Don’t Drop the Call for Telemedicine

Posted on by Elias Tsapelas

Is the dysfunction of Missouri’s legislature going to claim another victim? With just a few days left to go in this year’s legislative session, the odds of any bills that improve Missouri’s telemedicine laws making it across the finish line get smaller by the day.

Several months ago, I wrote about the positive developments in the world of telemedicine, and the laws Missouri needs to change to bring these benefits to state residents. I was optimistic because several bills expanding the role of telemedicine received hearings near the start of this year’s legislative session, and there was little to no opposition voiced against the changes. Unfortunately, for reasons unknown to me, the telemedicine bills haven’t moved much since their public hearings.

What makes the lack of movement so surprising is that much of what the telemedicine bills do is restore benefits that Missourians enjoyed a few short years ago. As I’ve written before, during the state of emergency for the COVID-19 pandemic, Missouri was one of the national leaders on telemedicine. Because various laws and regulations were waived for emergency response, it was much easier for patients to access their healthcare providers virtually. In response, patients and providers alike grew to value the service—until the emergency ended, and state lawmakers allowed the prior telemedicine restrictions to return.

Two of the telemedicine bills being considered this year seem like no brainers. One expands the definition of “telehealth” to include audio-only technologies. Not everyone has access to the devices or internet required to transmit video, and not every medical service requires a visual examination. Many in the mental health field would like the ability to treat patients over the phone, but state law needs to change for that to be possible.

The second bill makes it easier to establish the physician–patient relationship virtually. Currently, there are concerns about doctors prescribing medications to patients who they’ve never seen in person. Clarifying the process that needs to be followed for safely prescribing medicine remotely seems like it would benefit both patients and providers.

Many Missourians are still struggling with healthcare access, due in large part to a shortage of providers, and telemedicine is one of the best ways to expand the available pool of providers. There are many providers already calling on our general assembly to allow them to see more Missouri patients. There’s still enough time for our lawmakers to act and finally answer the call for improving telemedicine access.

No Way to Budget

Posted on by Elias Tsapelas

Do Missouri’s elected officials think the phrase “better late than ever” applies to passing the budget? Last week, our general assembly cut things incredibly close by approving next year’s spending plan just a few short hours before the constitutional deadline.

For months, I’ve been expressing concerns about this budget. After years of record-breaking spending growth, the well of exorbitant federal funds will soon be drying up, and state tax revenues are expected to decline or remain stagnant. Not to be deterred, in January, Governor Parson laid out his plan that recommended more of the same, including spending more than the state expects to bring in. Over the next few months, the House of Representatives worked to pare that plan back, ultimately finding some (but not enough) savings.

Over the past month, the Senate had been working on its version of the budget, but to no avail. Due to an apparent combination of time constraints and chamber dysfunction, the spending plan didn’t see the Senate floor until the day before Missouri’s constitution requires it be passed. The result of this delay was a budget that almost no one had seen in advance, yet still had to be approved by both legislative chambers over a matter of hours. All this had to happen without anyone making any changes.

The problems with this process should be obvious. Instead of each chamber having its own version of the budget to compare against the governor’s, and a conference committee process to reconcile differences, the compromises were made outside of the public eye. Instead of taxpayers being able to see how each chamber prioritizes spending, the lack of conference meant that there was no avenue for input from citizens on the final product. And instead of lawmakers having several days, if not weeks, to examine the proposed budget and suggest amendments, they were stuck with a take-it-or-leave-it offer.

Unsurprisingly, the approved budget looks like it leaves much to be desired. As Missouri’s legislators are fond of saying, passing the budget is the general assembly’s sole constitutional responsibility. Given the gravity of the assignment, it’s incredibly disheartening that the process played out the way it did. Over the next few weeks, I’ll continue unpacking the spending decisions of our elected officials. At this point, what’s clear is that Missouri desperately needs more budget transparency, and what happened this year should never be allowed to happen again.

The Final Week of the Session

Posted on by Elias Tsapelas

David Stokes, Elias Tsapelas, and Avery Frank join Zach Lawhorn to discuss:

– The state budget

– The final week of the legislative session

– The latest plan in the City of St. Louis to deal with the prevalence of temporary tags, and more

Listen on Apple Podcasts 

Listen on SoundCloud

Produced by Show-Me Opportunity

Missouri Needs to Be Prepared for Growing Energy Demand

Posted on by Avery Frank

When the legislature finally passed an education reform bill, I was hopeful this would mean we would see movement on other important bills as well. However, as we approach the final weeks of the legislative session, it seems that some bills may be sputtering out. Among them are bills that would strengthen Missouri’s energy sector—in particular, House Bills (HB) 1435 & 1804.

Missouri cannot keep putting off energy reform until the next year—change is happening now, and energy demand is growing.

For the first two decades of the 2000s, electricity consumption remained flat without significant growth, as increased demand was offset by increased energy efficiency. However, in recent years energy demand has been on the rise again.

Forbes, the Department of Energy, and The New York Times all note the same driving forces for this increasing demand—data center growth (accelerated by the growth of AI) and a boom in electrical manufacturing (batteries, computer chips, etc.). What is one thing data centers and factories have in common? They both require power 24 hours a day—something non-dispatchable resources like solar cannot effectively provide alone. (Small modular nuclear reactors are great at providing continuous power . . . just saying.)

Some prominent organizations, such as Goldman Sachs and McKinsey & Company, have forecasted that U.S. data center energy usage will double by 2030. To put it into perspective, Goldman forecasts that data centers’ share of total U.S. power demand will rise from its current 3% level to 8% by 2030. This is an enormous amount of electricity—equivalent to the power needed for over 40 million U.S. homes.

Ameren is planning to shut down all coal plants by 2045. To replace coal plants’ production and meet new demand, our state will need to build reliable, powerful, and clean power plants.

Nuclear power can check all of these boxes, but we need regulatory reform to allow nuclear to flourish in Missouri. To replace and meet new energy demand, our state should strongly consider nuclear energy.

The primary policy that has impeded our nuclear industry for decades is the construction-works-in-progress (CWIP) law. This statute prevents utilities from raising rates in order to help pay for construction-works-in-progress, making it much more difficult to develop nuclear projects. CWIP has proven fatal for Missouri’s nuclear industry, as nuclear projects are both extremely capital intensive and subject to extensive holdups in the regulatory process.

Nuclear plants do not arise out of thin air, and they will not be built in Missouri if there are too many regulatory barriers. Eliminating the longstanding CWIP statute by passing HB 1435 and HB 1804 would provide a backstop for the large upfront costs of small modular reactor construction so that utilities can work with both domestic and international nuclear developers to revive our state’s nuclear industry.

In the remaining weeks of the session, the legislature cannot forget about the need for modernization in the energy sector. Electricity demand is on the rise, and Missouri should prepare to meet this demand.

Useless and Expensive: The Proposed St. Louis MetroLink Extension

Posted on by David Stokes
Metrolink Expansion Factsheet (1)

Download a copy of the Fact Sheet 

The proposed St. Louis MetroLink extension, with its staggering $1.1 billion price tag, would be useless and expensive.

Demand for public transit along this proposed new light rail route, spanning 5 miles primarily along Jefferson Avenue, is such that there is currently NO bus route that serves this same route, yet we are to believe a light rail system is sorely needed and will be heavily used.

The projected ridership of 5,000 boardings per day is underwhelming, especially when compared to past forecasts for MetroLink ridership. In 2004, Metro predicted 80,000 daily boardings by 2025 for the Missouri side alone; yet, in 2023, the entire system averaged just 16,700 boardings.

We can look to the Loop Trolley debacle as a cautionary tale. Despite abysmal ridership numbers, St. Louis is stuck funding the trolley due to federal funding stipulations. The exact same thing will happen with this latest MetroLink extension proposal. It will cost over a BILLION dollars, have VERY FEW riders, and we will be forced to operate and fund it for decades. This project isn’t merely wasteful. It is an actively harmful expenditure of federal and local tax dollars.

A New Baseline We Can Build From with Andy Rotherham

Posted on by Susan Pendergrass

Susan Pendergrass speaks with Andy Rotherham about how we should evaluate schools in a post-pandemic world, the importance of accountability, and more.

Andrew J. Rotherham is a co-founder and External Relations leader at Bellwether, a national nonprofit that exists to transform education to ensure systemically marginalized young people achieve outcomes that lead to fulfilling lives and flourishing communities. Rotherham also works in Bellwether’s Policy and Evaluation practice area and serves on the Virginia Board of Education. He occupies a unique place in the U.S. education sector working across silos. He has been appointed to senior policymaking roles by Democrats and Republicans, works at the intersection of research and policy, media, and practice, and is a longtime champion of heterodoxy, empiricism, and pragmatism in education policy.

Rotherham writes the blog and newsletter Eduwonk.com.

Learn more about Bellwether: bellwether.org/

Listen on Apple Podcasts 

Listen on SoundCloud

Produced by Show-Me Opportunity

Watch: K-12 School Choice Calculator Webinar with EdChoice and Reason Foundation

Posted on by Susan Pendergrass

On May 8, 2024, Show-Me Institute hosted a virtual event where EdChoice’s Marty Lueken and Reason Foundation’s Christian Barnard discussed and demoed their K-12 School Choice Calculator.

The calculator was built to provide legislators, legislative staff, and stakeholders with an easy way to learn about the potential fiscal effects of funding educational opportunities in their state.

You can access the K-12 School Choice Calculator here: https://www.schoolchoicecalculator.com/

The Type of Audit We Can All Agree On

Posted on by David Stokes

If there is one thing local government in Missouri needs more of, it is audits.

I don’t mean Comprehensive Annual Financial Reports (CAFRs), or the Distinguished Budget Award that seemingly every city under the sun gets.

I mean an audit. The type of audit that gives people nightmares and, presumably, makes them more careful in their accounting and reporting out of fear.

In recent years, we have seen plenty of examples of failed accounting procedures in local government. There have been outright thefts, failures to competitively bid contracts, plenty of conflicts of interest and cronyism, and much more. I don’t think that politicians and bureaucrats in Missouri are less honest than in other states, but I do think that the huge number of small municipalities and other special taxing districts in our state gives them more opportunities for varying degrees of corruption.

We have seen local auditors who totally failed to do their jobs. Seriously, check out these links to the St. Louis County auditor’s page and be amazed at how few audits the office has actually performed over the past decade.

There is a bill in Jefferson City that expands the ability of the state auditor to preemptively begin audits of local governments when there is evidence of problems. Currently, the auditor needs to be invited by local officials or receive a petition from citizens. The former isn’t always done by local officials—for obvious reasons—and the latter can be time consuming and difficult.

This proposal, which is now on the governor’s desk, is an excellent one. It would benefit the taxpayers of our state.

Would it make local officials and bureaucrats nervous? I certainly hope so.

 

Kansas City Must Learn Lessons from Cerner Failure

Posted on by Patrick Tuohey

The recent Kansas City Business Journal report about Oracle drastically reducing its Kansas City workforce in the former Cerner offices is troubling but not surprising. It serves as a harsh reminder of commitments unfulfilled and a stern warning regarding future economic development endeavors.

In 2014, Cerner received the largest economic development project subsidy in the state’s history. The company pledged to add 16,000 *new* jobs in Kansas City in exchange for substantial taxpayer subsidies to construct its new headquarters. However, by 2019, Cerner had only managed to expand its workforce to 14,000 total, and not all the jobs were in Kansas City proper. Cerner fell short of its promise. Now, under Oracle’s ownership, the local employee headcount has been nearly halved to a mere 6,400. This is far from the 26,000 jobs—the 16,000 new plus the 10,000 Cerner had at the time—that were supposed to be in place by this year.

The issue runs deeper than just the numbers; it’s more about the impact on the local economy and the trust that was placed in these corporations. The Kansas City region was promised significant economic growth and job creation. Taxpayers delivered, but Cerner, and now Oracle, have failed to keep their promises.

Just like the Power & Light District, and the proposed downtown stadium, the Cerner project reveals the misplaced faith in economic development incentives. Time and again, we see that these incentives often fail to deliver. Instead, they serve as generous gifts to corporations, paid for by taxpayers, with little to no accountability.

The Cerner deal has been an abject failure. All city and state leaders who cheered this project should be held to account.

Current and future Kansas City leaders must learn from these missteps. They must scrutinize these large-scale economic development projects more rigorously and demand transparency and accountability. Tax incentives and subsidies, if issued at all, should include meaningful and measurable outcomes, strict legal standards for what constitutes a new job, and oversight from a clearly defined agency that will monitor the subsidy recipient over time. Holding corporations accountable for their promises will not only protect taxpayers; it may reduce the demand for subsidies in the first place.

The April 2 stadium outcome showed that voters demand more details and accountability from those who seek public funds. Leaders must provide them.

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