Missouri’s application for the federal Rural Health Transformation Program (RHTP) reads like a blueprint for major reform. It promises a “bold and comprehensive vision” that will “fundamentally shift the healthcare experience” for rural Missourians. That kind of language suggests that the state is ready to address long-standing structural barriers to care—and to the credit of those who wrote the application, it does identify many of the right problems.

A portion of the federal funding approved in the One Big Beautiful Bill last summer was designed to help states expand access, improve outcomes, and rethink how care is delivered in rural communities that have long struggled with provider shortages and limited infrastructure. As I’ve written many times before, Missouri, with large rural regions and persistent access challenges, is an obvious candidate for that kind of transformation.

But when you get to Appendix 1 (page 56), where Missouri outlines its actual policy commitments, the tone changes.

Take certificate of need (CON) laws. Instead of proposing reforms, the state spends its time disputing outside criticism, arguing that a report from the Cicero Institute “inaccurately claims” Missouri’s CON program is overly restrictive and that critics “overstate Missouri’s regulatory reach and understate its flexibility.” The focus shifts away from change and toward claiming the current framework really isn’t that bad.

The same pattern shows up on scope of practice (which procedures certain healthcare professionals are allowed to perform). Rather than committing to specific changes, the state says it will “reassess our current scope of practice laws” and “identify the optimal legislative and regulatory changes” at some point in the future. The emphasis remains on further review rather than action.

These are only a few of many examples that make the contrast in this application so striking. The front half lays out a vision built on “innovation,” “transformation,” and system-wide change. But the appendix, where commitments actually matter, falls back on the status quo.

It is true that the federal government bought into that vision. Missouri was awarded significant funding through this program, with the expectation that the state would follow through on what it proposed to improve access in rural communities. The application suggests that the state understands the problem. The commitments, however, raise questions about whether state leaders are serious about implementing real solutions.

As Missouri begins spending the RHTP funds it receives over the next five years, taxpayers should pay close attention to how closely the state’s actions align with its stated vision.

The post Missouri Talks Reform on Rural Health—Then Walks It Back appeared first on Show-Me Institute.

Healthcare supply is needlessly limited by regulations that often protect incumbent providers at the expense of patients.

The Solution

Enact free-market reforms to increase the availability of care across the state while also working to lower healthcare prices.

Key Facts

• Missouri needlessly restricts many medical professionals’ scopes of practice and has complex licensing requirements that reduce healthcare access.
• During the COVID-19 pandemic, Missouri was a national leader in waiving laws and regulations that placed unnecessary limits on healthcare access.

Remove Unnecessary Barriers

“Scope of practice” defines what medical professionals can do in a state, given their training. More treatment options for patients means more competition among providers, which is good for consumers in terms of service and price. This is especially true and important in rural areas where doctors may not always be available or nearby. While Missouri has made some incremental progress on broadening the scope of practice for nurses in recent years, the state still has more restrictive laws than most of the country.

“Telemedicine” is the provision of medical care over the telephone and the internet. For the sake of public health and because many patients felt more comfortable staying at home during the pandemic, Missouri temporarily loosened the regulations that govern who could see a physician online and under what circumstances. Despite the recent expansion of Missouri’s telemedicine laws to include audio-only technologies, there is still work to be done to safely expand telemedicine.

“Licensure” is the manner in which the state regulates certain professions. Unfortunately, licensure can often act as a barrier to entry, especially for qualified healthcare providers from other states. While Missouri’s passage of universal license reciprocity in 2020 was a step in the right direction, the state’s licensing laws are still unnecessarily limiting the number of qualified and willing providers who could otherwise be treating Missouri patients.

Repeal Certificate of Need

Missouri’s Certificate of Need law restricts healthcare competition by requiring many healthcare providers to get state approval before entering new markets or expanding services offered in existing facilities. This restriction hampers market newcomers and puts upward pressure on healthcare prices by restricting supply.

Retake a Top Spot

At the start of the COVID-19 pandemic, Missouri quickly became a national leader in expanding healthcare access. Governor Parson waived numerous laws and regulations regarding scope of practice, license reciprocity, telemedicine, and even Certificate of Need requirements. But in the years since, the waivers were allowed to expire, and Missouri’s legislature has taken minimal action to address the issue.

Missouri’s laws and regulations that specify what the state’s providers are allowed to do and where they can practice play a key role in the recruitment of new state residents and workers. Greater freedom for providers makes job opportunities in a state more desirable for prospective employees. If Missouri’s elected officials are serious about addressing the state’s healthcare access issues, making healthcare employment in Missouri more competitive is required.

Policy Recommendations

• Remove the unnecessary barriers to healthcare access that were previously waived during the COVID-19 pandemic, such as expanded providers’ scope of practice.
• Remove the statutory delays to reciprocity licensure and create additional pathways for licensed healthcare providers in other states to treat patients in Missouri.
• Repeal Missouri’s Certificate of Need laws.

The post Free-Market Healthcare Reform appeared first on Show-Me Institute.

Created, at least in part, to help states deal with the reining in of Medicaid provider taxes, the fund guarantees each state $500 million (half of the $50 billion divided by 50 states), but the other half ($25 billion) is going to be awarded based on a scoring system the federal government recently rolled out. Most notable among the recently published scoring criteria are points for enacting many of the free-market healthcare reforms my colleagues and I have been writing about for years.

The scoring system doesn’t just assess demographics or the number of rural hospitals, though they are a big part of the rubric. It also awards states points for policy changes that reduce red tape and open the door for better care. Some of these items include repealing certificate of need (CON) laws, expanding scope of practice for nurses and other healthcare professionals, improving short-term health insurance options, and making telehealth more accessible. Missouri has debated each of these ideas for years, and made some progress, but now enacting these meaningful reforms has additional monetary stakes.

Despite recent incremental progress on the free-market healthcare front, there’s still a lot that Missouri could do. Our CON laws are some of the worst in the country. They stifle healthcare competition by forcing providers to receive permission, often from their competitors, before adding new hospital beds, building new facilities, or even purchasing certain types of equipment.

Scope of practice restrictions are another self-inflicted wound I’ve written a lot about in the past. Missouri gives advanced practice registered nurses less autonomy than in many other states. Our state already has a shortage of healthcare providers, and removing those restrictions would help improve healthcare access, make Missouri jobs more competitive, and ultimately lower costs—all without sacrificing patient safety.

On the telemedicine front, Missouri has made progress by expanding services to audio-only technologies earlier this year but has the potential to go much further. More flexible rules on prescribing and treating patients could dramatically expand access for families, especially for those in rural communities.

At the end of the day, many of the reforms incentivized by the OBBB are policies Missouri should have adopted years ago, but the federal funding offers lawmakers a new reason to finally take action. If Jefferson City seizes this golden opportunity, Missouri can both improve the state’s healthcare policy and score some additional resources that could help in these tough budgetary times. That sounds like a rare win-win to me.

The post Reform First, Dollars Second appeared first on Show-Me Institute.

If passed, SB 177 would require any new charter school to receive a certificate of need from the governing board of the local school district or the governing body of the city or county in which it intends to operate. This added hurdle would not only create an unnecessary extra step, but it would also give existing public school districts—which are historically opposed to charter schools—more power to block competition.

The Problem with SB 177’s Requirements

The rationale for certificate of need (CON) laws is that the number of providers in a particular market must be controlled in order to prevent market oversaturation. Such laws are inherently anti-market, as they give regulators, rather than entrepreneurs and families, the ability to determine need and to select who may participate in the market.

SB 177 would require a “governing board of the [local] school district or governing body of the city or county in which the proposed charter school would be located” to affirm that the following conditions apply to the school district in which the charter is proposed:

1. Consumer demand for alternative educational options exceeds supply;
2. The school district’s attendance area contains sufficient economies of scale to ensure both an adequate supply of high-quality teachers and potential students in order for the proposed charter school to succeed without hurting the school district; and
3. The proposed charter school is likely to:
   • Alleviate economic and racial inequities
   • Improve students’ academic outcomes
   • Reduce student–teacher ratios
   • Result in a more efficient education service without duplication of services
   • Limit the number of schooling disruptions
   • Address family priorities including safety, convenience, transportation time, neighborhood walkability, and school culture.

These conditions range from things that are too vague and open to interpretation to things that shouldn’t be considered to begin with.

Little Incentive to Allow Competition

For incumbent school districts, there is little incentive to allow competitors to challenge their market share. In fact, no local school board in Missouri has ever sponsored a charter school in its district, despite having the ability to do so. It seems unlikely then that any district would grant CON approval to a charter school.

What Missouri Should Pass Instead

Rather than passing legislation that stifles charter school expansion, Missouri should focus on removing barriers to entry for charters. SB 398 and House Bill 1044 would expand charter access to additional districts, including those in charter counties or municipalities with more than 30,000 residents. These bills would move Missouri in the right direction. Of course, if Missouri wanted to remove all barriers to access it should allow charter expansion without regard to population requirements. It is a sad note that of the 43 states with charter schools, Missouri is the only state without a rural charter.

Limiting competition and restricting opportunities for students across our state is not how to improve education in Missouri. SB 117 would represent a big step backward in Missouri education policy. We need to continue moving forward.

The post Preventing a De Facto Ban of Charter Schools appeared first on Show-Me Institute.

The post Certificate of Need Requirement for Charter Schools appeared first on Show-Me Institute.

In short, the answer is Missouri’s Certificate of Need (CON) laws. These laws give the government power to manage competition in the healthcare industry by requiring permission before providers can open certain facilities, expand certain services they offer, or even install certain medical devices.

While being required to ask for governmental permission may sound bad enough, what makes CON laws even worse is that the healthcare facilities that are covered by the state’s CON laws help decide whether new competitors are allowed to enter their healthcare markets. It shouldn’t be surprising that when given the choice, incumbent businesses prefer less competition nearly every time. Competition means more choices—which in turn lead to lower prices. Artificially limiting supply, which CON laws do, has often been shown to result in higher prices.

So how does this apply to what’s happening in northern Missouri? According to a recent article in the Missouri Times, the Hannibal Regional Medical Center asked the state legislature this year for money to build a new radiation oncology unit in Kirksville, which is approximately 100 miles away from its Hannibal location. The Northeast Regional Medical Center (a hospital located in Kirksville) opposed the funding on the basis that the creation of a new medical campus would “cause a duplication in services that could produce a financial hardship for both hospitals.”

Apparently, this story goes even further back than this past legislative session. Two years ago, the Northeast Regional Medical Center submitted a CON application for permission to replace a linear accelerator (a machine used for radiology treatments) for its Kirksville hospital. In response, the Hannibal hospital filed an opposition under Missouri’s CON laws, effectively barring the hospital from purchasing the device that would allow it to offer better cancer treatments for its patients.

While it’s still too early to know what the result of the fight in northeast Missouri will be, it’s important to recognize what’s happening. As a result of the veto power afforded by Missouri’s CON laws, instead of Missourians having greater access to valuable cancer treatments in northeast Missouri, neither the hospital in Kirksville nor the one in Hannibal will be allowed to offer expanded services. In other words, Missouri patients lose.

Unfortunately, sometimes it takes a real-world example to illuminate the costs that Missouri’s CON laws impose on the state’s patients. It’s long past time for Missouri to repeal its CON. As long as the state’s incumbent healthcare providers are allowed to pick who their competitors are, Missouri patients will continue to suffer.

The post CON-sanity appeared first on Show-Me Institute.

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.

The post Repeal Certificate of Need For the Health and Welfare of Missourians appeared first on Show-Me Institute.

The post House Bill 777: Certificate of Need appeared first on Show-Me Institute.

But while the jury is still out on whether society-wide lockdowns really work to stop pandemics, the jury is not out on the importance of supply-side health care reforms: supply-side health care reforms work, and they help patients.

Of course, we’ve made this point often, and one reform we have emphasized in particular is Certificate of Need (CON) repeal. In short, a CON law “gives government the power to manage competition in a given industry through the allowance, or disallowance, of new providers, facility expansions, or certain services as defined by the law.”

In Missouri, the health care facilities covered by the state’s CON law include nursing homes and hospitals, and competing hospitals and care centers are included in the process of deciding whether to allow new competitors into their health care markets. The economics here are simple: more competition means more choices, which puts downward pressure on prices. That’s good for customers and their pocketbooks, but naturally, incumbent hospitals and other care centers would rather have less competition.

But just because hospitals and other care centers might not want competition doesn’t mean the government should be empowered to prevent it. Imagine if grocery stores, or gas stations, or restaurants had a say in deciding whether consumers could have new options for groceries, gas and dining. It’d be bizarre, anti-market, and anti-consumer. Yet, this is how large swaths of Missouri’s health care market operate, and this system survives at least in part because most of the public doesn’t realize what’s happening.

Supply-side health care reforms like interstate license reciprocity have both immediate benefits for combatting a pandemic as well as long-term access benefits beyond the pandemic itself, and such a reform was very popular because the benefits were immediate and easily explainable. But it’s important for legislators to start considering long-term supply-side reforms, like CON repeal, that may have been a low priority during the pandemic because the benefits would be slower to materialize. Fortunately, several bills have been filed for 2023 that would repeal the state’s CON law; I hope they fare well in the coming year.

Something that sounds like “hospital construction reform” may be a low priority when people are being exposed to a lethal respiratory disease, but policymakers should prepare our health care system for the (hopefully) vast period of time between now and the next pandemic, when more typical health care needs will need to be met and the price for care will be an acute concern for payers. Competition in health care is a good thing for patients’ wallets, and Missouri should repeal its CON law to ensure the state’s health care market is as competitive as possible.

The post Certificate of Need Repeal Must Become a Legislative Priority appeared first on Show-Me Institute.

Bizarre, right? I thought so and wrote a whole paper about it. The good news is CON laws are falling out of favor across the country, and there are rumblings in the Missouri Legislature that CON elimination could be a major priority in 2022. The bad news is it isn’t 2022 yet.

In the meantime, the old and broken system lingers, and as The Missouri Times reported this week, seasoned health care providers who want to serve Missourians (or just serve them better) are still having to go hat in hand to beg the government to let them offer care for people. Indeed, the Health Facilities Review Committee (HFRC), which grants or denies certificates, was back at work, and the absurdity of the system was once again front and center.

Among the lowlights, an hour-long debate over a pair of proposed senior living facilities in St. Charles County stands out. Opponents argued that the new facilities would pressure existing providers to find quality employees, presumably because the newer facilities would pay better and would, of course, be newer. (“Competition for staff” is a common objection at these hearings.) Opponents also argued that a lot of certificates of need had already been issued in the region, but the holders of many of those certificates haven’t opened facilities yet and thus a certificate shouldn’t be issued here.

In other words, opponents wanted the application denied not because there were too many facilities serving St. Charles County, but because there were too many certificates. What nonsense.

And then there are the applications to add or upgrade existing equipment.

Barnes-Jewish in St. Peters needed to ask the HFRC for permission “to replace its cardiac catheterization lab where doctors work to restore blood flow after a stroke” with a new $2.8 million investment. It was approved. A cancer center in North Kansas City was approved for a “$2 million replacement for its PET/CT system which administrators said was lacking.” It was approved. A Kansas City area provider wanted to add a $2.6 million MRI unit. Approved. Obviously.

Again, why is the state involved in this at all?

The idea that the government has any business interfering with qualified health providers creating or upgrading facilities is absurd and counterproductive to the public interest. I’m hopeful that next year will be the year that CON requirements are finally eliminated in Missouri. It’d be a great thing for providers and patients alike.

The post Missouri’s Health Facilities Review Committee Shouldn’t Exist appeared first on Show-Me Institute.

Few would have guessed what 2020 had in store for us, and fewer still need the challenges of last year recounted in detail. Missourians have faced threats to our health and to our democracy, to our communities and to our safety, and indeed to the health and continuity of our social and political institutions. Missourians rose to meet these challenges—challenges often imposed by their own state and local governments—and they succeeded in spectacular ways. Yet there are more obstacles to overcome, more work to do, and more reforms to pursue.

Indeed, great progress can happen in the face of great adversity. With this in mind, we offer our own “State of the State” today, looking backward not only at what Missouri was and has been, but forward with hope to what it is and still could be.

The coronavirus pandemic of 2020 was the biggest story of the past year, and the public education system’s response led to many of the state’s most severe and costly policy failures. And yet, most of the problems in Missouri’s educational system were only aggravated by the pandemic, not rooted in it: the lack of transparency and accountability throughout the educational system, and especially at the State Department of Elementary and Secondary Education (DESE); the inflexibility of the public school system, revealed in its inability to meet the individual needs of students; and the state’s failure to lead or even to follow other states in expanding charter schools and school choice.

The evidence is clear: wholesale reform must come to Missouri’s public schools. In the 2018–19 school year, less than half of Missouri students tested were proficient in Math and Language Arts. On the National Assessment of Educational Progress (NAEP)—a Congressionally mandated nationwide assessment of education systems in America—Missouri 4th-graders have dropped from the top half of the country for reading and math in 1996 to the bottom half today.

These failures didn’t happen all at once, but 2020 forced the problems into the spotlight. Today, 27 percent of parents report that they feel their children are now behind academically, compared to less than 7 percent before last year. Nearly 3 in 10 parents no longer trust their public school system to make decisions that are in the best interest of their children’s education.

Facts matter, and the fact that Missouri parents are losing faith in Missouri schools should alarm policymakers.

How will Missouri meet this challenge? Now more than ever, it is critical that the legislature provide all Missouri students and their families with choices for their education. Parents must have the opportunity to educate their children in other ways if they believe traditional district education is failing them.

To deliver on its education promises to parents and children, the state must pass three key reforms.

First, the state must create education savings accounts (ESAs) that give parents flexible access to a portion of their children’s public education dollars that can be used for other educational resources better tailored to their children’s needs.

Second, the state must unleash the power of charter schools by removing restrictions that unduly restrict their creation and by implementing school choice reforms, like Missouri Course Access (MOCAP), that are already the law. Specifically, the state must designate MOCAP as an independent local education association or charter school and get districts out of the equation.

And third, DESE must finally be the adult in the room and hold schools and districts accountable for what they have and have not done throughout this pandemic.

Especially in districts that have been unable or unwilling to reopen for traditional learning, parents and kids must have the opportunity to go elsewhere to ensure their educational needs are met. These three reforms would help meet not only the challenges of the pandemic today, but the challenges of the modern economy for years into the future.

At the core of the pandemic has been, of course, a health care crisis, and fortunately some headway was made last year in the face of these health care challenges. Thanks to the hard work of Rep. Derek Grier and the support of other public officials and stakeholders, Missouri took an important step in 2020 and removed licensing barriers that prevented out-of-state licensed professionals of all kinds, and health care professionals in particular, from readily providing services to Missourians. Moreover, Gov. Mike Parson acted wisely in ordering the relaxation of the state’s telemedicine and scope-of-practice regulations to better meet the needs of medical management in response to the pandemic.

These supply-boosting measures should be made permanent this year, and they should be the starting point for other necessary reforms. Along with making permanent the state’s telemedicine and scope-of-practice reforms, legislators must repeal Missouri’s certificate of need law, which unnecessarily caps hospital competition in the state, and they should take steps to deregulate health insurance to ensure that Missourians have ample choice and reasonable pricing in their health insurance products. Further, Medicaid will pose a policy and budgetary challenge to the state in the years ahead; legislators will need to work earnestly to mitigate its damage to other state priorities.

Damage to the state economy can happen in other ways, too, and nowhere is this more clear than in the condition of Missouri’s roads. Missourians depend on our roads to get to their jobs and to get their children safely to school; indeed, Missouri relies heavily on transportation for economic growth. Transportation and warehousing businesses employ over 83,500 Missourians, and over $700 billion of products travel over Missouri’s roads and bridges each year. These numbers are only expected to rise, and we cannot let an asset as important as our roads deteriorate through neglect.

Unfortunately, the Missouri Department of Transportation, or MoDOT, says it only receives a little more than half of the revenue it needs to maintain Missouri’s roads and bridges, both now and in the future. Notably, Missouri’s gas tax has not been raised since 1996 and is currently the second-lowest in the country. Toll roads, which work for Missouri’s neighbors, are an option that should also be considered here. Increasing user fees—to make sure that those who use the roads pay for them—is the fairest and best answer to address Missouri’s infrastructure funding problems.

Yet not all state “needs” for revenue are created equal. While increases to user fees in transportation might happen without a tax reduction elsewhere to help resolve MoDOT’s structural funding problems, that carveout from the principles of revenue neutrality and overall tax reform should be an exception, not the rule.

For instance, Missouri remains one of a dwindling number of states that does not require a sales tax on all out-of-state purchases. While proponents suggest, reasonably, that instituting the tax would “level the playing field” for local businesses, it also would increase the tax burden on the people of Missouri. Businesses don’t pay these taxes; Missouri’s families do.

Accordingly, the discussion about a new internet sales tax should start with revenue neutrality as its goal. No time is a “good time” for tax increases, and legislators should not think that hiking taxes as a way to generate new revenue during a pandemic and economic downturn is “good timing.” Taxes should sustain services, not backfill shortfalls, and the state should not impose new taxes on suffering families to solve its temporary, though difficult, budget problems.

And while legislators are “under the hood” of the state’s sales tax system, they should advance an array of other important sales tax reforms.

Those reforms should include a sales tax cap that puts a limit on how many layers of local taxes can be piled on Missouri consumers; the repeal of dining taxes; the reform of special taxing districts so that such projects can’t be used as fiefdoms of the private sector backed by the taxing power of government; and the movement of tax increase votes to November elections to ensure the will of residents is best represented in these elections.

But if state government really wants to help smaller retail businesses—to “level the playing field,” as we’re told internet sales taxes would do—it should start outside the realm of tax policy, by protecting Missouri businesses from the sorts of destructive, asymmetric lockdown orders that have crushed countless entrepreneurs across the state during this pandemic. We see no reason based in public health for allowing casinos to offer blackjack at all hours of the day while restaurants can’t offer dining; nor do we understand why, if Walmart can continue to sell shoes, competing shoe stores cannot also remain open.

No doubt, government officials have had to make hard choices, but they shouldn’t make those choices on the back of small business and to the benefit of their larger corporate competitors.

At the Show-Me Institute, we advance government policies that expand freedom and enrich the lives of our citizens. We also recognize the obstacles erected by special interests inside government itself that, unfortunately, can stand in the way of the public interest. Whether called rent-seeking, cronyism, or soft corruption, such barriers to freedom and the free market are wrong and must be fought at every turn. We’re happy to continue this fight on behalf of Missouri taxpayers.

In closing, here in her 200th year as a state, we’re happy to report that Missouri is strong and her citizens are resilient.

But she can be made stronger and more resilient. Much remains to be done, whether in education, or health care, or transportation, or taxation, or the fight against cronyism. We are more determined than ever to continue our efforts to make our state better, hold our leaders accountable, and offer greater freedom and a better life to our fellow citizens.

The post 2021 Show-Me Institute State of the State appeared first on Show-Me Institute.

Governor Parson has already taken two important steps to prepare Missouri’s health care supply for the coming surge in demand. A little more than a week ago, he waived multiple regulations that were preventing able providers from caring for Missourians. But as my colleague Patrick Ishmael and I have outlined, more action is needed to respond to COVID-19.

The next step is to allow providers to care for their patients to the full extent of their training. For example, if there were a shortage of doctors, and a nurse, medical student, or pharmacist could capably provide a service that had traditionally been delivered by a physician, the law should allow it. Reforming Missouri’s scope of practice laws would expand the state’s capacity to deliver medical services in a crunch. The governor has made some progress on scope of practice issues already by waiving the 75-mile requirement for APRNs and their collaborating physicians, but further steps, like appropriately allowing pharmacists to prescribe some medications, should be pursued.

Policymakers should also consider reducing the government-imposed barriers that are limiting available health care resources. Specifically, Missouri’s certificate of need (CON)laws (laws that require health care providers obtain government approval before opening health care facilities) hamper the response to COVID-19 by making it more difficult to build new (temporary or permanent) facilities. Missouri should follow the lead of the at least 18 other states that have suspended some portion of their CON laws in response to the coronavirus. Abolishing these barriers permanently would allow hospitals or other providers to build the facilities they believe communities need—not just the ones the government says the community should have.

Finally, the public health crisis and resulting economic downturn have highlighted the need for increased access to affordable health coverage. As many Missourians deal with the loss of their employer-sponsored health coverage and other income, it is essential they have access to a range of insurance options. Reforming state regulations on traditional coverage plans and also extending the duration of short-term medical plans would help ensure that Missourians have access to coverage that meets their needs while helping to mitigate financial risk.

Missouri will likely continue seeing increased need for health care resources over the coming few weeks, and there are policy responses that can help weather the storm. Here’s to hoping Missouri’s elected officials rise to the occasion by making the regulatory and legislative changes needed to help protect our state’s residents during this trying time.

The post More Policies to Fight COVID-19 appeared first on Show-Me Institute.

Providing health care for the most vulnerable Americans is a laudable goal, but making countless other Americans financially vulnerable in the process by dramatically increasing their insurance costs is not a result that should be celebrated.

Health insurance should not, at its core, be a maintenance plan. It should be insurance. And it should hardly ever be one size fits all. Unfortunately, limited flexibility in insurance plans was and is a signature feature of ACA plans.

It’s why short-term medical (STM) insurance plans are an important component of a fully functional health insurance marketplace. STM plans provide less coverage, but have much lower premiums than the more comprehensive and maintenance oriented ACA packages.

The importance of STM plans is why I hope that Missouri legislators will continue talking about these plans in 2020 and reforming the law to comport with the STM reforms pushed at the federal level last year, which would mean extending the terms of such plans to a new one year maximum. For several years now, I have supported greater liberalization of Missouri’s health insurance markets, including but not limited to its STM insurance market. Along with Certificate of Need reform, Missouri policymakers have two attainable health reform options that they can pursue immediately and without further federal action.

The post Will Missouri Reform Its Health Insurance Regulations in 2020? appeared first on Show-Me Institute.

The existential risks of an unreformed Medicaid program are not, however, the only health care issues that Missouri should grapple with next year.

• Earlier in 2019, I published a paper on the state’s Certificate of Need law, which can dictate where hospitals and other care centers open, and how readily Missourians can access important health care services. Missouri’s CON law should be repealed.
• I have talked about short-term medical insurance reforms for a long time as yet another option to provide consumer choice and economic value. Policymakers should reduce the mandated coverage requirements on Missouri health insurance products generally, but they should be especially careful about harmonizing Missouri’s short-term medical insurance market with the new rules instituted at the federal level early in 2018.
• Elias and I have also talked about other reform options, including reassessing the state’s scope of practice regulations, taking a fresh look at our medical licensing laws and pursuing innovative health care shopping incentive programs, both in public and private.

There will be many important items on policymakers’ legislative agendas in 2020. Medicaid reforms should be a high priority—not only as a health care priority, but as an issue that will affect the state’s financial health well into the future. But legislators should also not forget that great progress can be made for Missouri patients through other legislative changes, and I hope these largely modest reforms make their way onto the agenda.

The post Legislators Shouldn’t Neglect Health Care Reform Opportunities in 2020 appeared first on Show-Me Institute.

This essay presents the original rationale behind Missouri’s certificate of need law, explains how the law is implemented, and marshals both theoretical argument and empirical evidence to show that certificate of need law has, unfortunately, achieved the opposite of its intended effect in the Show-Me state. To read the entire essay, click on the link below.

The post End Certificate of Need in Missouri appeared first on Show-Me Institute.

• Certificate of Need Laws
• Medicaid Reform
• Public School Accountability

Click on the link below to read more.

The post Show-Me Institute’s March 2019 Newsletter appeared first on Show-Me Institute.

But rounding out the card is the important issue of Certificate of Need (CON). CON laws allow governments to prevent medical facilities from opening, expanding or providing certain services should a given activity fall under the oversight of the CON law. Want to open a new hospital or senior center? Considering a new investment in an existing facility? Unfortunately, the state of Missouri might just have the power to stop you.

In the next month or so we’ll release a paper that provides greater detail about what CON laws affect, here and around the country, but the argument against such laws can be summarized succinctly:

CON laws subvert the marketplace, replacing consumer health care decisions with those of bureaucrats—whose interests are not always aligned with consumers.

In an environment where health care prices continue to rise, it is bizarre that Missouri would maintain a system that places upward pressure on costs. Missourians need greater supplies of, and greater options for, medical goods and services; CON laws are an enormous barrier to that objective.

Currently there’s a minor constellation of CON repeal bills that have been introduced in the legislature, and it remains to be seen which one will break through and get the most attention. There are also a few bills that would “reform” the CON system, which simply constitute a reshuffling of the law. To put it plainly, you can repaint a car that’s a piece of junk, but under that paint job, it’s still a piece of junk. And that’s what CON laws are: junk. They hurt patients, benefit incumbent providers and disadvantage new market entrants.

Given this story about a recent hearing on CON repeal, it seems pretty clear that the providers benefiting from the current system would prefer the illusion of reform rather than the real thing. That’s understandable—they get an advantage under CON, albeit to the detriment of consumers. But allowing that to continue is wrong for Missouri and for Missourians. Keep it simple: repeal CON. Anything short of that is just window dressing.

The post End the Cronyism: Repeal Certificate of Need in Missouri appeared first on Show-Me Institute.

Certificate of Need (PDF): Missouri’s Certificate of Need (CON) law restricts health care competition by requiring health care providers to get state approval before entering new markets or expanding services offered in existing facilities. This restriction hampers innovative start-ups and market newcomers that would provide Missourians care and puts upward pressure on health care prices.

Charter School Expansion (PDF): Demand for charter schools in Missouri is at an all-time high. Unfortunately, charter schools are functionally limited to the Kansas City and Saint Louis School Districts. Tens of thousands of students are denied the opportunity for a better education.

Course Access (PDF): All across Missouri, students do not have access to higher-level coursework such as AP courses, calculus, or physics. A course access program would allow students to take courses outside of their traditional public school courses using a portion of their annual per-pupil funds to help pay for them.

Earned Income Tax Credit (PDF): State spending is on the rise in Missouri, led by a growth in public welfare dollars. Public welfare spending now accounts for more than 46% of total spending and 34% of spending growth. The growth in public welfare shares of total spending has eclipsed the growth of all other general expenditure functions. 

Economic Development Subsidies (PDF): Excessive use of economic development subsidies has hollowed out municipal tax bases and diverted tax revenue to specific developers. In the past 15 years, Saint Louis City alone has allocated $709 million away from municipal services through tax increment financing (TIF) and tax abatement. Studies from across the country indicate that these subsidies fail to generate promised jobs and growth. 

Education Savings Accounts (PDF): Missouri students are underperforming. On the 2015 NAEP exam, only 31 percent of Missouri 8th-graders were found proficient in math and only 36 percent were found proficient in English. For the Class of 2016, only 22 percent of Missouri ACT test-takers scored “college-ready” in all four tested subjects. Education savings accounts could help students who are trapped in failing schools via residential assignment to purchase school supplies, tutoring services, or even private school tuition.

Higher Education (PDF): The University of Missouri system, and higher education in the United States in general, are at a crossroads. Tuition is rising, resulting in over $1 trillion in student loan debt nationwide. At the same time, students who fail to secure a high-income job face serious financial consequences. As schools struggle with these crises, a rising tide of anti–free speech policy is sweeping across the higher education landscape.

Highways/Transportation Infrastructure (PDF): The Missouri Department of Transportation (MoDOT) will likely face funding shortfalls in the near future. The state will need to generate new revenue in fair and economically sound ways.

Income Tax Reform (PDF): Missouri’s economy has been stalled for almost two decades, as startup growth has slowed and entrepreneurs and taxpayers are leaving the state. Missouri is shrinking relative to other states and economies, ranking 48th out of 50 states in real GDP growth between 1997 and 2015. Individual income taxes are destructive to the state’s economic growth, productivity, and income, encouraging taxpayers to move their work or investments out of Missouri. This not only lowers economic output for the state, but also destabilizes revenue for state and local governments.

Open Collective Bargaining (PDF): Under current Sunshine Law in Missouri, government bodies may close meetings, records, and votes relating to contract negotiations until the contract is executed or rejected. This lack of transparency in negotiations between government unions and government officials can lead to contractual agreements that aren’t in the public’s best interest.

Prevailing Wage (PDF): Many government construction contracts dictate what potential contractors must pay workers. This can put projects out of reach financially for taxpayers, and can also hurt laborers by denying jobs to people who can do them at a more competitive price.

Public Pension Reform (PDF): Defined benefit (DB) pension plans promise employees annual payments for life upon retirement, but if a public plan does not have enough money to make these payments, taxpayers can be forced to fund the difference. Pension plans can come up short if they fail to make sufficient contributions or overestimate their investment returns. Nationwide, state and local public pension funds are underfunded by more than $1 trillion dollars.

Public Union Recertification (PDF): Once a government union comes to power, it can stay in power indefinitely. No further elections are scheduled and no term limits are imposed. This means workers can do little to ensure their union truly represents their interests and is held accountable.

Right to Work (PDF): Until last year, many workers in Missouri could be forced to join unions. That was unfair not only to the employees disempowered by the law, but also to employers who had to operate under it. Governor Eric Greitens signed right to work legislation into law on February 6, 2017, but in 2018 the state will hold a referendum on that law.

Sentencing Reform (PDF): High crime and incarceration rates present a significant cost to taxpayers, and imprisoning minors is especially expensive. Relaxing harsh and automatic sentencing laws for minors—while still allowing judges to try minors as adults for especially serious crimes—could reduce costs while increasing public safety.

Special Taxing Districts (PDF): Special taxing districts are political subdivisions formed to fund specific services and improvements such as fire protection and infrastructure. In practice, however, they often allow narrow special interests to tax the public for their own private gain while allowing little or no public input or oversight.

The post 2018 Blueprint: Moving Missouri Forward appeared first on Show-Me Institute.

THE SOLUTION: Repeal the Certificate of Need law.

Eliminating CON requirements would allow Missourians to benefit from true marketplace competition in the health care arena.

WHO ELSE DOES IT? California, Colorado, Idaho, Indiana, Kansas, New Hampshire, New Mexico, North Dakota, Pennsylvania, South Dakota, Texas, Utah, and Wyoming have no CON law.

THE OPPORTUNITY: Missouri would join a growing list of states that have opened the door to real health care competition.

KEY POINTS

• CON laws separate patients who need care from doctors who want to provide it.
• More competition would create pressure to reduce health care prices.
• Missouri would be able to compete with nearby states, including Kansas, where smaller hospitals are opening up because they aren’t restricted by CON laws.
• CON reform is an opportunity to help communities threatened by the loss of existing hospitals.
• Ending CON would empower patients to make choices that benefit their families, rather than support the government-backed competitive advantages of hospitals.

SHOW-ME INSTITUTE RESOURCES

Essay: Demand Supply: Why Licensing Reform Matters to Improving American Health Care

Blog Post: Missouri’s Certificate of Need Law Needs to Go

For a printable version of this article, click on the link below. You can also view the entire 2018 Missouri Blueprint online.

The post 2018 Blueprint: Certificate of Need appeared first on Show-Me Institute.

I was a little disappointed that the Missourian also went out of its way to portray many NoMORedTape respondents as somehow not grasping the purpose of the site, incharitably citing some of the least informed comments in its article while omitting serious responses. Indeed, I’ve found the vast majority of the comments to be enlightening.

Comments like:

I did not renew my minority women status because they made it so difficult. Faxes are no longer acceptable and the instructions were in a format that I could not open. When I used the password given me it was not acceptable. I gave up because I had no more time to spend on it.

And:

“Certificate of Need” process makes developing critically needed Senior Living buildings a political instead of market-based process. It is costing Missouri many millions of dollars of development. Our $35,000,000 development was just denied Monday in Jefferson City by anti-competition, anti-market political forces. Eliminate the “Certificate of Need” process entirely like almost ALL other states in our Union.

And:

Currently the Missouri Dept. of Elementary & Secondary Education has too strict of rules for teacher and administrator certification, specifically for CTE professionals. In a time when we need more qualified candidates, they are often discouraged by the process.

And:

The University requires vendors to have Liability insurance that covers the University Curators. We print t-shirts, when has anybody sued over a t-shirt? 4 million dollars of liability insurance! This increases our costs and limits the smaller players or unnecessarily burdens the smaller players.

And so on.

Point being, regulatory reform is a serious issue that many serious people take seriously. I hope that public colloquy projects, like NoMORedTape, become more common, not less so, and I appreciate the public policy dividends NoMORedTape has already realized by engaging the public as it has.

The post NoMORedTape Respondents Seek Hundreds of Regulatory Reforms appeared first on Show-Me Institute.