that problem last year by protecting DPC medical retainer arrangements from such insurance regulation, and it appears it won’t be the last state implementing these reforms, either. Enter Wyoming, last month:

Wyoming Gov. Matt Mead (R) has signed into law Senate File 49, which will exempt direct primary care practices from state insurance code regulations….

Dr. Hal Scherz, founder of Docs4PatientCare, says Wyoming’s protection of direct primary care providers will help bring relief to a health care system that has grown unreasonably expensive for patients and physicians.

“We’ve got a huge problem here that’s brewing in our health care system, and what direct primary care does is a win-win for all—patients, doctors, the system itself,” said Scherz. 

Dr. Scherz is exactly right. Direct primary care offers patients and doctors the opportunity to establish stable care relationships without the burdens of insurance and with the transparency of clear pricing. Taken together, less insurance paperwork and more doctor competition means better prices for patients and the opportunity for American consumers to finally see the cost curve for health care bent downward.

Nationally, sixteen states have passed retainer agreement reforms like those passed in Missouri and Wyoming, so the movement still has a long way to go to clear the way for more robust DPC availability. That said, it’s a great start, and one that doctors, patients, and free marketeers can be excited about.

Our Lady of Hope, Indeed

For the first time in 80 years, the Diocese of Kansas City-St. Joseph is opening a new Catholic school in urban Kansas City. According to the Star, around 200 students will enroll next school year and the school hopes to eventually increase enrollment to 625.  It will be known as Our Lady of Hope.

The school will occupy the building at 201 E. Armour, which was formerly used by the Derrick Thomas Academy Charter School. It will also house students from Our Lady of the Angels and Our Lady of Guadalupe, both of which are closing at the end of this year as part of a strategic restructuring.

I am incredibly excited to see the Diocese making strategic efforts to provide quality education to inner-city Kansas City students. But if I allow one shred of pessimism to enter my mind, I’m reminded of all of the great city Catholic schools that have closed over the years.  I’m confronted with the reality that the fight for school choice gets harder and harder as good private school options disappear. Voucher programs across the country have relied, at least at their beginning, on filling empty seats in existing schools. Only after they get that foothold have they been able to spur the creation of new schools.

The story of Our Lady of Hope should give us a greater sense of urgency. If there are no schools for students to attend, it won’t matter if the state passes a voucher program. School choice programs, and the tens of thousands of students they would benefit, need our fervent support now.

From a Kansas City Charter School to the Ivy League

For the first time in its history, University Academy (UA), a charter school in Kansas City, had a student accepted into an Ivy League school. The student’s name is Jazmyne Smith, and she will be attending the University of Pennsylvania.

As exciting and heartwarming as that is, the story of who helped her makes it even better. As KCUR reports, University Academy’s guidance counselor, Josh Burdette, had never helped a student get into an Ivy League school before. When he realized he had a student who had a good chance of being accepted, he reached out to David Burke. David is the guidance counselor at Pembroke Hill, one of the city’s most elite private schools, and he jumped at the chance to help. He guided Josh through the process of creating a compelling school profile to give to universities and even set up meetings with contacts at Ivy League schools and other prestigious colleges around the country.  University Academy has already reaped the benefits.

Schools have different ways of doing things, and that’s fine. The relationship that Pembroke Hill and UA have created shows that schools of all shapes and sizes can work together to help students.

What can we learn from all this? Cooperation and shared goals can help our students succeed. Because of Jazmyne’s hard work, Josh’s willingness to look outside his own school for help, and David’s willingness to lend his expertise, doors are being opened to UA students that seemed closed not long ago. The school is looking toward bigger and better things for their students—we won’t be surprised to see more UA graduates accepted into Ivy League schools in the future.

How Much Do Saint Louis Area Schools Really Spend?

If you’ve been listening to Saint Louis Public Radio’s coverage of school finance in the region, you might have some serious questions about how we fund our schools. I’m going to go ahead and answer two of them: No, the Saint Louis Public School District does not spend only $9,826 per pupil; and no, there is not a “$15,000 gap in spending between the highest and lowest spending districts in the Saint Louis area.”

According to data from the Department of Elementary and Secondary Education (DESE), the Saint Louis Public School District spent $14,779 per pupil in 2015 in operating expenses and $18,476 per pupil when you include the cost of debt and capital projects. The table below (which uses DESE numbers) gathers the spending figures for all of the districts in the region. It shows that in real dollars the gap between the highest and lowest spending districts in the Saint Louis area was less than $9,000.

So how did Saint Louis Public Radio get such different numbers? It’s difficult to say. They state that their

analysis uses a cost of living index to calculate to calculate a national per student spending of almost $12,000 in 2013. The analysis applies that same formula to measure what individual districts are spending in relative dollars.

While adjustments like these could be helpful, especially if they have to account for differences in cost of living, it is important to realize just that—these figures are adjusted.

Unfortunately, this isn’t clear to the average reader. For example, St. Louis Public Radio states:

There are some obvious high points, the Clayton School District is [sic] spent $19,681 per student, according the analysis. That’s compared to Clayton’s neighbor, St. Louis Public Schools, which spent $9,826 per student.

The publication could have easily tacked on, “in cost-adjusted dollars” to the end of the last sentence. More importantly, they also could have explained how they adjusted the spending numbers, figures that vary so wildly from those reported by DESE deserves some serious scrutiny. As it is, readers and listeners have no way of evaluating for themselves the methods that were used to adjust the spending numbers.

We can and should have productive dialogue about school spending and inequities in education. But we can’t have fruitful conversations without a mutual understanding of the statistics that are being used.

#Dropthesuit, Explained

If you follow the key players in the Saint Louis Charter School community on social media, you’ve probably seen the hashtag #dropthesuit recently. It refers to a recent action by the Saint Louis Public Schools, who are suing to get $42 million they believe was given erroneously to charter schools as part of the city’s desegregation plan.  Depending on the outcome, this case could financially cripple the city’s charter schools and jeopardize the education of the more than 10,000 students who attend them.

It is vitally important that our community know the facts of the case, because there’s more here than meets the eye.

Beginning at the beginning

Courts first heard the issue of school segregation in St. Louis in 1972. That year, Minnie Liddell, a parent in the Saint Louis Public Schools, and a group of 4 other parents filed a complaint in U.S. District Court arguing that the policies of the school district and the State of Missouri were promoting segregation in Saint Louis. The case was complicated and difficult, because segregation in the region involved much more than just school policy. Housing policy, history, and the free choices of individuals all contributed to the problem.

In 1983, after several iterations of the original lawsuit (you can see the whole timeline here), and under the gun of a court-mandated consolidation of the city and county school districts, the St. Louis Public Schools entered into a voluntary transfer program with the 23 districts in St. Louis County. At the same time, investments were made to create magnet schools, offer kindergarten, and make other improvements within St. Louis. The hope was that the magnets would bring white students in from the county, and black students who attended overwhelmingly black schools would be free to go to schools in the county.

While the program satisfied the demands of the courts, the crux of the plan was its cost.  Because the courts found the state at fault for the segregated conditions of schools, the state initially had to pay the lion’s share of the program. By the mid to late-1990s, the state argued that it had done what was asked of it and should therefore be released from its obligation to pay for the desegregation efforts.  The compromise that resulted is central to today’s lawsuit.

In 1999, voters in St. Louis City agreed to a dedicated two-thirds-cent sales tax to fund the desegregation program. The voluntary transfer program became a standalone entity, financed by this new tax, and still exists today. According to its website, this year about 4,500 students will transfer out of the city and into the county and 140 students will transfer from the county into city schools (charter and district). The rest of the money went to provide quality options within the city, both to attract white students and to provide minority students who remained as good an education as possible.

Starting in 2006, when charter schools became their own local education agencies, a portion of those funds started being sent to them directly (previously, the money had to funnel through the district). And therein lies the rub. The district thinks that only it should receive the money. The state says charters, which operate within the boundaries of the district as open-enrollment public schools, should get it as well. As the Post-Dispatch reports, the St. Louis Public Schools want the $42 million charters have received returned to them, and want the $8.8 million that is supposed to go to charter schools this school year to be remitted to the school district as well.

Should charter schools receive desegregation funds?

The purpose of the various desegregation lawsuits in St. Louis is clear. First, they were intended to provide an opportunity for black students to get out of the segregated schools in St. Louis City. Second, they wanted to promote schools that would attract white students from the suburbs to help integrate the schools. Finally, they worked to create quality school options for all students, regardless of race, in St. Louis.

With respect to interdistrict transfers, charters have little bearing on the first goal of these lawsuits. Most charter schools participate in the Voluntary Interdistrict Choice Corporation (VICC), but because such a small number of county students want to go into the city, they play a small role in it. Charter schools do not adversely affect the students who want to leave.

Charter Schools do affect the second goal. As my colleague James Shuls pointed out last week, charter schools attract white students to the school district. In fact, they have been singularly responsible for increasing white enrollment, helping integrate the schools.

Charter schools affect the third goal as well, by providing quality education options for students within St. Louis. According to the Department of Elementary and Secondary Education, City Garden Montessori, Northside Community School, and the St. Louis Language Immersion schools all earned at least 90% of the possible points in the state’s Annual Performance Rating. That places them in the top echelon of schools in the state and well exceeds the citywide average 76.1%. The three St. Louis Language Immersion Schools provide instruction in French, Spanish, and Chinese. These are the very types of diverse, quality options the desegregation money was levied to provide.

Now, I imagine there are numerous legal technicalities buried in the various motions related to this case, but the plain Jane, average-citizen understanding of the issues couldn’t be clearer. Charter schools help the city’s desegregation efforts. If those dollars are being levied to aid in desegregation, charter schools should have access to them.

What’s up with the timing? Didn’t charter folks just come out for the District’s property tax increase?

Why, yes. Yes they did. And that is what makes this very interesting.

If there is some kind of violation here, it has been happening since 2006. According to the Post-Dispatch article, concerns were first raised in 2008. Why is the lawsuit being filed now?

Well, on April 5 (a Tuesday) the district won its first property tax levy in 25 years. Charter school supporters backed the increase, as they are slated to get about a third of the money that it raises (because charters educate about a third of St. Louis’ public school students). The following Monday, April 11, the District filed the lawsuit. Was it just happenstance that the lawsuit wasn’t filed until after the property tax levy vote?

What will the impact of this lawsuit be?

This is the $42 million question. On one level, the increased revenue from the property tax vote is slated to provide about the same amount of money to charter schools on an annual basis that they would lose should they lose the lawsuit. If they lose, the best case scenario for charter schools would be for the state to pay the $42 million.  While the district would be able to have its cake and eat it too (with both a property tax increase and a huge windfall of desegregation money) the charter schools would be in about the same financial position as they are today.  That position is tenuous, however, as charter schools are funded at a level significantly below that of traditional public schools.

There is also a second, much more troubling scenario. Under the wording of the lawsuit, the plaintiffs are asking the state for the money that was allegedly improperly paid to charter schools. According to the Missouri Charter Public School Alliance, though, the State of Missouri could require schools to pay back the money the state gave them. I am not one for hyperbole, but this could very well end charter schooling in St. Louis. None of the schools has the money to pay back 10 years’ worth of desegregation payments.

Either way, losing this funding stream would harm charter schools and limit the kinds of programming they would be able to offer to students in Saint Louis.

Summing it all up

This lawsuit would hurt charter schools in Saint Louis, many of which are getting great results and providing a high-quality education for city children of all races. The average citizen may see the Saint Louis Public Schools attempting to claim money they believe they are entitled to, but to a more cynical observer this might look like an attempt to stifle competition at the expense of students. Providing a quality education in Saint Louis is the expressed purpose of the two-thirds-cent sales tax, and so long as charter schools are playing their part, they should have the city’s support. This suit is misguided, and my only hope is that when it is heard, the judge dismisses it on the spot.

House Passes Medicaid Audit Bill

Before it died amidst last year's Right to Work filibuster in the Senate, a bill requiring an independent audit of Medicaid's rolls appeared well on its way to passage. The legislation would have required that a third-party vendor be used to cross-reference residency, income, and other data about the state's Medicaid enrollees to ensure that those in program were, in fact, qualified for it. The concern here is that as the cost of Medicaid skyrockets in the state, other state spending priorities will be pushed aside. 

High among those jeopardized priorities: state benefits for some of Medicaid's very neediest beneficiaries. This video from the Foundation for Government Accountability provides an example from cash-strapped Illinois.

The good news is that this year both the House and Senate have passed legislation to implement these regular audits. Barring any legislative hiccups in the final mile, this could be good news for taxpayers, currently qualified Medicaid beneficiaries, and other state priorities. Stay tuned.

Leaving a Trillion Dollars on the Table

In recent years, Missouri’s economic growth has been anemic. While nationwide states have averaged 2.0% growth in GDP since 2009, Missouri has only averaged 0.7%.  Many forces affect economic growth, but a fascinating new article by Eric Hanushek, Jens Ruhose, and Ludger Woessmann shows just how large of a role education plays in the equation. What’s more, it shows the potential economic gains from improving Missouri’s education system.

Missouri currently sits near the middle of state rankings of educational achievement. According to Hanushek and colleagues, if Missouri improved its level of educational achievement to that of Minnesota, the top performing state, it would generate $1.065 trillion dollars in state GDP over the average life of a child born today. Yes, you read that right: Trillion with a “t.”

A key paragraph:

“The results of this exercise again suggest the importance of knowledge capital for state economic prosperity. We find that differences in achievement and attainment account for 20 to 35 percent of the current variation in per-capita GDP among states, with average years of schooling and achievement levels making roughly even contributions. In a sense, this estimate is surprisingly large, because both labor and capital are free to move across states—and thus tend to equalize rewards to workers with different skills. But our results are quite consistent with those obtained from similar analyses of the role of student-achievement levels in explaining differences in economic performance across countries (see “Education and Economic Growth,” research, Spring 2008).”

Missouri has serious fiscal crises looming on the horizon. Our pension systems are underfunded.  Our age-dependency ratio (the ratio of those who pay into our social services to those who receive them) is slated to grow from 61% in 2010 to 77% by 2030. If we don’t grow our economy, we are going to be forced to make some difficult and unpleasant financial choices. 

Improving our education system offers a way out. Rather than raising taxes or taking part in economic development shell games, we can actually help people become more productive and create more real, lasting wealth. And, if the authors of this article are right, our education system can be the engine of that economic growth.

If you’re interested in how we can improve Missouri’s schools, check out the education section of our 20 for 2020 document.

Support Us

The work of the Show-Me Institute would not be possible without the generous support of people who are inspired by the vision of liberty and free enterprise. We hope you will join our efforts and become a Show-Me Institute sponsor.

Donate
Man on Horse Charging