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.

As I wrote last month, our state lagged much of the country in resuming its Medicaid eligibility redetermination processes following the COVID-19 pandemic. Instead of starting in April as many states did, Missouri began processing redeterminations a month ago on July 1. Now that there are three months of data from across the country to look at, a new report from the Paragon Institute estimates just how much Missouri’s foot-dragging might cost.

For a quick refresher, during the pandemic, the federal government barred states from checking whether Medicaid enrollees remained eligible to receive services as they normally would. As a result, Missouri’s program set new records for enrollment and spending. But the catch is that likely more than 20% of those enrolled today aren’t eligible for coverage, so once the federal government allowed redeterminations to resume on April 1, states had significant financial interest in rightsizing their program rolls as quickly as possible.

No, this rightsizing doesn’t mean removing people from the program who are still eligible to receive services. What it means is that states typically pay health plans monthly for each Medicaid enrollee, so if 20 percent of those enrollees are ineligible, just using Missouri’s current enrollment of 1.5 million, that means taxpayers could be paying the health care costs of 300,000 people they shouldn’t be. And that’s really expensive!

So how can Missouri clean up the program’s rolls as quickly and accurately as possible? And how much will it cost if they don’t? That’s what the Paragon Institute report tries to answer.

First, the report estimates how much is being wasted per month on ineligible enrollees. For Missouri, if 20 percent of program enrollees are in fact ineligible, that means more than $120 million is wasted every 30 days. The federal government is giving states 12 months to process all of their redeterminations, but since so much is wasted per month, and since the share of these costs paid by the federal government will be declining each quarter, the sooner the eligibility checks can be completed, the better. The report suggests that if Missouri were to process all 1.5 million redeterminations in 6 months instead of the 12 months allowed, approximately $364 million could be saved.

Additionally, not all current enrollees are equally likely to be ineligible. Paragon suggests states should be prioritizing the redeterminations of the recipients who are most likely to be removed in order to maximize the savings. All told, if Missouri were to follow all of Paragon’s suggestions (other than the ones that can’t be done because it’s too late), our state could end up saving $729 million. That’s no small amount of money.

The Paragon Institute report shows us how much money Missouri’s overpopulated Medicaid rolls are costing the state, and considering how our state Medicaid agency started processing redeterminations three months later than necessary, I’m worried taxpayers are about to watch their money burn. If time really is money, Missourians should keep their eyes peeled for at least the next 12 months.

The post The Budget-busting Cost of Waiting appeared first on Show-Me Institute.

Over the past two months, many states across the country—but not Missouri—have started deflating their bloated Medicaid rolls. (Reminder: enrollment got to be this high because prior to April of this year, the federal government barred states from checking eligibility or removing anyone from the program since March of 2020, as part of the response to COVID-19.)

Unfortunately, the Centers for Medicare and Medicaid Services reports that Missouri is waiting until July before removing any ineligible enrollees. If true, Missouri stands in stark contrast to states such as Florida or Arizona that started checking their Medicaid enrollees’ eligibility as soon as the federal prohibition was lifted. Recent articles suggest that Florida has already identified upwards of 250,000 ineligible enrollees, which translates to significant savings for taxpayers.

In theory, removing ineligible recipients from government-sponsored health coverage shouldn’t be a controversial topic. Prior to COVID-19, states were required by federal law to check whether their Medicaid enrollees were still eligible for the program at least once every year but could check as frequently as every six months.

Regular redeterminations (eligibility checks) are important because people’s circumstances change frequently, and they may not always go out of their way to inform the government of any changes. In Missouri, like many other states, the government pays health plans monthly to provide health coverage to Medicaid recipients, regardless of whether they receive any services. Given how expensive health coverage is, this means that there are likely billions of tax dollars being spent improperly on the program every single month.

With hundreds of thousands of eligibility checks needed, the potential for significant reductions in wasteful government spending is why states are rushing to clean their Medicaid rolls. It’s also why I suggested Missouri consider hiring outside help for processing redeterminations, given how difficult an administrative task it would be.

Though it’s just another thing to add to the list of this year’s legislative failures, it’s telling that our elected officials couldn’t even get out ahead of something as long choreographed as the resumption of Medicaid eligibility checks. If spending is all about priorities, it’s clear Missouri’s elected officials don’t consider reducing government waste to be one of them.

The post Missouri’s Refusal to Lead appeared first on Show-Me Institute.

The Post-Dispatch article states that Missouri spends less state money on public health than any other state. That certainly seems to indicate that public health expenditures are too low in our state. But what if many other states collect public health money at the state level, while here in Missouri we collect it at the city and county level? As long as services are provided, would it really matter who collected the money first? I don’t think so.

Another comparison ranks Missouri rather high nationally in public health spending (ninth) and properly notes that most Missouri public health money is raised and spent at the local level. Most Missouri counties have a local property tax dedicated to funding their health departments. Many of our larger cities do also. So, we ought to realize that the reason the state may rank so low is that we fund public health at the local level while other states seem to fund more of it at the state level. I don’t think there is anything wrong with that, but I think people need the full picture of funding services like this before making judgments.

The post TIF and the Pandemic, Part Two appeared first on Show-Me Institute.

But that hasn’t kept Kansas City and other local government from bah-humbugging it, flying the banner of coronavirus prevention as it dumps coal in the stockings of local proprietors in the food service industry. In November, city officials shut down The Corner Bar and Grill in the historic 18th & Vine District during a Chiefs game when a “field supervisor noted multiple violations of the mask and social distancing rules” set out by the mayor. In fact, until relatively recently, Kansas City proper was requiring all bars and restaurants to not only close by 10 p.m. to mitigate the spread of COVID-19—because it’s, what, not communicable during the day?—but force all of the patrons out by that time, or else be sanctioned by the city.

The Corner Bar’s closure and the city’s draconian time restrictions meant that when the Chiefs played the Denver Broncos for the league’s Sunday night game on Dec. 6, Kansas City bars were forced to turn patrons away due to capacity limitations and to warn patrons who were allowed inside that they’d be kicked out of the bar before the late game had finished. This isn’t hearsay either; this happened to me. However, not all places of imbibing and engorging for the game were closed. I eventually found myself at, of all places, a local casino that is not only open 24 hours a day, 7 days a week, but whose social distancing norms are, shall we say, necessarily loose.

Having the right to leisurely eat, drink, smoke and gamble at 10:30 p.m. on a Sunday from the comfort of a barstool in the middle of a pandemic would feel a lot more liberating if you do these things at any establishment of one’s choosing, pandemic or not. But on this Sunday night, the patrons of the Argosy Casino had acquired an immunity to coronavirus (or, rather, to government-imposed coronavirus restrictions) that the small businesses and patrons in downtown Kansas City had not yet achieved. Shortly after that weekend, Kansas City officials “clarified” that the city’s bar and restaurant patrons could now remain in their seats and finish their meals, even past 10 p.m., but couldn’t order food or drink after that hour and had to be out of the building by 11 p.m.

It’s tempting to accept the clarification of mandated closure times as an improvement, and in technical terms, it is. After all, requiring establishments to close in the middle of a sports event is bad for business. But local officials are merely returning rights to taxpayers that I believe should never have been taken to begin with and where in other local businesses like casinos, the same rules aren’t being applied. That’s before addressing whether these new rules should be applied at all, and on what actual scientific basis they’re being pursued.

But I’ve said this before and I must say it again, especially now that we’re close to the 2021 legislative session: If a rule is good enough for big businesses, it’s good enough for the small ones too. That applies to all of “Chiefs Kingdom,” both in Kansas City itself and outside it. If casino patrons can live it up safely and watch the Chiefs beat the hated Broncos late at night, so too can supporters of local bars. If Chiefs fans can socially distance at Arrowhead, so too can fans of Blue Springs High School. And in the coming weeks, state legislators must start the process of reining in the excesses of local governments. Kansas Citians may live in Chiefs Kingdom, but they aren’t the subjects of their elected officials.

The post Living in Chiefs Kingdom Doesn’t Make You Kansas City’s Peasant appeared first on Show-Me Institute.

Blue Springs School District, a school district in Jackson County, sued the Jackson County Health Department after it was issued a notice of non-compliance with capacity limitation rules for its home opening football game.

What did Blue Springs do wrong? Attendance at the game exceeded the 100-person fan limit set by the county for outdoor events. The county is adamant Blue Springs cannot do that, threatening to ban all fans for the season and force the team to quarantine for two weeks if it happens again.

Blue Springs simply wants to allow for home football players, cheerleaders, and dance team members to give four tickets to their family members and two tickets to visiting team players—totaling 550 fans and 11 percent normal capacity. Yes, this exceeds the 100-person limit, but is the 100-person rule being enforced everywhere throughout the county?

Let’s compare this to the Thursday night opener for the Kansas City Chiefs. The county allowed roughly 16,000 fans, or 22 percent of Arrowhead’s normal capacity to attend.

Double standard? Absolutely. When the order was issued, the county intentionally exempted Kansas City, the city with the highest COVID case numbers in the county. Jackson County wants Blue Springs held at less than 2 percent of its stadium’s capacity while the Chiefs can have 22 percent. Shouldn’t Blue Springs be allowed to have the same percent capacity applied to its stadium?

Due to the limit set by the health department, Blue Springs decided that no visitor fans can attend games going forward. Even worse, with roughly 100 students on the active roster, each player/cheerleader/dance team member gets one ticket to give to their parents or guardians. Imagine a senior who has to choose between their mother, father, or grandparent attending their game. If one person from a “household” can attend, why can’t one or two more?

Jackson County defended the 100 person limit (2 percent capacity) for Blue Springs and 15,895 fan limit (22 percent capacity) for the Chiefs by saying, “Just because the Chiefs have the resources to do this in a relatively safe matter doesn’t mean that a high school stadium does.” But is this true? Blue Springs and the Jackson County Health Department developed a plan that health officials deemed safe for the school district to teach thousands of students each day indoors and in-person. The health department said Blue Springs has enough resources for that.

Wouldn’t the school district have enough resources to take a fraction of the people compared to the current school day and place them in a less risky area outdoors? I think so. The Jackson County Health Department should assist Blue Springs in implementing an 11 percent capacity plan instead of threatening to quarantine the players and ban its fans.

The post Local Kansas City Area School District Sues Jackson County Health Department – for Good Reason? appeared first on Show-Me Institute.

On August 4, Missouri voters will decide whether the state should become the 38th to expand Medicaid. Proponents of the measure suggest expanding the program would “save” the state money, but a closer analysis suggests the opposite is true: Not only will the program cost the state money, but it will come at the expense of other important budget priorities.

How do proponents create the illusion of savings? Let’s take a look at the numbers.

Today, Missouri’s Medicaid program covers nearly 940,000 people and costs around $11 billion per year. The federal government pays about two dollars for every dollar the state spends, yet the program still consumes nearly 40% of the state’s budget.

If Medicaid were expanded, Missouri’s Department of Social Services projects that more than 285,000 able-bodied adults would enter the program within the first year at a cost of around $2.7 billion. For these new recipients, the federal government’s match would be more generous, at $9 for every dollar Missouri spends instead of the usual $2. But even at that higher match rate, Missouri’s share of the expansion cost would be significant.

To find “savings,” then, expansion advocates rely on several dubious assumptions.

First, federal funding for Medicaid is treated as “free money.” Although Missouri taxpayers are also federal taxpayers, the cost to the federal government is discounted in the “savings” analysis. And with the federal government in a period of historic deficit spending, new Medicaid spending will be debt for our kids and grandkids to pay off.

Second, proponents’ models assume an increase in expansion enrollment that is much lower than what Missouri’s own Medicaid agency expects. We don’t have to look far to see states that have been burned by their pre-expansion estimates of enrollment and associated costs. Illinois, Arkansas, and Louisiana saw initial expansion enrollment dramatically exceed their estimates. If Missouri sees enrollment slightly above the current estimates from the state’s Medicaid agency, the savings vanish even in the pro-expansion models.

Third, advocates forecast the cost for each new enrollee to be less than similar individuals who are already enrolled in the state’s Medicaid program. By underestimating the cost per beneficiary, expansion supporters shave even more costs from their estimates—even though the state knows they’ll cost more.

And fourth, the most dubious of all, expansion advocates assume the number of disabled Missourians on the program will drop by more than 20 percent over the next four years. By enrolling more individuals under the expansion guidelines (where the federal government pays a higher share), supporters assume they can shift some of the state’s existing Medicaid costs to the federal government. The problem is, this type of maneuver is not allowed. Missouri cannot enroll people who are already eligible for Medicaid into the expansion population, so the idea that the number of disabled Missourians in the program could drop by more than 20 percent is simply unrealistic.

We should also keep in mind that when supporters of the proposal say Medicaid Expansion will save Missourians money, they don’t literally mean the program will cost less. The cost of the program grows year after year, even now. What supporters are saying is that they think it will be less expensive to the state than if the state didn’t expand at all.

There are other important unknowns that must be taken into account, including the risk that taking more federal dollars today may put our state in an even worse budgetary bind tomorrow. For instance, if the federal government finally decides to rein in the deficit by reducing its match on the Medicaid expansion population, state taxpayers may be left holding the bag.

Balancing Missouri’s budget around Medicaid is already an incredibly difficult task, especially amidst an economic downturn. Balancing the budget after expansion would be even more painful, because state legislators will have to come up with hundreds of millions of dollars annually to address both traditional Medicaid and the expansion’s costs. These tough decisions are sure to put priorities like education, roads, and public safety funding at serious risk. Suggesting that the state could save money by spending more on Medicaid was always a dubious proposition, but at some point forecasting gimmicks have to give way to common sense.

The post Debunking the Myth of a Costless Medicaid Expansion appeared first on Show-Me Institute.

I want to be very clear that I am not taking this global crisis lightly. Michigan has had thousands of cases in the past few weeks, and I’m extremely worried about my family, friends, and others in Michigan. I think these stay-at-home orders are beneficial in the fight against the coronavirus, but I also think there is a balance between trying to ensure safety and trying to excessively control citizens. It seems fair to question whether Michigan has achieved that balance.

The most recent executive order contains what I think are some unnecessary and seemingly arbitrary restrictions on the everyday lives of Michiganders. For example, all public and private gatherings of any size between people who do not live in the same household are prohibited. If you own two residences, you are not allowed to travel between them.. Stores are not allowed to sell goods from the following categories: carpet or flooring, furniture, garden centers, and paint. Businesses are also to refrain from advertising or promoting items that are not groceries, medical supplies, or essential items. Lottery tickets, however, are fine to purchase. The executive order also prohibits of the use of any boats with a motor, which is especially relevant to both industry and citizens in a state surrounded by the Great Lakes.

Most states have stay-at-home orders in place, but Michigan’s order goes much further. Where do we draw the line? Other states are taking safety precautions without completely banning leisure activities and further disrupting businesses

I’m certainly not the only one with this opinion; others argue that Michigan has become an outlier. For the sake of my co-workers and friends still in the Show-Me state, I hope that Missouri does not follow Michigan’s path.

The post An Opinion of Michigan’s Stay-at-Home Order from Someone Stuck in Michigan appeared first on Show-Me Institute.

What’s driving Missouri’s Medicaid value problem? To answer that, it’s helpful to start with the basics and look at who the program is covering and how the cost of care is being paid for. Missouri’s Medicaid program is responsible for the health care costs of more than 850,000 of the state’s most vulnerable residents. The way in which those health care services are provided is called the delivery system. In Missouri, the two primary methods are fee-for-service and managed care delivery systems.

When a Missourian enrolls in Medicaid, their eligibility criterion largely determines which delivery system will be used for their coverage. Individuals classified as aged, blind, or disabled are covered under fee-for-service, while everyone else is enrolled in managed care.

The fee-for-service system works the way it sounds; each time an eligible recipient receives a Medicaid-covered service, the provider of that service is reimbursed by the state at a previously agreed upon rate. Managed care works differently; instead of paying for each individual service, the state pays contracted health insurance companies a monthly rate, and the insurance company then negotiates a rate with providers to reimburse for each service its enrollees receive.

The division of recipients may play an integral role in explaining the existing systemic failure. The current arrangement puts the relatively healthier populations into plans that require monthly payments whether care is provided or not. And the populations with the most complex medical needs  are placed into a system where the state is left deciding rates and reimbursing for each expense.

There’s little evidence to suggest this is the best possible division, or that either of the current systems can increase the value received for each tax dollar spent. Another conclusion from the report mentioned above stated: “. . . methods to pay providers lack incentives to contain costs or enhance quality.” This is another way of saying that reining in Medicaid’s costs or improving the program’s efficiency is unlikely unless policymakers consider reforming the state’s delivery systems.

In other words, the current system is failing in important ways, and that failure cannot be reversed without substantial changes in the way the system is run. In future blogs I’ll expand on the problem and suggest solutions. For now, I’ll ask this question: When will there be a real concentration of effort in Jefferson City to address this problem? Will it receive the attention it deserves in the 2020 legislative session—or will the can be kicked down the road yet another year?

The post Medicaid’s Value Problem appeared first on Show-Me Institute.

Missouri’s governor and other state officials attributed the decrease in enrollment to the state’s improving economy. It makes sense that an improving economy would reduce the need for government-funded health benefits, as more people are employed today than were a year and a half ago. But as Missouri’s enrollment is declining faster than the national average, and the state’s economic growth remains lackluster compared to the rest of the nation, it is unlikely the economy alone can fully explain the drop in enrollment. I think the following point from the Medicaid director’s statement highlights an important yet under-discussed driver of the enrollment change:

From 2014 to 2018, a previous administration did not robustly verify eligibility requirements of individuals on an annual basis and therefore automatically renewed a significant number of enrollees, many of whom did not qualify for assistance . . .

In other words, the drop in Missouri’s Medicaid enrollment is not surprising because the program has been providing health coverage to individuals who did not meet eligibility requirements. This is a shocking admission from our state’s government, considering the federal government requires states to annually verify each participant’s Medicaid eligibility.

The extent of the wasteful spending remains unclear, but the fact it occurred is sadly unsurprising. A recent audit of the Medicaid program in Louisiana found that 82% of enrollees were ineligible at some point during the year they were enrolled. My colleagues and I have written about the state’s potential for wasteful Medicaid spending, and this report confirms our worst suspicions.

As Medicaid costs consume more and more of our state’s budget, limiting improper spending on ineligible individuals is essential. Policymakers should consider a new investigation into how much taxpayer money was wasted while wrongfully propping up the program’s enrollment in the first place.

The post Why is Missouri’s Medicaid Enrollment Falling? appeared first on Show-Me Institute.

The Governor’s statement matches the sentiment of previous writings by my colleague, Patrick Ishmael. The costs for our state’s Medicaid program are too high and are continuing to grow. It would fiscally irresponsible to consider adding more people to the program until our policymakers can get a handle on the program’s biggest cost-drivers. Missouri is not alone in the struggle to contain growing health care costs, but that is not a reason to sit idly by as scarce state revenues continue to be diverted from other priorities. With that in mind, our policymakers should consider looking outside Missouri for potential solutions.

Several other states that have declined to expand Medicaid have submitted proposals to the federal government for initiatives that would help contain costs. Two of those proposals, Wisconsin’s and Florida’s, were recently approved and offer policy ideas that could benefit Missouri.

Wisconsin is the first non-expansion state for which a work requirement proposal was approved. Researchers at the Show-Me Institute have written about the potential benefits of work requirements in Missouri. Unfortunately, Missouri’s lawmakers considered but were unable to pass work requirement legislation in 2018. With the federal government indicating new willingness to accept such proposals, perhaps this issue could serve as a starting point for Medicaid cost containment and reform discussions in 2019.

Florida’s proposal allows the state to reduce its retroactive eligibility requirement for non-pregnant adults from 90 to 30 days. Currently, Medicaid programs cover the medical costs of beneficiaries up to three months prior to their application to the program, provided the individual was deemed to have been eligible during that period. And while the existence of that coverage may seem surprising, the reduction of that retroactive window could actually be beneficial to applicant, the idea being that a shorter period of retroactive eligibility incentivizes beneficiaries to apply as soon as possible when they get sick and believe they are eligible. Florida officials also believe the policy will encourage the maintenance of coverage, even when participants are healthy. On top of that, it is estimated the policy change could save up to $98 million annually, though it is unclear at this point how those savings estimates would translate to Missouri.

Both policies have the potential to save the state tax dollars, but neither of them should be expected to fully address the growth in Medicaid costs. Nevertheless, lawmakers shouldn’t let the perfect be the enemy of good. There are certainly other possible avenues for reform that could help address the “failing system,” but these already-federally-approved initiatives may be the easiest place to start.

The post Opportunities for Medicaid Reform appeared first on Show-Me Institute.

Since Medicaid is such a large part of state spending, it is worth taking a closer look at where and how this money is being spent. Below is a map that shows the percentage of counties’ populations enrolled in Medicaid, also known at Mo HealthNet. The data table, provided by the Department of Social Services, can also be sorted by expenditures, enrollees, and percentage of the population for each county.

The data displayed are from FY2016; in FY2017, another $570 million and 26,948 enrollees were added to these numbers. This information could help provide a clearer picture of Medicaid’s costs and the variation in participation rates across counties. With such information, lawmakers and taxpayers can better understand how changes—whether cuts or expansion—to the program would affect the state.

The post Map: Medicaid Spending and Enrollment by County in 2016 appeared first on Show-Me Institute.

In my opinion, the only law needed is that the milk in question must be clearly labeled as unprocessed, or “raw.” When that information is available, adults can make their own choices.

The News-Leader article is very good, and contains some great quotes. And by “great,” I mean “infuriating.” Check out the nanny state in action:

The board said allowing unregulated dairy farmers to sell to the public was not in the interest of the public they are charged to protect. Without regulations or testing, no one would know if the raw milk was safe.

Check out the local health department version of “we had to destroy the village in order to save it”:

Though consumption of raw milk is legal, board member Aaron Grier said the ban could help people get more informed about the farm where they’re buying it.

We have to ban it so we can we be sure you want it! And here is where they went even further than state law in making certain that people in Christian County don’t get to make decisions that affect themselves:

However, the board voted to ban all raw milk sales and distribution, including Grade A permitted raw milk, which can be sold to end-consumers, under state law.

I presume that the elected county officials have the capacity to overrule the appointed board. I hope that the citizens of Christian County bring these concerns to the elected board, and I wish them luck in changing this absurd decision.

The post Milk Does a Regulator Good appeared first on Show-Me Institute.

These numbers, though, may not matter for too long. The federal health legislation, set to go into effect in 2014, is expected to expand the Medicaid pool drastically and add at least $1.34 billion total cost over 10 years.

The Kaiser Family State Health Facts website has data on Medicaid spending per enrollee, as well as on total state expenditures. Unfortunately, the site did not have both Medicaid spending data and total state expenditure data available for the same ranges of years, so my comparisons are not perfect. They do, however, serve to illuminate the spirit of the argument. The figures for Medicaid spending per enrollee are from 2006, the state expenditure figures are from 2004, and total Medicaid spending is from 2007.

Here are some spending facts for Missouri:

According to American Academy of Pediatrics in Missouri in 2007, the state will lose $1.60 in federal matching funds for every $1 it cuts from its state Medicaid budget.  The governor proposed a $120 million cut from the Medicaid budget, so assuming that proportion does not change, we can extrapolate that to be about $312 million total from the Medicaid budget.  As of September 2009, MO HealthNet had 865,477 enrollees, and $312 million averages to around $360.49 in cuts per enrollee.  This means that the cut amounts to approximately 8 percent of the 2006 amount per enrollee.

So, even without a close analysis of which services are being cut, it is clear that this amount is not as alarming as might be expected.  (It would place Missouri  43rd in the country on per-capita expenditure, based on the numbers from 2006.)

Frankly, I believe the real issue is how these cuts are made. Medicaid and Medicare are large black holes for resources that have the potential to swallow the state and federal budgets. It is not sustainable for them to grow continuously, and would be better if they could be shifted into the private sector via vouchers or well-designed cuts. Spending large amounts of money on Medicaid, if not spent in the right manner, can be even more detrimental than a smaller amount because it can distort the market and incentive structures. A closer analysis of how these cuts are being done is necessary to come to any distinct conclusions, but the numbers by themselves are not as frightening as some may believe.

The post Medicaid Cuts: As Scary as They Look? appeared first on Show-Me Institute.

What the article doesn’t mention is that the study it cites also concluded that an investment of $10 per person per year in “proven community-based programs” would give us the aforementioned rate of return. Furthermore, according to this study, “evidence shows that implementing these programs in communities reduces rates of type 2 diabetes and high blood pressure by 5 percent within 2 years; reduces heart disease, kidney disease, and stroke by 5 percent within 5 years; and reduces some forms of cancer, arthritis, and chronic obstructive pulmonary disease by 2.5 percent within 10 to 20 years.” Missouri spends almost $10 per person per year, the figure observed in the study, but still has poor health outcomes. This tells me that we are probably not spending our money in the most effective way.

There is further evidence of that in a comparison of four measures of public health in Missouri and Nevada, the one state that spends even less than we do in this area:

* Information on high blood pressure from CDC; all other information from statehealthfacts.org

So, even though we spend more than Nevada on public health, we still have higher numbers in all four of these categories. This is admittedly an overly simplistic analysis, but the point is that amount of state public health spending is obviously not the only factor that matters for health outcomes in Missouri. The programs themselves should be evaluated for effectiveness, to determine whether investment of additional resources in them is worthwhile.

The larger point here is that using state taxpayer funds to address public health problems might not be the best strategy, given the frequent ineffectiveness of state-run programs. Instead, we should end the tax benefit for employer-provided health insurance, which would allow individuals to have control over their health insurance. People would then have a direct financial incentive to become more sensitive to the effect that their lifestyle choices have on their premiums. As a result, a greater number of people would make healthier choices, in addition to the obvious incentive of health in and of itself.

The post Public Health Spending appeared first on Show-Me Institute.

It was a smart move on the city’s part. Offering free vaccines is a recipe for shortages. Charging for the cost of administering the vaccine — as pharmacies do — prevents demand from skyrocketing and depleting the vaccine supply. And allowing people to buy the vaccine at their local retail pharmacies is better than forcing everyone to come to a few central clinics. People are used to going to those retailers for prescriptions or other vaccines, so they don’t have to go out of their way to find a clinic they’ve never been to before.

And, while it’s true that taxpayers paid for the H1N1 vaccine, as the people quoted in the article stated, that doesn’t mean that they should all receive it for free. Administering the vaccine would require the city to hire nurses. Taxpayers shouldn’t be made to incur yet another flu-related expense, especially considering that new H1N1 cases have been declining for weeks.

The post St. Louis Made the Right Call in Giving Vaccine to Retailers appeared first on Show-Me Institute.

I assume this piece was not original to the Post, but it may have been. I remember about 15 years ago when a state rep from south Saint Louis County wrote a similarly themed article for the Post, and then got in a lot of (political) trouble when it turned out she had just copied it from somewhere else. I remember her name, but don’t feel like printing it. She did lose her next election, if I recall correctly. (All that stuff predated the web by a few years, so no free links are available.)

Not everything he (or she) writes here is crazy or wrong, so feel free to take my lack of comment on certain areas as being along the lines of agreement in those instances:

Dear Tea Party Members:

This morning I was awoken by my alarm clock powered by electricity generated by the public power monopoly, Ameren UE, regulated by the US Department of Energy.

All true, as it goes, but are you really that dependent on the government to get you out of bed in the morning? And didn’t the alarm clock get built in the first place by the mechanics of the free market?

I then took a shower in the clean water provided by the municipal water utility, Missouri American Water.

This is the first flat-out error: Missouri-American is a regulated, private company, not a municipal water utility.

The water was heated by the public natural gas monopoly, Laclede Gas,

Laclede Gas is a private company.

and disposed of by the the municipal sewer utility, Metropolitian Sewer District of St. Louis.

A government entity — ask Tom Sullivan about them.

After that, I turned on the TV to one of the Federal Communication Commission regulated channels to see what the National Weather Service of the National Oceanographic and Atmospheric Administration determined the weather was going to be like using satellites designed, built, and launched by the National Aeronautics and Space Administration.

This totally ignores the role that private companies and people played in all of this, and ignores the fundamental question of whether this regulation is necessary. I can guarantee you the television needs of Americans would be met just fine without government regulation.

I watched this while eating my breakfast of US Department of Agriculture inspected food and taking the drugs which have been determined as safe by the Food and Drug Administration.

This is all true, and a legitimate role for various levels of government, but let’s not pretend that nobody in America was able to feed their families before the government got involved. A nation of farmers fed itself just fine.

At the appropriate time as regulated by the US Congress and kept accurate by the National Institute of Standards and Technology and the US Naval Observatory,

Does the author really think people could not tell time before the government got involved?

I get into my National Highway Traffic Safety Administration approved automobile and set out to work on the roads built by the local, state, and federal departments of transportation,

The private provision of highways is very common in other countries.

possibly stopping to purchase additional fuel of a quality level determined by the Environmental Protection Agency, using legal tender issued by the Federal Reserve Bank. On the way out the door I deposit any mail I have to be sent out via the US Postal Service.

The Post Office versus FedEx and UPS? Enough said.

If I had kids, I would probably drop them off at the nearby public school funded by the state and federal Department of Education.

Many Americans choose private education for their children for a number of reasons, the failure of certain public school systems among them. Clearly, there are many excellent public school systems as well.

At lunch time, I pick up a bite to eat at a nearby restaurant that has been inspected by the local department of health which enforces state and federal guidelines for food safety and workplace safety. I then return to my cubical where I listen to the local FCC regulated radio station

As with television, I will guarantee you that, beyond distributing the channel spectrum as a common good, government involvement is not necessary for radio to operate, at all.

as I work on a computer that has been certified by the Consumer Products Safety Comission to be safe and compliant with FCC Part 15B regulations.

The computer industry has grown as it has during the past 40 years because of private markets, not government involvement.

Sometimes instead of work, I go on a business trip and use an airplane inspected by the Nation Transportation Safety Bureau to travel. But first I have to take off my shoes and anything metal as a walk through the the inspection station set up by the Transportation Safety Adminstration.

Watching grandpa get a body cavity inspection because he shares a nickname with a terrorist is not an argument for government success.

After checking the weather with the National Weather Service, the Federal Aviation Adminstration gives the all clear for the airplane taxi off the tarmac and to take off.

Then, after spending another day not being maimed or killed at work thanks to the workplace regulations imposed by the US Department of Labor and the Occupational Safety and Health Administration, I drive back to my house which has not burned down in my absence because of the state and local building codes

People CAN build things on their own, you know.

and the fire marshall’s inspection, and which has not been plundered of all its valuables thanks to the local police department.

It’s a sad view of society that assumes we would all descend into chaos without government force — perhaps a true view, but still a sad one. I tend to think people cooperate in many more ways without government coercion than the author does.

At home, I can call up my grandparents on a cellular telephone that is FCC Part 15B complaint and designated on a frequency regulated by the National Telecomunication and Information Administration.

As with computers, the telecommunications revolution is attributable far more to private initiative than to government control and regulation.

I then log onto the Internet which was developed by the Defense Advanced Research Projects Administration, an agency of the Department of Defense which is the parent agency of the US Army, Navy, Air Force, and Marine Corps who are defending our country so that I can enjoy my freedom to post on Freerepublic and Fox News forums about how SOCIALISM in medicine is BAD because the government can’t do anything right.

End of letter. Many of the points the writer makes are valid to varying degrees, but he discounts or ignores the role individuals and private actors played in many of the advancements he credits to government. What is also missing is any even remote debate over whether or not these things are the proper role of government as set by our Constitution. As it stands, the letter makes Americans sound like a nation of people who could not blow their nose (the closest to a clean scatological reference I could think of) without government involvement and approval.

Seriously, you thank the government for helping you get out of bed in the morning? That is not the type of life I want to live and not the type of country I want the United States to become.

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