Blueprint for Missouri

Issue Area 01

Economy

An economy that works for Missourians allows people to earn a living, invest, and start businesses.

3 Policies

Issue Area 02

Education

Missouri’s education system should empower families with real choices, operate transparently, and hold schools accountable for results.

5 Policies

Issue Area 03

Health Care

Health care should be easier to access, easier to understand, and more affordable for patients.

2 Policies

Issue Area 04

State and Local Government

Governments should be transparent, responsible with taxpayer money, and focused on essential services.

7 Policies

17 Policy Recommendations

The full Blueprint

Each policy is a self-contained working document: the problem, the evidence, the proposal.

Economy

3 Policies

Occupational Licensing

Cut barriers that keep Missourians out of the trades they’re qualified to enter.

Economic Development Subsidies

Stop picking winners; reduce TIF, tax-credit, and grant programs that distort markets.

Nuclear Energy

Permit, build, and operate small modular reactors to meet Missouri’s grid demand.

Education

5 Policies

Statewide School Choice

Empowering families with real options across public, charter, and private pathways.

Education Funding Formula

Reform the formula so dollars follow students and incentives reward outcomes.

School Report Cards

Plain-English accountability metrics every parent can read and act on.

Missouri Parents’ Bill of Rights

Codified rights to records, curriculum, and meaningful participation.

Early Literacy

Evidence-based reading instruction beginning in kindergarten.

Health Care

2 Policies

Free-Market Healthcare Reform

Direct primary care, telemedicine, and association plans as real alternatives.

Healthcare Price Transparency

Prices posted, plainly, before treatment — by procedure, by facility, by physician.

State and Local Government

7 Policies

Income Tax Reform

Flatten brackets, broaden the base, and lower the rate Missourians actually pay.

Property Tax Reform

Caps, exemptions, and assessment fairness for Missouri homeowners.

Budgetary Reform

Bring obligations back into line with revenue, not the other way around.

Taxpayer Bill of Rights

Codified protections so Missourians know what their tax dollars can — and can’t — do.

Office of Government Efficiency

An accountable, mission-specific office to audit how state government actually runs.

Local Government Transparency

Open records, open meetings, and open budgets — by default, not by request.

Welfare Reform

A welfare system that helps Missourians rise, not one that traps them at the bottom rung.

The post Blueprint for Missouri 2026 appeared first on Show-Me Institute.

Over the past several months, I’ve written about the many changes coming to Missouri’s welfare programs as a result of the One Big Beautiful Bill (OBBB). One of the most impactful changes involves the Supplemental Nutrition Assistance Program (SNAP). In short, if Missouri doesn’t get its SNAP payment error rate below 6%, state taxpayers will start paying for a portion of the program’s benefit costs (the federal government currently covers 100% of benefits), which could potentially increase the state taxpayer cost to $400 million per year. A similar change is coming to Medicaid.

Despite accounting for roughly one fifth of total U.S. healthcare spending, Medicaid has until now lacked stringent federal accountability for payment errors. Just last year, more than $31 billion in improper payments were made across the program according to the U.S. Department of Health and Human Services (HHS). The OBBB requires HHS to reduce state Medicaid matching payments (more here on how Medicaid is financed) starting in 2030 when improper payment rates exceed 3% of total Medicaid expenditures.

Missouri should be particularly concerned about this change. In 2022, when the state’s Medicaid program was last audited by the federal government, its improper payment rate was 4.2%, which already exceeded the new 3% threshold. And there’s little reason to believe things have improved since then. Just last month, I wrote about the recent state audit showing that Missouri lacks systems to check enrollees against death records and that thousands of recipients went years without having their eligibility verified.

The financial implications for Missouri could be substantial. With more than one in five Missourians now on the program and Medicaid already consuming a massive portion of the state budget, even a small reduction in federal matching payments could force state taxpayers to cover millions more in costs.

The good news is that Missouri has more time to address this than it does for SNAP. The bad news? Given the state’s track record on technology modernization and the sheer volume of problems that need fixing, there’s plenty of reason for skepticism about whether Missouri will rise to the challenge.

While the OBBB’s focus on program integrity might be a nuisance for state bureaucrats, there’s no doubt that a corrective measure is long overdue. Taxpayers shouldn’t be burdened with millions (or perhaps billions) in new Medicaid costs because our state can’t get its improper payments under control.

The post Medicaid’s Wake-Up Call appeared first on Show-Me Institute.

The lack of transparency in healthcare pricing means that patients don’t know the price of the treatment they receive until they get the bill and that hospitals are shielded from competition.

The Solution

Arm consumers with the information they need to make healthcare decisions.

Key Facts

• In Missouri, prices for the same service can differ widely depending on a patient’s insurance. For example, the price of a pelvic CT scan at a single hospital can vary by a multiple of 20.
• After several years of increasing compliance rates, hospital compliance with the federal price transparency rule, which went into effect in 2021, has fallen nearly 40% in the past year.

What We Don’t Know Is Costing Us

Advocates of government-run healthcare often claim that market forces do not operate in healthcare. However, they neglect to mention that competition has been artificially suppressed by a lack of price transparency. Studies have found wide variation in prices paid for healthcare procedures across regions, among hospitals, and most alarmingly, within the same hospital based on the type of insurance or lack thereof.

With total healthcare spending rising from 16% of gross domestic product (GDP) in 2007 to 25% of GDP today—and with projections estimating it will eclipse 37% by 2050—price transparency is critical for both the insured and the uninsured because it creates several ways to control costs:

• It allows patients to compare providers.
• It helps insurers negotiate lower rates.
• It aids employers in offering cost-effective plans to workers.
• It facilitates alternatives to fee-for-service payment models.
• It enables physicians to partner in cost-containment efforts.
• It forces hospitals to compete with each other on price and quality.

Hospitals Are Ignoring Transparency Rules

In June 2019, the Trump administration issued an executive order requiring hospital price transparency. Since January 2021, hospitals have been required to provide not only list prices but also negotiated charges for 300 shoppable services. Hospitals must make this information available both in machine-readable and consumer-friendly formats. However, a report from PatientRightsAdvocate.org found that, as of November 2024, only 14% of hospitals in Missouri and 21.1% nationwide are fully compliant. Alarmingly, the same website’s prior-year analysis showed significantly higher compliance rates of 25% and 34.5%, respectively. Furthermore, providers are only half of the healthcare equation; not only should all providers be subject to the same price transparency requirements, payers for services such as health plans should be required to publicly post the rates they negotiate. Until patients can be informed consumers of the care they purchase, we can’t expect to keep the cost of medical services under control.

Policy Recommendations

• By state law, require that hospitals and other healthcare providers publish pricing information to the public in user-friendly and machine-readable formats.
• Prohibit providers from pursuing medical debt collection if they are found to be noncompliant with transparency requirements.

The post Healthcare Price Transparency appeared first on Show-Me Institute.

In this episode, Susan Pendergrass is joined by Brian Blase, president of Paragon Health Institute, and Elias Tsapelas, director of state budget and fiscal policy at the Show-Me Institute, to break down the health care provisions in the “One Big Beautiful Bill.”

They focus specifically on the bill’s Medicaid provisions, including efforts to enforce eligibility checks, freeze the growth of provider tax schemes, and reduce improper enrollment. Blase and Tsapelas also discuss the reality behind claims that millions will lose coverage, the true cost of Medicaid expansion, and the perverse incentives that allow states to game the federal reimbursement system.

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Produced by Show-Me Opportunity

The post The One Big Beautiful Bill’s Impact on Medicaid with Brian Blase and Elias Tsapelas appeared first on Show-Me Institute.

Here’s an overview of some of the legislation passed this session (some of which is still awaiting the governor’s signature):

$50 MILLION FOR MOSCHOLARS PROGRAM

• First public investment in the K–12 scholarship program, with $50 million approved in the state budget
• Could triple the number of students served, expanding access to private school, homeschooling, and
specialized support

TELEHEALTH AND HEALTH CARE REFORMS: SB 79

• Improves telehealth access by allowing both audio-only and audiovisual services on any HIPAAcompliant
platform
• Expands health benefit offerings by allowing certain organizations to offer health plans to members,
sometimes referred to as farm bureau or association health plans, without many of the burdensome state
and federal restrictions that apply to traditional insurance offerings

PROTECTING PROPERTY RIGHTS: HB 595 AND HB 343

• Prohibits cities and counties from requiring landlords to participate in voluntary federal housing
programs such as Section 8 housing vouchers
• Bans caps on security deposits and restrictions on tenant screening criteria like income, credit, and
criminal history

CAPITAL GAINS TAX EXEMPTION: HB 594

• Exempts 100% of long-term capital gains from Missouri state income tax for individuals
• Applies to all individual income reported as capital gains for federal tax purposes, starting tax year 2025
• Designed to encourage investment and entrepreneurship by reducing the tax burden on productive
activity

EXPANDING LICENSE PORTABILITY: SB 150

• Expands access to temporary occupational licenses across most licensed professions in Missouri by
repealing the harmful compact exemption, ensuring that more professionals moving to Missouri can
start working without unnecessary delays
• Provides expedited occupational licenses to law enforcement spouses moving to Missouri, allowing
those licensed in another state for at least one year and in good standing to receive a Missouri license
within 30 days of applying

Download a copy of the report here.

The post 2025 End of the Legislative Session Report appeared first on Show-Me Institute.

For several years now, my colleagues and I have been writing about the benefits of price transparency in healthcare, and the fierce opposition the idea has faced in Jefferson City. Naively, I assumed that informing patients of the cost of healthcare services before they were provided would be uncontroversial. After all, what other expensive goods or services do consumers purchase without knowing what they’ll pay beforehand? But after several price transparency bills received hearings last year the points of contention became a little clearer.

During public testimony on House Bill (HB) 1837 last year, the Missouri Hospital Association stated that complying with the bill’s price transparency requirements would be financially burdensome. This was confusing because HB 1837 simply added state-imposed penalties if hospitals didn’t comply with federal transparency requirements that are already on the books. As I’ve written previously, back in 2019, the Trump administration issued an executive order requiring hospitals to publish a list of standard charges for 300 common procedures in a user-friendly, shoppable display. This was a requirement that has since been extended to health plans and was kept in place throughout the entire Biden administration.

But as I’ve also explained at length, Missouri hospitals have been reluctant to comply (at least in spirit) with the federal requirements. In the years since, state legislators across the country have begun filing bills to encourage greater compliance. At first, the Missouri bills languished in committee without receiving public hearings. Then, last year, bills received hearings in both chambers of the legislature and were even voted out of committee. Unfortunately, this year, the subject didn’t receive a hearing in the House and wasn’t successfully voted out of committee in the Senate.

It’s hard to know what changed since last year that led to the policy losing support among Missouri’s legislators, but I think it’s safe to assume that hospitals still oppose the effort. Going into next year’s session, I’ll continue highlighting the benefits of price transparency and the importance of policymakers taking action to help rein in skyrocketing healthcare costs. While it may be true that price transparency isn’t a silver bullet for all that ails America’s broken healthcare system, it’s a step in the right direction that shouldn’t be delayed because certain providers claim they can’t afford it. Missouri patients can’t afford the wait.

The post A Step Backward for Transparency appeared first on Show-Me Institute.

Congress is expected to debate a budget reconciliation package later this spring that primarily extends tax cuts passed in 2018 but also may include some federal Medicaid spending reforms. Here are a few ideas that have been discussed (keep in mind this is a non-exhaustive list, and all details are subject to change):

• Reduce “enhanced” federal match: As I explained in earlier parts of this series, the federal government is currently paying 90% of all Medicaid costs for able-bodied adults in the expansion population but only 65% for everyone else (aged, blind, disabled, etc.). Congress is considering reducing its expansion share to something closer to what is paid for the traditional population.
• Rein in financing gimmicks: In recent years, states have ramped up their use of Medicaid financing gimmicks to help pay for rising healthcare costs. Missouri is more reliant on provider taxes than almost any other state in the country. Congress is considering changing this arrangement to reduce the amount of money states can earn with these gimmicks.
• Work requirements: Show-Me Institute researchers have been writing about the potential of implementing Medicaid work requirements for more than a decade. But the federal government has rarely allowed them, and after a few court cases several years ago, it was determined that congressional action was needed for them to move forward. While it’s unclear who would be included in the requirements, how exactly they’d work, or whether they would be possible in Missouri, it’s certainly worth watching what Congress decides to do on this topic.

In the coming weeks and months, I’ll be keeping a close eye on whether Congress follows through with any of these reforms. It’s never too early to begin thinking about, if enacted, what they could mean for Missouri. There’s no doubt that the federal government reducing its spending on Medicaid could have an enormous impact on our state’s budget. But as with most things, the devil will be in the details. It will be particularly interesting to see if the federal government affords states any additional flexibility to deal with potential Medicaid changes.

In the next post of this series, I’ll discuss some of the steps Missouri’s lawmakers can take today to reform Medicaid and prepare for any opportunities in the future that could help get the state’s program back on a sustainable fiscal track.

The post Medicaid’s Check-Up: Part 5 appeared first on Show-Me Institute.

-An update on where we are in the legislative session
-The literacy crisis in Missouri’s schools
-The problems with healthcare access in Missouri
-Slow and steady progress on education reform
-Why we need to cut spending
-People want local government to handle the basics

Click here to find the newsletter.

The post Show-Me Institute’s March 2025 Newsletter appeared first on Show-Me Institute.

Missouri voters approved Medicaid expansion as a constitutional amendment in August of 2020, during the height of the COVID-19 pandemic. Due to legal challenges and various technical issues, expansion-eligible Missourians didn’t begin joining the program until October of 2021. As I stated in part one of this series, because of COVID’s impact on the program as well as the federal rules accompanying the increased funding, it’s been nearly impossible until now to fully analyze the rollout of Medicaid expansion.

Before voters weighed in on the measure, expansion supporters made several claims about how the policy would impact Missouri. At the time, I wrote repeatedly about three of their key claims with which I disagreed. First, they estimated that fewer than 250,000 people would enroll within the first year. Second, they said the expansion enrollees would be “newly eligible” for the program, which is something the federal government requires as a condition of receiving extra federal funding. And third, they said the expansion wouldn’t cost state taxpayers any money. In fact, they argued it would save money. Unfortunately, none of these projections came true.

As I also mentioned in part one of this series, prior to the pandemic, Missouri’s Medicaid enrollment was around 850,000, with about 520,000 of those being kids. Within one year of expansion being implemented (October 2022), Missouri’s Medicaid enrollment had ballooned to 1.4 million with 288,000 adults in the “newly eligible” expansion population. Today, with COVID safely in the state’s rearview mirror, program enrollment is still nearing 1.3 million total with 340,000 adults enrolled as a result of the expansion of eligibility requirements. The only Medicaid eligibility category that has seen a decline in recent years is that of people with disabilities—but that is a topic I’ll discuss in greater detail in the next post in this series.

To quickly summarize the impact of expansion thus far, enrollment has exceeded projections by around 35 percent, and current program costs are approximately 75 percent ($7.8 billion) higher than they were in 2019. The prediction that Medicaid expansion would be costless relied on Missouri being able to shift a significant portion of its costs to the federal government, which would in turn have saved state taxpayers money. Thus far, this has not been the case as Missouri taxpayers’ contribution to the state’s Medicaid program has grown by 74 percent ($1.6 billion) over the same period.

While hindsight is 20/20, it’s fair to say that the current problems with Missouri’s Medicaid program were predictable four years ago. Further, there’s no longer any reason to think today’s data represent anything other than the new normal for the program. It’s time to accept that Missouri voters were sold a bill of goods on Medicaid expansion, and it’s incumbent on our state’s elected officials to explore whatever actions are possible in the coming years to fix the problems that expansion has created.

The post Medicaid’s Checkup: Part 2 appeared first on Show-Me Institute.

Susan Pendergrass speaks with Charles M. Silver, professor at the University of Texas at Austin School of Law, and David Hyman, professor at Georgetown Law, about their proposal for reforming Medicare by giving money directly to patients instead of providers. They explain how fraudulent practices like ‘upcoding’ are draining taxpayer dollars, driving up healthcare costs, and offer solutions to reduce fraud and improve efficiency.

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Produced by Show-Me Opportunity

The post How to Reduce Medicare Fraud with Charles M. Silver and David Hyman appeared first on Show-Me Institute.

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.

The post Catching up on Telemedicine appeared first on Show-Me Institute.

For years, I’ve written about how big of a problem the Medicaid program is for Missouri’s budget. More recently, I’ve discussed our state’s broader budgetary troubles. Medicaid has long been Missouri’s single largest budget item, and the size of the program continues to only increase. Since 2020, program enrollment has increased by more than 40%, with more than 1.4 million Missourians now on the rolls. Additionally, Medicaid’s total cost has grown by nearly 80% in just four years, from approximately $10.8 billion to $19 billion.

One saving grace over this period of skyrocketing growth is that state taxpayers have been spared from the brunt of the cost increases due to an enormous injection of federal funds. This doesn’t mean that state taxpayers aren’t paying more for Medicaid today than ever before. In fact, state spending on the program has increased by more than 70% since 2020. But during that time, Missouri also experienced a tremendous run of state revenue growth, which, taken together with the increased federal funding, has meant that Missouri’s lawmakers have staved off addressing the long-running Medicaid cost problem. Going into next year, things are going to change drastically.

The federal government has ended its “enhanced” pandemic-era match for Medicaid funding. Typically, the federal government pays roughly 65% of Medicaid enrollee’s healthcare bills, but from 2021 until very recently, Missouri has received an additional 5% for adopting Medicaid expansion, and an additional 6.2% to help cover the increased program costs from the pandemic. Missouri lawmakers will have to replace the extra federal funds with state tax dollars.

This means that, without action, state lawmakers should expect the general revenue cost of the Medicaid program to increase significantly next year, likely by at least several hundred million dollars. And given that recent reports suggest that state tax revenue growth is expected to remain relatively flat, it’s possible the cost of Medicaid might even increase by more than the state’s tax collections. If that were to happen, unless reforms were made to the Medicaid program, significant budget cuts to other state spending priorities such as education, roads, or public safety would be needed to finance Medicaid’s cost growth.

Unlike the COVID-19 pandemic, the coming budgetary shortfall is entirely predictable. The federal government gave states more than a year’s warning for when it would be reducing Medicaid payments, but Missouri’s elected officials have thus far chosen not to prepare for that reality. Successfully reforming Medicaid will take months to implement, which means that time is running out if policymakers want to make the changes necessary to steer our state clear of the budgetary shortfall that’s ahead. Let’s hope state lawmakers realize this sobering truth before it’s too late.

The post Beware the Medicaid Hole appeared first on Show-Me Institute.

The post House Bill 1837: Hospital Price Transparency appeared first on Show-Me Institute.

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.

The post New Avenues for Price Transparency appeared first on Show-Me Institute.

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.

The post Expanding Interstate License Reciprocity Can Improve Access to Health Care appeared first on Show-Me Institute.

On December 7, 2023, Brenda Talent joined Mike Ferguson in the Morning on NewsTalkSTL to discuss the 2024 Blueprint: Moving Missouri Forward.

Download the 2024 Blueprint here.

The 2024 Blueprint: Moving Missouri Forward explores 16 policy areas in which common-sense reform could immediately and positively impact everyday life for Missourians. Issues covered range from education and health care to unemployment insurance and budget reform. Each article identifies a problem that affects the citizens of our state, provides background information and analysis, proposes one or more solutions, and then boils the solutions down into actionable recommendations. We believe that the proposals our policy team has assembled can put Missouri on the path to a healthier economy, a better public education system, and a more vibrant and flourishing civil society.

The post Brenda Talent: How to Move Missouri Forward in 2024 appeared first on Show-Me Institute.

Download the 2024 Blueprint for Missouri here

On Wednesday, December 6, 2023, the Show-Me Institute hosted a Virtual Town Hall outlining the 2024 Blueprint for Missouri. Watch a recording of the event here.

Listen to the event as a podcast:

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The 2024 Blueprint: Moving Missouri Forward explores 16 policy areas in which common-sense reform could immediately and positively impact everyday life for Missourians. Issues covered range from education and health care to unemployment insurance and budget reform. Each article identifies a problem that affects the citizens of our state, provides background information and analysis, proposes one or more solutions, and then boils the solutions down into actionable recommendations. We believe that the proposals our policy team has assembled can put Missouri on the path to a healthier economy, a better public education system, and a more vibrant and flourishing civil society.

Produced by Show-Me Opportunity

The post Watch: A Blueprint for Missouri in 2024 appeared first on Show-Me Institute.

Last month at a congressional hearing, Rep. Jason Smith stated that hospital compliance was still incredibly low, and only four out of 6,000 hospitals nationally have been fined. The American Hospital Association (AHA) claims compliance is much higher—around 70%—and the lack of fines is because many hospitals are working with the Centers for Medicare and Medicaid Services to become compliant as prescribed in the rule.

A little less than a year ago, my colleague checked nearly every hospital in the state for compliance, which was not an easy task. Compliance was at less than 30% statewide, and calling many of those websites “consumer-friendly” was a bit of a stretch. Now, taking the AHA’s claims about improvement with a grain of salt, I wanted to check some of Missouri’s hospital websites for myself.

The good news is that the interface on many of the websites appears to be better. I could more easily search for a few basic health care services, but I would still say the process was more difficult than it should be. Additionally, one of the most important benefits of price transparency is the ability to “shop” around; doing that is quite difficult because it requires navigating to each hospital’s website separately and trying to find the same procedure price bundles to compare.

If this is what compliance looks like, Missouri’s got a long way to go. Fortunately, some states across the country have already made a concerted effort to be compliant, as well as increasing costs for hospitals that remain noncompliant with federal transparency rules. States such as Florida and Maine have created their own online tools that make comparing prices and services between hospitals much easier. Some states, such as Colorado, take the push for price transparency a step further and prohibit health providers that refuse to disclose their prices from using the state court system to collect medical debt.

This past legislative session, there was some hope that Missouri would join the ranks of Colorado with a similar bill restricting providers that aren’t transparent from collecting medical debt, but the bill that was filed never received a hearing. As far as I know, there hasn’t been any movement on creating a state-sponsored price comparison tool.

Price transparency is not some cure-all that will fix everything that’s wrong with America’s health care system. But making it easier for patients to see what they’ll have to pay before they’re told to pay it would represent a significant step forward, and other states are making progress on this front while Missouri lags behind. Although there has been some progress since last year, there’s still plenty of room for improvement on the health care price transparency front in our state.

The post Still Waiting on Price Transparency appeared first on Show-Me Institute.

First with the Volunteer Health Services Act in 2014 and then with a raft of licensing reforms in recent years—including unilateral license reciprocity/universal license recognition (ULR) in 2020—Missouri has been on a solid policy trajectory on licensing reform in the last decade. Just last week, in fact, the Archbridge Institute announced that by its metrics, Missouri has the second lowest burdens for licensure in the United States behind only Kansas.

Clearly, the Show-Me State can’t allow itself to be second fiddle to the Sunflower State, so the legislature. must. act. now.

And while my grammar here is intentionally overdramatic, my point is unironic: Missouri can and should make its licensing system better. I was reminded of this when I heard that the House was debating adoption of the Interstate Medical Licensure Compact (IMLC,) which deals with physician licensing and which I even wrote about in my 2016 paper “Demand Supply: Why Licensing Reform Matters to Improving American Health Care.” There, I noted:

[U]nder the Compact . . . the status quo licensing restrictions remain largely the same, harming physicians and patients alike. The Association of American Physicians and Surgeons (AAPS) has concerns similar to [researcher Shirley] Svorny’s, cautioning that the Compact will “[increase] the power of a private bureaucratic organization to intervene in, define, and control the practice of medicine.” The Compact would preserve the 50-State licensing regime physicians and patients currently live under, with the wide variety of requirements to not just earn but also maintain a physician’s license in each jurisdiction.

As I’ve long argued, licensing reciprocity statutes are superior to “compacts.” A “compact” that allows physicians and other professionals to practice in other states that they otherwise couldn’t has the potential to be a good thing, but in a state with license reciprocity on the books, a “compact” has the potential to actually harm consumers.

That’s because in a state like Missouri, if the legislature passes a compact law for a profession, it could actually supersede the state’s better reciprocity statute. As my former colleague Corianna Baier observed last year:

[T]he current licensing reciprocity statute states that licensing reciprocity “shall not apply to an oversight body that has entered into a licensing compact with another state for the regulation of practice under the oversight body’s jurisdiction.” On its face, this language indicates that the license compact would overrule licensing reciprocity to the injury of Missouri consumers.

Here’s another way to think about it. With Missouri’s current licensing reciprocity, Missouri consumers have access to professionals in 50 states and Missouri licensees have access to 1 state (Missouri). (Of course, they may have access to other states with reciprocity, but that is not controlled by Missouri lawmakers.) If Missouri were to enter the Audiology and Speech-Pathology Interstate Compact, it seems that consumers seeking audiology or speech pathology services would have access to professionals from only 16 states (the 15 in the compact plus Missouri), and Missouri licensees would have access to customers in 16 states. While this change gives a small benefit to licensees, Missouri consumers lose out. [Emphasis mine]

This is an important point and explains why we have seen redoubled efforts to pass “compact” language for some professions in Missouri recently. A compact would take power from the market and give it to powerful, entrenched leaders in various professions and allow them to regulate members and competition for that field.

The simple fix (and one that you might have surmised from the title of this post) is to remove the “compact exception” to license reciprocity. Clearly, the adoption of the IMLC for physicians may be advantageous to physicians and the medical bureaucracy, but Missouri’s reciprocity statute must supersede such agreements to be in the interest of consumers. Striking language in the current statute to the contrary would be a major advancement that, I think, would catapult Missouri into an unambiguous position as the national leader in licensing reform, ahead of that state-that-shall-not-be-named to the west.

If the IMLC bill continues through the legislative process, it may be the best vehicle for compact-excising reform to come, but we’ll see what the remainder of the session brings on this policy front. Stay tuned.

The post Legislature Must Remove the “Compact Exception” to License Reciprocity appeared first on Show-Me Institute.