Catching up on Telemedicine

Posted on by Elias Tsapelas

Is Missouri ready to reclaim its spot as a national leader in telemedicine? The numerous Missourians still struggling with healthcare access would certainly hope so.

Missouri used to be a leader in telemedicine. During the pandemic, various rules and regulations that stifled telemedicine access were waived, and in their absence, the service grew immensely popular. But today, the waivers have long since expired, and telemedicine is once again too difficult to access. All that has to happen to return Missouri to the top of the national pack on telemedicine access is for the state’s legislature to act.

A little more than a month ago, the Cicero Institute put out a report grading each state on telemedicine access, and offered specific reforms that would help states move up the rankings. Cicero’s conclusions for Missouri were in line with what my colleagues and I have written before: it’s currently too difficult to get some prescriptions via telemedicine, and it should be easier for healthcare providers who aren’t specifically physicians in Missouri to care for Missourians via telemedicine.

Fortunately, there are several bills being considered in this legislative session that would significantly improve Missouri’s telemedicine laws. One approach would make it easier to establish the physician–patient relationship virtually. This would in turn make it easier for providers to prescribe medications to patients they’d never seen in person.

Another approach expands the definition of “telehealth services” to include audio-only technologies. Not everyone has access to a computer, phone, or internet that is capable of transmitting video. Further, not every medical service that could be provided virtually requires the provider to see the patient visually. For example, some psychologists may be able to safely care for patients over the phone.

Perhaps most importantly, both approaches are currently allowed by Medicare in some circumstances and were allowed in Missouri when the telemedicine waivers were in effect a few years ago. None of this is to say that there aren’t some situations where telemedicine treatment may not be appropriate, or that there may be times when an audio-only visit isn’t sufficient. But when telemedicine can safely and appropriately provide a service, Missourians ought to be able to choose that option. Missouri has several years of firsthand data showing that telemedicine access can be expanded without sacrificing patient safety, and more states are recognizing the benefits of the service.

Missouri’s lawmakers should act soon because the state’s healthcare access problem isn’t going away, and expanding telemedicine services is one of the best ways to address it.

Arguments for a New Stadium Fall Apart Like Bad Concrete

Posted on by Patrick Tuohey

Leaders of the Kansas City Chiefs held a press conference on Wednesday to unveil their plans for the Truman Sports Complex should the Royals move their stadium downtown. If anyone doubted that the April 2 vote is really about Royals owner John Sherman wanting to move the team to a new stadium downtown, this event made it clear.

The Chiefs are putting in a relatively small amount of money for renovations. According to Kansas City PBS affiliate KCUR:

The total cost of the proposed renovations is estimated at $800 million. Chiefs Chairman Clark Hunt says the Hunt family would pay $300 million of that total. Jackson County taxpayers would be on the hook for the remainder . . .

Got that? Taxpayers are putting up the lion’s share of the renovations to a stadium owned by billionaires. It gets worse. As if learning that taxpayers will fund the majority of the Chiefs’ plans isn’t bad enough, Chiefs President Mark Donovan chose to insult voters’ intelligence. Again, according to KCUR:

Unlike the Royals, who last year cited structural concerns at Kauffman Stadium as one of the main reasons for building a new downtown facility, the Chiefs intend to stay in the same arena bowl over the long haul. Arrowhead opened in 1972, one year before Kauffman Stadium.

Donovan chalked the contrast up to construction differences.

“Believe it or not,” Donovan said, “One team got a good batch of concrete, one team didn’t.”

This is more ridiculous than it sounds because we already know, thanks to KMBC News, that Kauffman Stadium is perfectly fine:

The Royals have repeatedly said the concrete has an issue, but a study reveals that Kauffman Stadium is in “satisfactory condition,” consistent with a “first-class” MLB baseball stadium.

Jackson County voters are being asked to support a new tax because John Sherman, the billionaire owner of the Royals, wants a new stadium in downtown Kansas City. The Chiefs don’t need a new tax. The existing Royals stadium isn’t falling apart. The deal won’t add value to downtown or be good for residents. This press conference made it fair to wonder how much of this is just a power play for personal gain.

Spin vs. Reality: The Jackson County Stadium Tax Proposal

Posted on by Patrick Tuohey

On April 2, 2024, Jackson County voters will be asked to approve a new 3/8 percent sales tax to support improvements to “funding for park improvements consisting of Arrowhead Stadium and its surrounds, and a new Major League Baseball stadium in Jackson County.”

 

Learn more here: https://bit.ly/3SPIAGQ

 

Produced by Show-Me Opportunity

Chiefs Team President Accidentally Speaks Truth

Posted on by Patrick Tuohey

A Kinsley gaffe, named for the journalist and Slate editor Michael Kinsley, is “when a politician tells the truth—some obvious truth he isn’t supposed to say.”

Chiefs President Mark Donovan committed such a gaffe when he spoke at a press conference to unveil planned renovations at Arrowhead Stadium. He was asked why the Chiefs aren’t planning to build any retail developments if the Royals leave the complex to move their stadium downtown. He responded: “Right now in this market, this is not a location that is worthy of developing. As harsh as that sounds, it’s just the reality from a business standpoint.”

At the very least, this was an impolitic thing to say about the region. Located between Kansas City and Independence on Interstate 70, the location would seem to have a lot of potential. More importantly, Donovan concedes what many economists conclude and what Show-Me Institute researchers have been pointing out for years: stadiums do not generate economic growth.

Rest assured, I will be adding Donovan’s comment to my PowerPoint deck on the many false claims of economic development impact statements.

Velda City and Northwoods Are Basically Stalking Their Citizens

Posted on by David Stokes

What do we call people (usually men) who keep asking women out again and again and again despite repeated rejections? We call them stalkers.

What do we call cities that keep asking voters again and again for tax hikes despite repeated rejections? Well, nothing, I guess, but we should call them stalkers, too.

Right now, the best examples are the two small municipalities of Velda City and Northwoods in North St. Louis County. For the upcoming municipal elections in April, Velda City residents are being asked to approve three (three!) taxes that they voted down last year. This includes a marijuana tax and a use tax that they rejected in the April 2023 elections. The third tax increase is a utility tax increase that voters have rejected twice (twice!) recently, in both 2022 and 2023.

In Northwoods, voters are once again being asked to approve a use tax despite voting against the tax in both April 2023 and April 2022. This is ridiculous, and it isn’t a one-time problem.

Last year, for the April municipal elections, four municipalities within St. Louis County placed a use tax proposition on the ballot despite the fact that voters in those cities had rejected the use tax just one year before. Those four municipalities were Chesterfield, Fenton, Town and Country, and the previously discussed Northwoods. Chesterfield voters, in particular, have basically told the city, “I don’t want to go out with you,” and the city responds, “That’s ok, I’ll ask you out again tomorrow.”

Maryland Heights was even more aggressive. There, voters rejected a use tax in November of 2022 yet there they were again in April 2023, voting just five months later on the exact same tax increase proposal.

The Hancock Amendment thankfully requires the public to vote on municipal tax increases. But it violates the spirit of the amendment and common decency to just put taxes on the ballot over and over until the public passes them. While all the examples I have given are in St. Louis County, I assure you this is a problem statewide.

Missouri House Bill 2058 has been introduced to require a minimum space of two years before an issue can be put back on the ballot once it is defeated. This change is sorely needed for Missouri voters. The people of Velda City and Northwoods deserve a break from their governmental stalkers.

Listen: The Latest on the New KC Stadium Tax

Posted on by Patrick Tuohey

On February 28, Patrick Tuohey joined Mundo in the Morning on KCMO to discuss a new 3/8 percent sales tax being proposed to support “funding for park improvements consisting of Arrowhead Stadium and its surrounds, and a new Major League Baseball stadium in Jackson County.”

The vote will be on April 2.

Considering the Four-Day School Week? Pilot It and Evaluate It

Posted on by James V. Shuls

I am often engaged in policy discussions. Every now and then, someone I am speaking with says something that makes me wonder, “Why didn’t I think of that?” This happened during a recent panel discussion in Jefferson City. I was joined on the panel by the Show-Me Institute’s Avery Frank and Eric Wearne, an associate professor at Kennesaw State University. During the question-and-answer session, someone asked what advice we might give to a superintendent who is thinking about moving to a four-day school week. Eric offered some advice that was incredibly insightful and incredibly obvious, so much so that I was dumbfounded as to why it hadn’t crossed my mind.

Eric basically said, “Why do it all at once? Why not experiment at one school?” This suggestion may not make sense in a small, rural school district with one elementary school, but it makes perfect sense for a larger school district. Take the Independence School District, for example. The district has over 14,000 students and 20 elementary schools. The district decided to move to a four-day school week.

Think about what district leadership could have done if they had approached this like a researcher.

The Independence School District could have selected two elementary schools to pilot a four-day school week. If it is as appealing as the district says it is, then many teachers and students would likely want to move to that school. The district could have held a lottery to randomly accept teachers and students into the school.

Then we could have had a random assignment evaluation of the school district that moved to the four-day school week. We would have had a group of students in a five-day school and a group in a four-day school and the only difference between the two groups would have been random chance. This is the gold standard of social science research.

I understand the impulse of superintendents and school boards to consider the four-day school week, but they do not have to make the move all or nothing. Pilot it. Evaluate it rigorously. A move this significant deserves that kind of consideration.

This Is a Compromise?

Posted on by Susan Pendergrass

A year ago, the Arkansas Legislature passed, and the governor signed, the Arkansas LEARNS Act. This comprehensive act addressed a litany of education issues from literacy to networking. It expanded charter schools across the state; created the publicly-funded Arkansas Children’s Educational Freedom Account scholarship program, which will be available to all Arkansas children by 2025; and raised the minimum teacher salary from $36,000 to $50,000—a comprehensive policy that no doubt required compromises

Elsewhere, Tennessee has been lauded for completely overhauling its funding formula so that it is responsive, accountable, and student centered. Public funding is sent to where students attend school and not to where they attended school three years ago, as in Missouri. In the process of this redesign, Tennessee also raised teacher salaries and encouraged flexibility in teacher pay over the old step-and-ladder systems. Again, there’s nothing wrong with raising teacher salaries in the process of crafting good policy.

Currently, the Missouri Legislature is considering a bill that addresses a range of education issue, perhaps with the idea that if some groups like one part and others like another part, it may pass. That makes sense. The legislative sausage machine requires negotiation. But let’s look at this bill closely to see how much Missouri families might actually benefit.

The bill greatly expands eligibility for the existing MO Scholars education savings account (ESA) program. That could be a win for families. Almost every student in the state would qualify to receive a scholarship, because the income limit would be raised to four times the federal poverty line, or $120,000 for a family of four. The bill also eliminates the current geographic restriction on which students are eligible to receive scholarships—a much-needed change.

There’s just one problem with the ESA expansion proposed in this bill. Unlike Arkansas (or Iowa, Arizona, Utah, West Virginia, New Hampshire, North Carolina, and Florida), Missouri isn’t willing to provide the scholarships. Sure, Missouri is willing raise the cap on the amount of money that the existing six approved scholarship organizations can fundraise in order to pass out scholarships. But that’s as far as the bill goes—no public funding at all.

There is a distinct possibility that, to get this passed, Senate Bill (SB) 727 (or actually its committee substitute) will be amended to provide state funds to raise minimum teacher pay in the state from $25,000 to $38,000 with a provision that school districts can request reimbursement for any mandatory salary increases from a new Teacher Salary Baseline Grant Fund.

A gap seems to exist between those who believe in school choice and those who support public education. I’m for both, but I’m just one voice. I think it’s fine to try to bridge that gap by offering concessions to both sides. But let’s make sure they carry equal weight. If one comes with public funding and the other comes with “good luck getting the money together,” then they’re not really equal. Maybe it’s time to go back to the drawing board.

Show-Me Energy: Decommissioning Power Plants Part 2

Posted on by Avery Frank

The decommissioning of coal plants is happening across the nation. Senate Bill (SB) 757 would mandate that prior to closing an electricity-generating power plant, there needs to be a new power plant ready to replace it with equal or greater nameplate capacity This bill is being proposed as an attempt to try to smoothen this energy transition for Missouri consumers. In the near future, many Missouri plants such as Rush Island in Jefferson County (2024), Sioux in St. Charles County (2032), and Labadie in Franklin County (half 2036, half 2042) will be taken offline (The years in parentheses signify Ameren’s preferred timeline to close these plants.)

If you clicked on this post without reading Part 1, I encourage you to go back and read Part 1. In that post, I defined some of the energy jargon used in this debate. This post will focus on the provisions of SB 757.

Does SB 757 address capacity factor and dispatchability?

The bill does not explicitly mention capacity factor or dispatchability. Here is a passage from the bill text:

The new replacement reliable electric generation shall be equal to or greater than the full nameplate capacity of any existing electric generating power plant and shall be certified as an equal or greater amount of reliable electric generation by the Missouri public service commission and the regional reliability organization in which the electric utility company operates. (emphasis added)

Unless the public service commission comes up with its own system of power accreditation, it seems this bill will hinge on the actions of our regional reliability organizations.

While I will not go into all of the specific details, the two main regional energy organizations in Missouri—Midcontinent Independent System Operator (MISO) and Southwest Power Pool (SPP)—have outlined their resource accreditation process for rating power sources and individual power plants (you can read MISO’s method here). MISO’s plan “informs long-term investment and retirement decisions by accurately representing the capacity value of a resource in the prompt year.”

What a statement like that means is that MISO (and SPP also) account for capacity factor and value on the grid by examining different yearly, monthly, and daily variables—all with declared intentions to “maintain reliability.”

However, we should still be cautious, as utilities also can miscalculate or serve other agendas. For example, California has dramatically increased its amount of renewable energy sources in the past 10 years, which now account for up to 42% of its net electricity generation. In the same timeframe, California has cut its nuclear supply by over half, down to 8%. As a result, the dispatchability problem has reared its ugly head in recent years, as in 2020 California had power outages due to insufficient energy for the first time in over 20 years. Sadly, 2020 wasn’t the end of California’s power struggles, as problems have continued. California’s regional reliability organization, California Independent System Operator (CAISO), has even at times called for residents to “use less power between 4 and 9 p.m.” Whether it was due to miscalculation or prioritizing other agendas, Californians are struggling because of a lack of dispatchability and reliability.

That brings me to my main questions concerning SB 787. Can Missouri citizens confidently rely on these regional reliability organizations (MISO, SPP) to protect their energy needs? Will these organizations continue to prioritize both capacity and dispatchability? Is there a way to ensure that other agendas are not prioritized over our energy needs?

On its face, this bill appears to add protection for Missourians, but these questions are worth answering. If there is any possible room for interpretation, shouldn’t it be made clear that both nameplate capacity and dispatchability must be taken into account?

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