What if We Decided to Lean in to Testing?

Posted on by Susan Pendergrass

The College Board’s Advanced Placement (AP) program teaches college-level coursework to high school students and then tests their knowledge with an AP exam. Missouri’s participation in this program lags behind the national average, both in test taking and test passing. Missouri’s high school students are missing an opportunity to get college credit without paying college tuition. Do we have an anti-testing culture?

Missouri quietly released last year’s Missouri Assessment Program (MAP) scores for schools and districts recently. Because Missouri, like most states, currently has a chronic absenteeism problem and because Missouri chose the broadest rule for suppressing data due to privacy concerns, dozens of districts have no useable public test score data in either English/language arts (ELA) or math. How are these districts doing? I have no idea. But I do know that the average spending per student in the “no test score districts” was over $27,000 last year.

The state board of education’s reactions to last year’s statewide test scores, which were dismal, included the two standards—not enough teachers and not enough money. They threw in COVID and classroom behavior for good measure. And despite having multiple districts with fewer than 10 percent of students scoring at grade level on the MAP exam, the state board decided to keep designating 512 out of 518 school districts as fully accredited and have the remaining six be partially accredited—grade inflation at its best.

What if we leaned into testing to find out how we’re doing? What if we didn’t blame money or the kids? Success Academy, a well-known charter network in New York City that enrolls almost exclusively low-income students of color, had to rent an exhibition hall to accommodate students taking an AP exam this spring because there were so many of them. The academy’s founder and CEO, Eva Moskowitz said, “With rampant grade inflation and inconsistent state standards, AP and SAT tests are a critical tool . . . especially for low-income students of color.”

As the pandemic moves further into the rearview mirror, we need a clearer picture of the toll it has taken on Missouri’s children and their futures. We need more accountability, not less.

New Avenues for Price Transparency

Posted on by Elias Tsapelas

Why is health care so expensive? In part, it’s because patients rarely have the opportunity to shop for a better deal. When you don’t know the price of a procedure before you receive it, how could you possibly weigh your options? While it is true that many patients have likely never considered shopping for savings on their health care, they’ve also never really been given a reason to. Fortunately, two states recently passed laws designed to encourage cost savings for patients and insurers alike.

A few months ago, laws went into effect in both Texas and Tennessee that provide patients with new avenues to avoid overpaying for health services. These laws offer a glimpse at one of the next steps for states in the effort to make prices more transparent. More specifically, these new “self-pay” laws allow individuals covered by certain health plans to receive deductible credit if they can find services cheaper than the rate their insurer negotiated.

Are there really that many services where patients could find cheaper prices than what their insurer has agreed to pay? Surprisingly, the answer appears to be yes. According to a recent report, when offering to pay cash instead of using insurance Josh Archambault found:

We recently made some phone calls in Nashville and found we could pay $541 in cash for a colonoscopy, far less than the $2,400 average rate the three largest insurers in the state negotiated. In fact, we found at least four providers in downtown Nashville that would charge less if we paid cash instead of using our insurance card.

In other words, it’s likely that many patients are currently overpaying for services when they use their insurance. And what these new laws do is allow patients to take the $541 option and require their insurer to count that spending toward their yearly deductible, as their insurer would do for any other spending on covered health services. For many patients, especially those with chronic illnesses, this change could result in significant cost savings.

As I’ve written before, price transparency isn’t a silver bullet for our health care system, but it will be key for lowering health care costs—if Missouri lawmakers ever decide to get serious on the issue. Going into this year’s legislative session, I hope our lawmakers decide to make tackling skyrocketing health care costs a priority. Following what’s recently worked for both Texas and Tennessee would represent a step in the right direction.

How Unions Choose School Board Candidates with Michael Hartney

Posted on by Susan Pendergrass

Susan Pendergrass speaks with Michael Hartney about his new latest report, Students or Salaries? How Unions Choose School Board Candidates.

Download the full report here.

Listen on Apple Podcasts 

Listen on SoundCloud

Michael Hartney is a Hoover Fellow at Stanford University’s Hoover Institution, an associate professor in the department of political science at Boston College, and a senior fellow at the Manhattan Institute. He is also a research affiliate at Harvard University’s Program on Education Policy and Governance (PEPG), and, in 2020-21, a W. Glenn Campbell and Rita Ricardo-Campbell Hoover National Fellow.

Produced by Show-Me Opportunity

As Legislature Returns, Whose Priorities Will Take Priority?

Posted on by Patrick Ishmael

Happy New Year! After a lackluster 2023 legislative session, hope springs eternal for 2024 as the Missouri Legislature returns to do the people’s work in Jefferson City this week. Show-Me Institute analysts have shared ideas for legislative priorities in the 2024 Blueprint, and over the winter break I reiterated some discrete ways of improving governance in the state.

But even the best-laid plans can go awry, so how optimistic are legislators that items important to taxpayers will get across the finish line this year? As an article in the Missouri Independent emphasizes, it depends on who you ask:

“I mean, I think we’ll get things done,” said Senate Majority Leader Cindy O’Laughlin, a Shelbina Republican. “Will we get everything done that we want to do? No, we never do. But I’m an optimist.”

Democrats and Republicans share many of the same goals, O’Laughlin said, and progress can be made if people are willing to sit down and talk about how to reach those goals.

The Missouri House has generally been effective in advancing good legislation in the last few years, often only to be stifled in the Senate. The real question for whether 2024 will be “successful” hinges on how the Missouri Senate, now in an election year, handles its business. Will the majority party see itself often split, with leadership joining with the minority party to pass or stop legislation as it did in 2023? Will the majority party use Previous Question motions to scuttle filibusters from all quarters to pass its priorities? Will we see a mix of the two? Or will the chamber mostly be mired in dysfunction and nothing really gets done (again)?

How the factions in the Senate align will play an enormous role in what actually gets done in 2024. With a handful of exceptions, the last few years have been littered with missed opportunities, primarily because the Senate has alternated between watering down important measures or not passing them at all. So 2024 is a Yoda moment of sorts, especially for Missouri’s outgoing senators; lawmakers have entered “do or do not, there is no try” territory if they want to build a legacy before they leave the legislature for good. Giving lip service to good legislation isn’t going to cut it this time around.

What’s ultimately done (or not) remains to be seen, and we at the Show-Me Institute will keep you posted as the session progresses. But I hope that all Missouri legislators will set aside their squabbling and make decisions that keep the good- and limited-government promises made to their constituents. If they do, 2024 could be a banner year for the state, but if they don’t, well, this year will look a lot like last year. And that would be unfortunate.

Why Don’t We Remove the Floor from Missouri’s Income Tax Triggers?

Posted on by Patrick Ishmael

RSMo §143.011(4)(1) represents the essence of Missouri’s income tax reduction trigger law. Passed in 2022, the law reduces the state’s income tax over time to a floor of 4.5%, assuming certain revenue targets are met. Importantly, the section states that “[n]o more than three reductions shall be made under this subsection.” In other words, when the tax cut triggers are all met, no further cuts below 4.5% can be made.

Why stop at 4.5%? As the state’s general revenue grows, shouldn’t tax rates be adjusted accordingly so that the total size of government doesn’t also grow? By eliminating the limit of three reductions to the income tax rate from the law, Missouri can set forth a fiscally responsible glide path to eliminating the income tax entirely, using current law to facilitate this autopilot tax reform. Letting taxes drop as revenues rise is an appropriate and efficient way of achieving this end.

We have talked at length and for years about how destructive income taxes are to growth and why they should be phased out and ended in Missouri. Accelerating that stepdown is worthwhile, but not stopping that stepdown is just as important, given the current law. Policymakers should remove the floor and let the individual income tax rate continue to fall if government revenue keeps rising.

The Authority of the Missouri Auditor Should Be Expanded to Enhance Local Transparency

Posted on by Patrick Ishmael

The Missouri State Auditor’s Office plays a crucial role in promoting transparency and accountability in government. Although the Auditor arguably already has many powers to advance these ends, state law could provide the state auditor with further explicit authority to ensure local spending is transparent and publicly reported.

To achieve this transparency objective seems simple. A new statement could be added to RSMo §105.145(2) that says, “the auditor may require the submission of supporting documents for such financial transactions, including but not limited to check registers or their electronic equivalent, and digital bookkeeping files.”   Such an addition wouldgive the state auditor the authority to require supporting documents for financial documents reported to the state by local governments. The auditor could then post the documents online, giving the public a complete and detailed picture of how their money is being spent.

With such a change to state law, the State Auditor would be better equipped to ensure that public funds are being used in a transparent and accountable manner. For its part the public would be able to see how money is spent rather than being forced to use the Sunshine Law to get such records—a process that, as staff at the Show-Me Institute has discovered over many years, is often made more difficult by officials apparently trying to prevent the dissemination of these records.

No more asking “pretty please” for transparency from local bureaucrats. The Auditor’s Office would be able to deliver this transparency if it had such explicit powers.

Expanding Interstate License Reciprocity Can Improve Access to Health Care

Posted on by Patrick Ishmael

Interstate licensing reciprocity in healthcare is an issue near and dear to my heart. Starting with the implementation of the Volunteer Health Services Act in 2013 and followed by a host of reciprocity reforms in recent years, Missouri has found itself at the forefront of licensing reform issues nationally.

But Missouri can do better, and that means updating state law to ensure that the objective of reciprocity—that is, the expansion of health care supply to patients by leveraging qualified individuals from other states—is in fact achieved.

Two areas, then, that require attention in Missouri are the six-month delay in reciprocity admission that’s permitted under RSMo §324.009(3) and the compact exception in RSMo §324.009(10) that allows licensing boards to step in front of reciprocity reforms by entering into preemptive compacts. Both the six-month delay and compact exception can be easily corrected by deleting those provisions.

These tweaks to Missouri law may seem obscure and small, but they are important, and they should be implemented as quickly as possible for the benefit both of the professionals affected and the consumers and patients that will benefit from increased access to those professionals.

Repeal Certificate of Need For the Health and Welfare of Missourians

Posted on by Patrick Ishmael

Certificate of need (CON) laws have been a subject of debate since their inception in the United States half a century ago. Intended to control healthcare costs and improve access to care, Missouri’s CON law requires healthcare providers to obtain government permission before opening certain facilities, expanding certain care services, or installing certain medical machines.

Yet research tends to show CON has the opposite effect of its original intention, leading to higher costs and reduced access to care for patients. This is not surprising, of course. As President Ronald Reagan once joked, often when the government comes “to help” is when the public should get concerned.

Missouri can stop “helping” in this counterproductive way by unwinding its CON law. By repealing its certificate of need law through removing sections 197.300-197.367 from the state’s statutes, Missouri could promote competition, reduce costs, and increase access to care for all Missourians.

To find out more about the CON issue in Missouri, read our 2019 paper on the subject, End Certificate of Need in Missouri.

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