Did you know that Mississippi spends a higher share of our overall wealth on healthcare than almost any other state in America? Yet despite this, we still have some of the worst health outcomes in the country.
Source: AFP Mississippi report on Certificate of Need, James Bailey
Some believe that the answer is to spend an even larger amount by expanding Medicaid. Mississippi’s House of Representatives has just voted to do precisely that.
The debate over Medicaid expansion now appears to hinge on whether under the expansion scheme there will be any realistic work requirement. Critics fear that without a robust requirement for recipients of free health care to be in work, Medicaid expansion is little more than a something-for-nothing system of soft socialism.
It remains to be seen if the Senate will support the House’s bill – and if it will do so by a large enough margin to overturn any future gubernatorial veto.
There is, however, another proposal that has attracted far less attention that really would improve healthcare in our state.
Healthcare in Mississippi is deliberately restricted by a set of laws known as Certificate of Need, or CON, laws. These laws require anyone wanting to expand existing services or offer new services to apply for a Certificate of Need permit. By not issuing permits to new operators, competitors are kept out of the market - which suits the existing providers.
Our recent report on Certificate of Need reform shows how harmful this red tape can be. If we removed this protectionist red tape, we would get far more bang for our buck, however much the legislature decided to spend on Medicaid.
Florida, Tennessee and both North & South Carolina have all recently removed their CON laws – and they each have significantly better healthcare as a consequence.
Now there is a chance that Mississippi might do something similar. Rep Zuber’s excellent bill (HB 419) opens the possibility that some CON rules could be repealed.
Of course, now that the bill is before the House, every sort of parasitic vested interest is frantically lobbying to kill the bill.
Why? CON confers on existing providers a means to legally exclude the competition.
Imagine in the search engine Yahoo! had been able to use CON laws to shut down Google? Or if Friends Reunited could have used CON laws to prevent Facebook? Or if the folk that made DVDs could have used CON to prevent Netflix from taking off? CON laws have been doing precisely this to healthcare in our state.
CON laws in Mississippi are one of the last vestiges of the good ole boy system that has held Mississippi back.
Conservatives have a massive majority in the Mississippi state legislature. Are they about to deliver real conservative policy? Or will we see the implementation of a soft-left, progressive-but-slower agenda to expand government?
When it comes to education, a blizzard of bills has just appeared which suggest that we might actually see something authentically conservative soon.
The Mississippi Student Freedom bill (HB 1449) is the most exciting piece of legislation I have seen in the House in three years.
It would give families the right to have their child’s share of state education tax dollars paid into their child’s own Magnolia Scholarship Account. Each family would then be free to allocate that money to meet their child’s needs.
Think how transformative it would be if every mom and dad were allocated $8,000 - $10,000 tax dollars to spend on their child’s education, be it public, private, charter school or home school?
The Mississippi Student Freedom bill would establish a system of school choice similar to what Governor Sarah Huckabee Sanders has implemented over in Arkansas. Eligibility would be phased in over time, but the end goal would be to allow universal school choice.
“But what if lots of students from failing school districts tried to move to successful school districts?” some will ask.
The bill anticipates precisely this concern. School districts will not be compelled to take kids from out of area if schools in those districts are already full.
Unsurprisingly, various vested interests that currently get to spend your education tax dollars are bitterly opposed to allowing families to have control. No prizes for guessing why. Turkeys might not vote for Christmas, but that does not stop Christmas from happening.
A second bill in the House, the Opportunity Scholarships bill (HB 1452) proposes a similar system of school choice, but one that would only be available for those in failing school districts. Good, if not quite excellent.
Then there is the INSPIRE bill (HB 1453), which offers a complete overhaul of our antiquated school funding system.
Mississippi's current school funding formula, the MAEP, was created in 1997. MAEP stands for Mississippi Adequate Education Program Funding, but it has proved to be anything but adequate.
The MAEP funding system is Soviet in its complexity. Over the past quarter century, it has proved pretty useless at getting your tax dollars where they are supposed to go: the classroom. We ought instead to have a formula that funds students, not a system.
This is precisely what the INSPIRE bill would do. Every child in Mississippi would get an amount weighted to reflect their own needs.
For years, policy makers have talked (and talked) about change. Now, there is a plan to make it happen.
What is so significant about all these bills is that they have been sponsored by the House’s new education committee chairman, Rep. Rob Roberson. He has made a remarkable start in the role.
It is clear, too, that Speaker Jason White is also a driving force behind these excellent reforms. If he is successful, Mr. White will transform our state’s education system for the better. Every family in the state should rally behind him. Indeed, every Mississippian who wants to see our state doing better should be with him 100%.
Mississippi is now surrounded on every side by school choice states that have either implemented or are implementing these kinds of changes. Here is our chance to be a leader, not a laggard.
Mississippi voters have elected an overwhelmingly conservative legislature. It ought to be possible for them to make these mainstream conservative policies happen.
Douglas Carswell is the President & CEO of the Mississippi Center for Public Policy.
Mississippi's current school funding formula, the MAEP, was created in 1997. However, a generation later, it's time for a fundamental overhaul of the way we fund education. The MAEP is hideously clunky and complicated, and few even understand it. We need a transparent and easily understood system that is tailored to meet individual student needs.
An individualized funding system means weighting the amount that every student gets above a base amount, depending on every child’s circumstances. For example, the amount ought to be adjusted to reflect the fact that a child might have special needs or be especially gifted. There needs to be some weighting for low income and concentrated poverty, perhaps, and some career and technical weighting would also help prepare young Mississippians for the workforce.
Tennessee recently showed how a weighted system can work, and now Rep. Rob Roberson’s excellent new INSPIRE bill (HB 1453, “Investing in the Needs of Students to Prioritize, Impact and Reform Education) proposes an alternative to the MAEP, rather than just some amendments to it. By adjusting the different weights for the formula, it is now perfectly possible to implement a new system in which every district is a winner, as well as the students.
Mississippi needs a new funding formula, not just a band-aid on a system that is long past its sell-by date. Last year, Mississippi’s Senate voted by a clear majority to replace the MAEP, and now there's a clearly thought-through alternative to it. Let's start over with a formula that people believe in and will fund.
The Mississippi Center for Public Policy teamed up with the Heritage Foundation to host a packed lunch with Senator Roger Wicker and leading foreign policy strategist, Michael Pillsbury.
Drawing from his bestselling book about China, “The Hundred Year Marathon”, Michael Pillsbury explained just how easy it is for China to gain access to top-secret American defense plans.
Pillsbury explained how under President Nixon and Henry Kissinger, America initially took a pro-China approach, seeking to engage and assist what was then the world’s most populous country.
China, Pillsbury suggested, has learned our strategy all too well and is able to take advantage of it. Even today, America’s administrative state continues to assist China is ways that are not always in America’s best interest.
Pillsbury went on to suggest that America should adopt a Reagan-era approach of achieving peace through strength, building up our military capability in the hope that we never need to use it.
China, some believe, has made plans to invade Taiwan within the next few years. America needs to prepare for every eventuality.
Wicker went on to emphasize the importance of the US navy and the need to ensure the navy had sufficient strength and capabilities.
Taiwan, both Wicker and Pillsbury agreed, should be strengthened in a way that resembles the defense of a porcupine. While not a proactive threat to anyone, a porcupine’s needles ensure than anything that attacks it risks incurring serious pain. Taiwan, they suggested, can be strengthened to a point where China would reconsider making any move on the island state.
Not enough people in Mississippi work. Out of every 100 working age adults in our state, 46 are not in the labor force.
Nearly half of working age Mississippians are not in formal employment – and they aren’t actively looking for employment either.
At the same time, there are a record number of jobs available. According to the US Bureau of Labor Statistics, in October last year there were 80,000 unfilled jobs across the state.
Not only are there lots of jobs available in Mississippi, but according to new research a record number of people are now moving to Mississippi to take up those opportunities. 2022 saw a net inflow of 12,000 (often young) people to our state, coming largely from Tennessee, Louisiana, Alabama, Texas and Florida.
A combination of labor market deregulation, inward investment and tax cuts seems to be transforming Mississippi for the better. Our state is no longer a place that people leave, but somewhere people move to in search of new opportunities. What can we do to ensure that more people in Mississippi take full advantage of those job opportunities?
It is not enough to merely talk about opportunities. With 80,000 job vacancies right here, right now, there are opportunities to work all around us. The issue is why some folk aren’t taking the opportunities that are there.
Some have suggested that we hire more career counsellors in high schools. I am certain that career counsellors do a wonderful job, but if that is the only policy solution, I suspect labor force participation will remain low.
If we are going to increase workforce participation, we need to ask difficult questions about welfare. Does welfare create disincentives against work?
Mississippi has a population of 2.95 million. Approximately one in five (19 percent) live below the poverty line (calculated as the minimum income needed to get by with the bare essentials.)
The way in which the myriad of assistance programs impacts the half a million plus people below the poverty line matters, and needs to be properly understood if we are to improve workforce participation.
Welfare programs can have unintended consequences, and one of them is the creation of so-called ‘benefit cliffs’. A benefit cliff is what happens when someone loses benefits if their income increases, but the benefits they lose outweigh the additional income gained.
Given the maximum income thresholds allowed, we know, for example, that if someone’s monthly income went from $400 a month to $410 a month, they would no longer qualify for some Temporary Assistance programs.
If your income rose above $1,215 a month, you could lose the right to claim Supplemental Nutrition Assistance Program (SNAP). When your income per person goes over $19,392 a year, you may no longer qualify for Medicaid (although the ‘cliff’ cut-off is not always as abrupt as is sometimes supposed).
Take into account the different benefit cliffs, and you could have a powerful range of disincentives.
Even if a person was notionally better off when holding down a 35 hour week job, the time and effort it would take for a relatively modest increase in income might leave some feeling having a job was not worth it.
It has been suggested that benefits do not create a problem of ‘cliffs’, but of straight forward dependency. They point out, for example, that those on food stamps are not those hovering on the edge of the labor market, but full-time welfare dependents. There may be some truth in that, too.
So, what is the solution?
The answer to benefit ‘cliffs’ is not to increase welfare payments in order to remove disincentives, but to institute more stringent work requirements for those on welfare programs.
In Arkansas under Sarah Huckabee Sanders, anyone that fails to accept a suitable job within five days of being offered one, or who fails to show up for job interviews without notice, can now lose their benefits.
If we are serious about increasing workforce participation, we may well need to implement something similar.
Today is officially Ronald Reagan Day in Mississippi!
Governor Tate Reeves has signed a proclamation making February 6th, the date on which the 40th President was born, Ronald Reagan Day.
“Ronald Reagan was born on this day in 1911,” said Douglas Carswell, President & CEO of the Mississippi. “I believe he was one of the greatest leaders America has ever had. He defeated Soviet communism, revived an ailing economy and renewed America.”
“America needs another Ronald Reagan and his sense of optimism”
Thirty three years ago, the Soviet Union fell apart. A Marxist-Leninist system that had stood in competition with the Western way of life for half a century was no more.
Unfortunately, in that moment of triumph, Western leaders made a grave error; they started to believe that there had been an inevitability about Western success.
If the Soviet Union had ditched communism in favor of free markets, everyone else would become more Western, too, right? Wrong – and nowhere more so than with regard to China.
At the turn of the century, when China was welcomed into the World Trade Organization, all the clever people at the State Department assumed it was only a matter of time before China’s emerging middle class would make the country more like us.
Under Deng Xiaoping and immediately after, China had permitted private enterprise, and the country’s communist rulers had imposed limits on their power. China’s provinces enjoyed a high degree of autonomy, with Hong Kong even having her own legal system, currency and democracy.
Deng’s leadership, we can now see, did not represent a new direction for China, but a brief interlude. Under Xi, China has reverted to the Ming tradition; authoritarian government, overzealous control, the targeting of anyone independently wealthy.
Rather than becoming part of the international system, China seems to be a threat to it. Democracy has been crushed in Hong Kong. Military bases have been built in the south China sea. Taiwan is at risk of invasion.
If China is behaving like she is in competition with the Western way it is because she is. We need to recognize this and act accordingly.
Just as there was never anything inevitable about the success of the West, nor is there anything inevitable now about the rise of China.
In fact, China faces serious demographic decline. Ruled by an innovation-sapping authoritarian regime, China may not be destined for global hegemony the way we have been told. But that may not make the Chinese government any easier to deal with.
At the same time, rather than becoming more Western, many parts of the world besides China – such as Turkey, Pakistan or Egypt - seem less Western than they were.
The West itself is becoming less Western, with Europe undergoing dramatic demographic change. Having prevailed against a Marxist-Leninist system in Russia, Western leaders allowed a Marxist-Identitarian system to incubate in our universities. Many US universities no longer teach Western Classics and have in effect abandoned the European Enlightenment.
The West needs leaders willing to set aside post-Cold War assumptions. Rather than presume Western success, we need leaders who recognize that it is tough and difficult to stand up for Western interests – but also essential.
Above all, we need leaders that appreciate that Western culture is the product of ideas and insights that did not arise in a vacuum. The Western way needs safeguarding not just aboard, but on college campuses here in the United States, too.
Often in politics, it is easier to define a problem than it is to solve it.
Remember Barack Obama’s eloquent speech about the need to unite America beyond red states Vs blue states? When Obama left office, America was more politically polarized than before.
Who could forget Al Gore’s theatrics as he talked about the need to save the planet? I doubt a Gore-run administration would be able to control the country’s borders, let alone control global sea levels or the climate.
Remember how during last year’s gubernatorial race here in Mississippi, Brandon Presley, the Democrat candidate, waxed lyrically about the fate of rural hospitals? Hosing federal funds around is unlikely to change the fact that hospitals that are underused will remain underused.
Politicians can certainly make problems worse. Obama, I would argue, exacerbated America’s divisions. Gore & co have advocated for an energy policy that does nothing to control the climate, but has made people poorer. Subsidising an underused health service is unlikely to make it magically sustainable.
Occasionally, however, politicians have it in their gift to do something that really would improve things.
In a report we published this week, we show that there is a solution to Mississippi’s healthcare crisis staring us in the face: our leaders could abolish the anticompetitive laws that intentionally limit the number of healthcare providers in our state. This would improve access to healthcare and lower costs for everyone.
For years, if a healthcare provider wants to offer new services or expand existing services in 19 key areas of health care, they are required by law to get a permit. These Soviet-style permits, known as Certificates of Need (CON), are also required for a provider wanting to spend more than $1.5 million on new medical equipment, relocate services from one part of the state to another, or change ownership.
Unlike other sensible licensing requirements, CON requirements are not designed primarily to assess a provider’s qualifications, safety record, or fitness. They are about central planning to decide if each new applicant’s services are “needed” by the community. I believe that it should be up to patients and practioners to decide what is needed, not government bureaucrats.
CON laws in Mississippi limit the provision of long term care, despite demographic change that has seen the number of elderly people needing care increase dramatically. Ambulatory services, key diagnostic services, psychiatric services and many other services are all limited by CON laws.
If the case for change is so overwhelming, why has it not already been done? In any market, when there are restrictions imposed to keep out the competition, there will be various vested interests that lobby for their retention. So, too, with CON laws.
Defenders of CON restrictions suggest that CON repeal would be risky and dangerous. They like to imply that any reform would reduce access and quality would suffer.
Such concerns are unfounded. Over 100 million Americans—nearly a third of the population—live in states without CON laws in health care. Four in ten Americans live in states with limited CON regimes that apply to only one or two services, such as ambulance services or nursing homes.
If our lawmakers are serious about improving healthcare in Mississippi, I hope they read our report, which sets out not only what needs to be done, but provides a roadmap explaining how to do it.
High flying rhetoric won’t improve our state. Getting down to work and removing CON laws will.
Report identifies key reforms needed to boost health outcomes in Magnolia state
Removing outdated restrictions on health care would boost health care in Mississippi, according to a new report published today. Mississippi has some of the worst health outcomes in the country, and the full repeal of these anticompetitive laws in the health sector would cut costs and improve access to treatment.
For several decades, an official permit has been required for health care providers wanting to offer new services or expand existing services in 19 key areas of health care. These permits, known as Certificates of Need (CON), are also required for a provider wanting to spend more than $1.5 million on new medical equipment, relocate services from one part of the state to another, or change ownership.
Unlike other health care licensing laws already in place, the CON process is not designed primarily to assess a provider’s qualifications, safety record, or fitness. Instead, CON laws require regulators to centrally plan the health care sector by assessing whether each new applicant’s services are “needed” by the community. That question, however, can only be truly answered through the voluntary choices of practitioners and patients.
“If you want to know why Mississippi does not have medical care where it is most needed, CON laws bear much of the blame. They intentionally take away options for health care,” explained Douglas Carswell, President and CEO of the Mississippi Center for Public Policy.
“What started out a generation ago as a misguided attempt to restrict increases in health costs has become a legally-sanctioned protectionist scheme. These outdated laws are indefensible and must go.”
CON laws in Mississippi limit the provision of long term care, despite demographic change that has seen the number of elderly people needing care increase dramatically. Ambulatory services, key diagnostic services, psychiatric services and many other services are all limited by CON laws.
The report, authored by Matthew Mitchell, one of America’s leading experts on health care regulation, references overwhelming evidence which shows that CON laws mean higher spending, less access, and diminished quality of care.
Mitchell’s report identifies a road map for reform, highlighting how full abolition could be achieved. “The evidence from other states without CON laws not only shows how a Mississippi without CON would enjoy greater access to lower cost and higher quality care, but it also gives us a roadmap for how to do it. In the report, I talk about 11 different strategies for reform,” said Mitchell.
“The Governor and the new Speaker have both committed to improving health outcomes in Mississippi by repealing restrictive practices. We are excited to see legislation aimed at CON repeal, as well as action by the Board of Health to remove the red tape,” added Carswell.