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.

Listen on Apple Podcasts: https://apple.co/2G3INVh

Grace-Marie Turner is president of the Galen Institute, a public policy research organization that she founded in 1995 to promote an informed debate over free-market ideas for health reform.

She has been instrumental in developing and promoting ideas for reform to transfer power over health care decisions to doctors and patients. She speaks and writes extensively about incentives to promote a more competitive, patient-centered marketplace in the health sector.

The post SMI Podcast: The Case For Choice In Health Care appeared first on Show-Me Institute.

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Unfortunately, bad policy can also recur like an eclipse—and sadly, not nearly as infrequently as Kansas City’s two-hundred year solar eclipse cycle.

Seven years ago, Congress passed the Patient Protection and Affordable Care Act (or “Obamacare”) on a party-line vote and into law. Not only has that law disrupted the health care of millions of Americans—particularly rural Americans—but it has doubled down on a broken status quo that puts “insurance” at the center of our health care system rather than care. Forcing people to purchase value-questionable comprehensive insurance plans as a stand-in for actual care has not worked so far, and it will not work in the future.

But what’s especially frustrating is that some of the same folks who made Obamacare the law of the land now want to commit even further to a government-centric approach to health care policy, labeling it “bipartisanship.” I submit that bipartisanship that views government as the white knight of health care is not an appropriate compromise position, nor is it the solution to our country’s health care problems. The market is.

Market solutions to health care require reliable pricing signals established by the transacting parties, not the continued reliance on a third-party negotiator for services that has affected care quality, cost, and access over the last half-century. That means disintermediating insurance in our health care system. It means massively overhauling Medicaid to ensure our most vulnerable receive the care they need and that the program doesn’t bankrupt us in the process. It means clearing the way for people to freely help one another through licensing and regulatory reform. It means, in other words, often doing precisely the opposite of what Obamacare supporters want government to do—rather than get government more involved in our health care, it means getting it less involved.

I hope that good policy won’t be eclipsed by a broken Obamacare health care system that continues to hurt millions of Americans. But I especially hope the bad policies driven by Obamacare aren’t exacerbated yet again by another cycle of bad government-centric policy, now seven years on from its last appearance. We’ve seen these mistakes before, and we don’t really need to see them again.

The post Obamacare’s Total Eclipse of Bad Policy appeared first on Show-Me Institute.

But as has been said, a journey of a thousand miles begins with a single step. The House’s action today is an important step of a longer journey, not only at the federal level but among the states as well. From licensure reciprocity to direct primary care promotion to Medicaid reform, the list of projects to be undertaken by free marketeers at the state level is a lengthy one that would never be accomplished in a single law, federal or otherwise. Indeed, ours is a policy journey that will span years and even decades to reach anything resembling completion.

That said and with the initial passage of the AHCA, I am hopeful that the federal government is commited to taking that long and important policy trip with us.

The post House Vote The First of Many Important Health Care Milestones appeared first on Show-Me Institute.

Along with noting the FMMA’s existence, there’s also a reason worth teasing out for why the FMMA held its first conference in Oklahoma City. The short answer is “it’s where the FMMA’s organizers are based,” but a more complete answer is it’s where some very interesting free-market business models are being put into practice.

Advocacy of free market health care is the longtime passion of Dr. Keith Smith, co-founder of the Surgery Center of Oklahoma [and the FMMA]. The center began to post fixed prices for common medical procedures years ago, and has provoked widespread admiration within the medical profession for efficiency, reasonable cost and frequent support for those who are less fortunate.

At the Surgery Center, Dr. Keith Smith and Dr. Steve Lantier have established an operational structure and market-oriented billing as explicit alternatives to the third-party payer systems that now dominate U.S. health care.

The center posts online an up-front price for medical procedures in diverse areas of practice, including orthopedics, ear/nose/throat, general surgery, urology, ophthalmology, foot and ankle, and reconstructive plastics. In all, a total of 112 procedures are listed.

Translation? Transparent pricing plus direct pay works out to a pretty good business model premised on competition and service. Price transparency is huge because it’s generally pretty difficult to price shop in the U.S. health market, in part because the third-party payer system disincentivizes it, and because many providers aren’t willing to publish those prices. That makes it difficult to force prices down through competition. Posting prices should be common practice in the industry; unfortunately, it’s not.

It’s good to see folks in the movement getting organized when it comes to demonstrating that, yes, free-market reforms to health care do exist and can work. In the coming months, Show-Me readers will hear a lot more about free-market health care alternatives. Stay tuned.

The post Free-Market Health Practitioners Get a Group appeared first on Show-Me Institute.

In his 2006 book The Audacity of Hope, then-U.S. Sen. Barack Obama was correct when he called America’s Medicaid system “broken.” Unfortunately, the program remains broken almost a decade later; from busting state budgets to delivering substandard care and access to our most needy, Medicaid serves as an important reminder that spending is no substitute for reform.

More spending, however, is exactly what some in Jefferson City want. Repackaged as a “Medicaid Transformation,” the Medicaid expansion element of the president’s health care law is being rebranded because “the Obamacare Medicaid expansion” — which is what it is — would never fly with the public.

Missourians recognize that, rather than expansion, Medicaid needs reform. Free-market ideas can take us in a better direction to deliver improved care to the less fortunate while also better serving the taxpayers who fund the program.

Free-market Medicaid reform principles aim to empower individuals, improve access and services for the needy, address problems of bureaucratic waste and leverage market forces to improve care for all. Indeed, markets have helped to make all sorts of goods and services less expensive and more available in many areas of our lives. They can do the same for health care.

Here are some ideas the state should be considering to make Medicaid better.

First, empower Medicaid’s patients. An important Oregon study suggests one of the few health benefits of Medicaid enrollment is the knowledge that an enrollee will not become bankrupt if the worst happens. With that in mind, Missouri should convert much of its Medicaid program into government-held health savings accounts (HSAs), splitting current Medicaid spending levels among the beneficiaries. After purchasing at least a catastrophic health care plan, beneficiaries could roll over any remaining money from year to year. This would provide the safety net Medicaid was supposed to be while still allowing patients to tailor their spending to their needs. One size does not fit all when it comes to health care. The state should stop acting like it does.

Second, give Medicaid enrollees an incentive to leave the program. Another Oregon study found that rather than decrease unnecessary emergency room use, Medicaid enrollment actually increased it. As a reform, then, if an enrollee abides by the program’s rules and avoids wasteful ER use, the enrollee could take some percentage of the remaining money with him or her when leaving the program, either as a private HSA or as a reduced amount in cash. This would help both the patient and the taxpayers: It would reward the Medicaid enrollee for healthy and fiscally prudent behaviors and reduce taxpayers’ costs.

Third, with so many newly minted, price-conscious Medicaid consumers, implement price transparency measures for common medical procedures. The federal government has started the process of forcing greater hospital price transparency, but states have done a poor job of empowering customers with the information to shop for health care like they can for cars, homes and even Lasik eye procedures. This also would reduce Medicaid access problems; rather than enrollees having to find providers who accept Medicaid patients, Medicaid beneficiaries could go practically anywhere with their HSA accounts.

Finally, pursue regulatory reforms of “certificate of need” and “scope of practice” laws, areas of regulation that often act as needless barriers to patient care. Along with ensuring prices are as transparent as possible, the state should make sure care is as accessible as possible through as many places and people as possible. Well-researched regulatory reforms that remove unnecessary obstacles to care would help both the poor and middle class.

To be clear, these ideas are meant to contribute to the Medicaid reform conversation, not end it. But that is what the conversation in Jefferson City should be about — reform, not expansion. It is time for the state deliver on its promise of a better Medicaid program.

Patrick Ishmael is a policy analyst at the Show-Me Institute, which promotes market solutions for Missouri public policy.

The post Expansion Is Wrong Move For Medicaid appeared first on Show-Me Institute.

What would be a better way to deliver this care? Here are some ideas:

• The state currently spends (roughly) between $3,000 and $5,000 on each child and adult enrolled in the Medicaid program. Split the current level of Medicaid spending into the equivalent of state-held health savings accounts (HSA) that the beneficiary controls. After the purchase of at least a catastrophic insurance plan, the enrollee could decide what additional health services he or she needs to spend money on, if any. Leftover money could be rolled over year to year, meaning beneficiaries wouldn’t feel compelled to use or lose those health dollars unnecessarily.
• Give enrollees a reason to leave the Medicaid program on their own. If a Medicaid patient complies with the regulations of the program — high among them, to not use emergency room services unnecessarily — then the patient could take the bulk of the leftover money when he or she exits the program, either as an HSA or as a reduced amount in cash. Indeed, beneficiaries would have something to gain by leaving Medicaid.
• Health insurance is insurance first, not a health plan. One of the few benefits found in an Oregon study on Medicaid was that enrollees felt financially secure after they joined the program. Not only can Medicaid reform of the nature described above provide that security, it can do it at a lower cost and with greater flexibility for the patient.
• Sow the seeds of even wider, positive health care reforms. A market-based reform of the kind articulated here would inject thousands of cost-conscious consumers into the health care marketplace who are not only empowered to negotiate for the services they need, but have the incentive to negotiate.

That’s where I would start Medicaid’s reformation. You can call these ideas a free-market solution or a transformation, but most importantly, I think you could call it a vast improvement over what we have now. Medicaid needs to be reformed first and foremost, and failure to do so will hurt all of its stakeholders. Patients and taxpayers deserve better than the status quo; I think these proposals would help to move the reform discussion and the Medicaid program in the right direction.

The post What Would A Free-Market Medicaid Reform Look Like? appeared first on Show-Me Institute.

How controversial is the tax? By Kansas City standards, more controversial than most. Early last year, The Star‘s Yael Abouhalkah asked readers in an editorial, “How tough is it to kill a tax in Kansas City?” His case in point: the “temporary” health levy now up for renewal. Kansas City is one of the highest-taxed cities in the country. If the extra health levy is allowed to expire, it would be a small but important step for the city to get back along the path of tax sanity. Whether city officials will support its expiration is another matter.

But for its part, The Star‘s editorial board is not convinced the tax should be renewed, and I have to agree. Many Kansas City families’ budgets will already be tighter in 2013 than they were last year, especially with the uptick in the payroll tax, which Washington’s “fiscal cliff” deal did not address. Who is looking out for them? And is the renewal of this tax the best use of tax money for a city that is already heavily taxed? To their immense credit, Kansas City’s citizens have made the city one of the most philanthropic. It would be better to rely on the demonstrated generosity of individual Kansas Citians to support Truman’s programs rather than to force Kansas City’s families into subsidizing Truman’s programs through taxation, particularly during these difficult economic times.

We can all agree that fundamental health care reform must come to the region and to the country, but this tax and the federal Affordable Care Act do not get us there. Missourians need free market-based health care solutions that deliver power to the patient, not the government, and we need to actually get treatment costs down for everyone through the power of competition. The extra health levy does not fix our health care problem. It just papers it over.

The post Extra Health Levy In Kansas City A(nother) Tax Too Far appeared first on Show-Me Institute.

• A look at the Show-Me Institute’s new policy questionnaire, “Principles or Politics?”
• A message from Executive Director Brenda Talent
• We profile the three latest additions to the Show-Me Institute staff.
• Fellow Andrew Wilson reports on how the latest tax changes in Kansas will impact Missouri jobs.
• Why Charles Willey, M.D., tireless advocate for free-market healthcare reforms, supports the Show-Me Institute.
• A review of Road to Freedom: How to Win the Fight for Free Enterprise, the latest book by Arthur Brooks, who recently spoke in Saint Louis at a Show-Me Institute co-sponsored event.
• Education Policy Analyst James Shuls reports on how Missouri’s schools are “stuck in the middle” in terms of academic achievement.
• An overview of some of our scholars recent appearances on broadcast media.
• An article on the recent effects that TIF and eminent domain have had on the Saint Louis County neighborhood of Hadley Township

The post Show-Me Newsletter: 2012, Number 3 appeared first on Show-Me Institute.