Health Care Bills On the Move from the House to the Senate

Posted on by Patrick Ishmael

We’re approaching the end of the session, and it’s worth highlighting a few health care-related bills that are winding through the Missouri General Assembly.
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  • HB 769 makes “medical retainer agreements” exempt from regulation by the state’s Department of Insurance. MRAs are direct-pay arrangements—where a patient and a doctor contract directly for care. Such contracts are not a matter of insurance, but in other states there have been pushes to regulate them under the “insurance” umbrella. HB 769 would preempt such a move.

  • HB 985 enhances Missouri’s Medicaid eligibility verification system by leveraging the resources of a third party. Over the past year MO HealthNet has been hit by a series of embarrassing reports of waste and mismanagement. Suffice it to say, money wasted is money that cannot go to the poor beneficiaries who need it most. HB 985 tries to tackle the problem of waste on the enrollment side by trying to make sure those limited dollars flow to beneficiaries who, in fact, qualify for them.

  • HB 319 expands on an existing state law dealing with MO HealthNet telemonitoring services, also known as telemedicine. Telemedicine allows medical professionals to diagnose medical problems remotely, which for people in medically underserved communities is a great technological innovation and benefit. Section 208.670.1 of current law already allows for reimbursements for telehealth “in the same way as reimbursement for in-person contacts”; HB 319 pushes MO HealthNet to further adopt and advance telemedicine practices.

Tolling Coming to I-70?

Posted on by Joseph Miller

With the prospect of a fuel tax increase looking more and more remote in the Missouri Legislature, policymakers are once again looking to the possibility of tolling I-70 as a method of staving off an impending funding crisis at the Missouri Department of Transportation (MoDOT).

Tolling would be an effective way of raising funds to rebuild the aging I-70, with only those using the new highway paying for its reconstruction and maintenance. Tolls can be set higher for vehicles that do more damage to the roads, like interstate trucks, which on many parts of I-70 make up more than a quarter of total traffic, as the chart below demonstrates:

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Furthermore, if the state would lease I-70 to a private entity, it potentially would generate billions for MoDOT. To get an idea of just how much a toll road can be worth, a 66-year lease of the Indiana Toll Road (with similar traffic levels to I-70) is in the process of being sold for $5.7 billion. If Missouri can raise even a small fraction of that amount, MoDOT could retire Amendment 3 debt and ensure sufficient matching funds for federal dollars. A bill in the Missouri Senate, SB 534, sets up the framework to make this kind of lease possible.

Using a public private partnership to rebuild I-70 is not without pitfalls. If the state does not ensure competitive bidding or make sufficiently stringent lease requirements, the project could come out poorly for highway users. Furthermore, using large upfront lease payments on I-70 to bail out the rest of the state highway system will require higher tolls so that the private company can recoup its costs. In essence, I-70 drivers would pay for both I-70 and other state roads. That being said, given many examples of successful privatization in Missouri, as well as numerous privately operated highways worldwide, Missouri can and should navigate these obstacles.

Using a public private partnership to toll I-70 would be a big step forward for Missouri, and lease payments could be used to plug short-term gaps in MoDOT funding. However, without more extensive use of tolling (not currently allowed under federal law), it would be best for the state to combine a small gas tax increase now with plans to increase use of tolling in the future.

An Idea for Better Transit in Missouri: Raise Fares

Posted on by Joseph Miller

Public transportation in Missouri’s major cities is heavily subsidized; taxpayers cover more than 80 percent of total costs in Saint Louis and Kansas City. The main culprits of these subsidies are high costs and low utilization. For example, most bus routes in Saint Louis roll around the city nearly empty. But a contributing factor to this problem is fares, which remain inexpensive in both cities.

KCATA_MAX_DowntownFor instance, in Saint Louis, fares are $2 for the bus and $2.50 for the MetroLink. In Kansas City the bus costs only $1.50, aside from a few more expensive routes. Monthly passes offer a steep discount in both cities, and reduced fares are available for the young, the elderly, the disabled, and students.

Low transit fares are generally sold with two arguments. First, and most common, is that public transportation provides transportation to those with little or no income. Higher fares would therefore be a tax on the poor. But not everyone who uses transit is poor. In Kansas City about 78 percent of transit users are above the poverty line (79 percent in Saint Louis). Moreover, wealthy transit users are more likely to use high-capital-cost rapid transit, so they end up receiving a larger subsidy than poorer riders. In Saint Louis, MetroLink ridership is greatly buoyed by well-off passengers using the rail to get to Busch Stadium or summer festivals (the Cardinals effect is noticeable). They too hardly meet the criteria of a group in need of cheap tickets.

To justify subsidizing the well off, many public transportation advocates use the second argument for low fares: high transit ridership is in the public’s interest. They claim that getting people out of their cars and on to transit is good for the environment and good for congestion, thus worth subsidizing heavily. More than a few have advocated getting rid of fares altogether.

However, low transit fares have not gotten people to ditch their cars; less than 5 percent of Saint Louis and Kansas City residents use transit to commute, and those numbers aren’t increasing much. And the low fare revenue makes it difficult for public transportation to make the investments that might make transit more attractive to more residents. That is why even some transit advocates are calling for higher fares.

Saint Louis and Kansas City could set up a system with much higher standard transit fares with lower prices for those below the poverty line. In addition, tickets to stations near sporting events could be more expensive on game days. By looking for ways to make riders pay for more of what their service actually costs, transit agencies might be able to provide better services without going to the general taxpayers for aid. That could be better for everyone, whether they use transit or not.

Getting the True Value of Farmland

Posted on by Michael Rathbone

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It’s interesting when there are two wildly different takes on the same thing. For example, take me vs. the general public on Dances With Smurfs or Michael Burry vs. the rest of Wall Street on the value (or lack thereof) of sub-prime mortgage bonds. Another instance—one that is costing all of us—is the State Tax Commission vs. everyone else on the value of farmland. This difference can affect many our tax rates.

In a recent paper (H/T David Nicklaus), David Larson of the Bureau of Economic Analysis performed a valuation on all land in each of the lower 48 states for 2009. Based on his calculations, Missouri farmland is worth $64.236 billion. Based on my calculations, using data contained in the State Tax Commission’s 2009 Annual Report, the total value of Missouri agricultural property in 2009 would come out to $13.3 billion. That’s a gap of more than $50 billion!

A reason for this big difference is that, instead of assessing all agricultural land at a flat 12 percent rate, actively farmed land receives a different assessment rate depending on its productive capacity. This practice results in an effective assessment rate of around 2-3 percent.

Such low assessments erode the property tax base. Even if the true value of farmland in Missouri was half of Larson’s estimate, if it were assessed at a flat 12 percent rate, the state would have an agricultural property tax base nearly two-and-a-half times the size of its current base. This larger tax base either could allow property tax rates in some areas to be cut or some localities could see an influx of new revenue.

I don’t want farmers’ property tax bills to skyrocket. However, the truth is their property is under assessed to such an extent that governments are forced to rely on other more destructive forms of taxation (i.e., income taxes), which the rest of us have to pay, in order to fund essential services. We should value farmers for the work they do, but we should also properly value the land they work on lest we pay more than we should.

Taxing Smokers Does Not Show Support of Education

Posted on by James V. Shuls

As first appearing in the Columbia Daily Tribune:

These days there are a lot of calls to make people pay their “fair share,” and no, we are not referring to the 1 percent. We are talking about smokers. The argument for raising the tax on cigarettes is straightforward—smoking is harmful to individuals, and though smoking is an individual decision, it impacts each of us. We all bear the brunt of additional health care costs incurred by smokers. These are what economists call negative externalities. They are, in theory, why smokers should be taxed more for their behavior—to offset their costs to society. Most proposals to raise the cigarette tax, however, seek to tax smokers to pay for unrelated programs, such as education.

For example, Erin Brower of Raise Your Hand for Kids is seeking to put a 50 cent increase on the ballot to fund early childhood programs. Missouri Treasurer Clint Zweifel has proposed an increase to fund college scholarships, an idea Missouri Attorney General Chris Koster supports. In a recent special to the Joplin Globe, Koster called for a 73 cent per pack increase. These are certainly not the first calls for increasing the tax. In the past 15 years, tobacco tax increases have appeared two times on the ballot. Each time Missouri voters have had the opportunity to tax smokers more, they have failed to do so. Why?

First, Missourians are leery of using “sin” taxes to fund other programs, especially education. This was the same tactic used to legalize gambling in Missouri. Lawmakers said the revenue from gambling would go to education. They did not tell voters, however, that the money would supplant not supplement existing funds to education. There are fears that the same would happen with proposals to raise tobacco taxes.

Second, using tobacco taxes to fund other programs simply does not make economic sense. Missouri’s lowest-in-the-nation tobacco taxes help draw in an untold number of shoppers across state lines, especially in Kansas City and along the Illinois border. These shoppers make it a point to buy their cigarettes in Missouri, thus creating sales for our local businesses and generating tax revenue for the state. Raising the tobacco tax would deter these shoppers.

Tobacco taxes also have the negative distinction of being one of the most regressive taxes. Smokers tend to be from lower-income households. At the same time, middle-income families would benefit from many of the programs created from increased tobacco taxes, such as college scholarships. Thus, if Zweifel and Koster’s proposal was implemented, low-income families would be subsidizing the college education of middle-income families. What is the “fair share” for smokers to pay for a middle-class student’s college education?

The truth of the matter is that smokers are an easy group to target. Few, except for other smokers, are sympathetic to their plight. At the same time, we all support better educational opportunities for Missouri students. Therefore, taxing smokers is a relatively easy way to raise taxes to fund educational programs.

If lawmakers are seriously concerned about the negative externalities causes by smokers, they should direct tobacco tax revenue directly back to smoking prevention programs and the Medicaid costs for smokers. That is the only logically and economically consistent use of the tax revenue.

James V. Shuls, Ph.D., is an assistant professor of educational leadership and policy studies at the University of Missouri–St. Louis and a fellow at the Show-Me Institute, where Michael Rathbone is a policy researcher.

Monarch Voters Choose Transparency Over Union-Backed Candidate

Posted on by John Wright

This month voters in the Monarch Fire Protection District, a fire district in western Saint Louis County, chose to keep Robin Harris on the board of directors. Harris and fellow board member Jane Cunningham were instrumental in implementing transparency policies for the district, including open collective bargaining. The fact that Monarch kept its current board in place is good news for people interested in local government accountability; however, one special interest group, the local firefighters union, may not have seen Harris’ victory in the same positive light.

Supporters of both Harris and the opposition, Kelley Miller, were standing outside the polls on election day giving out information and encouraging voters to pick their candidate. A man gave me a flier that read, “Vote for Robin Harris.” I asked him why I should vote for Harris, and he told me Robin has done a good job representing taxpayer interests. The man told me he has known Robin for six years.

Lauren, an emergency medical technician from Troy, Missouri, gave me a glossy card instructing me to choose Kelley Miller instead. I asked Lauren why I should vote for Miller, and she told me that Miller would “take politics out of the district.” While she didn’t know Miller personally, as a fellow fire district employee over in Lincoln County, she felt Miller was the right pick for voters in Saint Louis County. She told me that fire protection employees at districts across the region work together during elections.

Lincoln County Fire Protection District, where Lauren works, is a union shop. If it seems odd that an EMT from two counties away would stand outside on a rainy day and ask Chesterfield residents to vote for a candidate she has never met, then this piece of information should clear things up for you. A union’s job is to negotiate with an employer to get the best deal for its members. If the employer happens to be a local government, such as a fire protection district, then the union spends resources to elect public officials that answer to the union. Thus, the union shops in the region work together to ensure that the people elected to the boards of fire protection districts are favorable to their interests.

The union-backed candidate lost this time, but there will be other district elections. The board of the Monarch Fire Protection District may one day be packed with union-backed members. However, the transparency reforms should stay. Transparency protects both officials and the public, so when it comes to local government, everyone benefits.

Missouri Could Save Millions by Looking to Wisconsin

Posted on by John Wright

A bill is making its way through the Missouri Senate that would allow government workers to hold their union representatives accountable through regular elections. Unfortunately, the bill’s fiscal note—an estimate of how much this bill will cost—overstates the cost of these elections.

If the Department of Labor and Industrial Relations (DOLIR)—the agency tasked with managing government union elections—had examined Wisconsin, another state that has a law like this, they may have seen how the agency would have been able to conduct elections with existing resources.

voteInstead of looking to Wisconsin, where similar elections are already held at no additional cost to taxpayers, DOLIR estimated that it would have to hire at least 21 new employees and 760 temporary elections officers to physically conduct each election. According to DOLIR, these elections and new hires would cost $1.5 million to $2.7 million a year. While $2 million is not a huge portion of a multibillion-dollar budget, it is a significant amount to most of the people paying for it, especially when DOLIR could eliminate that cost altogether by following Wisconsin’s lead.

The Wisconsin Employment Relations Council (WERC) holds union elections at no cost to the taxpayer. This cost savings is possible for two reasons: First, WERC contracts out with a respected arbitration company, the American Arbitration Association, for its union elections. In these elections, workers vote through telephone or the Internet using a secure ID number, rather than a traditional paper ballot. This service has been used successfully in Wisconsin for a couple years now, providing convenient, low-cost union elections to government workers. Second, WERC charges a filing fee to a union seeking election. The filing fee is administered on a sliding-scale basis, charging more to larger unions and less to smaller unions, and is enough to cover the cost of elections. Because of these two smart moves by WERC, Wisconsin began holding elections for state workers in 2013 without increasing WERC’s staff or its impact on the state budget.

Why didn’t DOLIR look to the practices of other state agencies when estimating the cost of these elections? That seems like the first thing you’d do when estimating the cost of a new government practice. I don’t know why DOLIR screwed up so badly. I do, however, know that government union elections can be an inexpensive and reliable way to protect our government workers’ voices when it comes to their unions and professional associations.

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