T1 Telehealth is a Mississippi company that provides innovative telemedicine services, but has been limited in the healthcare it can deliver because of government regulations that hampered competition. 

The Mississippi Justice Institute has been representing T1 Telehealth in its efforts to challenge these regulations. On May 9, 2019, after months of negotiations, the Mississippi State Board of Medical Licensure adopted a new proposed rule that will expand telemedicine services in the state by allowing additional providers to offer telemedicine in the emergency room. 

“The new regulations will be a great development, not just for T1 Telehealth, but for all telemedicine providers, for small rural hospitals that rely on telemedicine, and for patients across Mississippi,” said Aaron Rice, the Director of the Mississippi Justice Institute. “The Mississippi Board of Medical Licensure took the right approach to make the regulations fair and to increase access to healthcare in Mississippi.”

In Mississippi, there are 64.4 primary care physicians for every 100,000 residents, far below the national median of 90.8. Many rural hospitals struggle to fund and staff their emergency departments, which require multiple emergency room physicians to take turns covering shifts to ensure 24/7 access. Emergency telemedicine allows these small hospitals to keep their emergency rooms open, by staffing them with physician assistants and advanced practice registered nurses. When a patient arrives, an emergency medicine physician in another location uses audio/visual technology and other tools to see the patient, and to instruct the nurse or physician’s assistant on the care that is needed.

The old regulation prohibited physicians from providing emergency room telemedicine services to small hospitals unless they worked at a Level One Hospital Trauma Center with helicopter support. Mississippi only has one Level One hospital in the state, so there was no competition for this service. However, any physician who is board certified in emergency medicine is capable of providing emergency telemedicine services, and is able to transfer a patient by helicopter, regardless of the type of hospital the physician works for. The old regulation locked out companies like T1 Telehealth, which was the first private telehealth company in the state, even though the company saw a need and believed it could provide better emergency telemedicine services. The new regulation will now allow new companies to compete.

“The thing that Americans like better than anything is choice,” said Todd Barrett, CEO of T1 Telehealth. “People want to have the opportunity to say I don’t like that, but there’s this other option I can try and two competitors in a market understand that. They both strive to be the one people are going to call. That makes everything better and cheaper by helping to keep costs down and improve quality. There are two ways to differentiate ourselves and that’s either price or quality. This new regulation allows us to come in and prove ourselves, show how much better it is, what the results are, and how patients benefit.”

For Barrett, innovating in healthcare is all he has ever done. It is what he knows. Since graduating from Pharmacy School in 1988, he has started and sold three pharmacy companies and a technology company, each time sensing and filling a need.

“Can we create something that allows more patients to be treated and made better with less dollars and if it looks like that we’re interested in seeing how we can fit in and make that happen,” Barrett added. 

The new proposed regulation will be filed with the Secretary of State to allow time for public comments. It will also be reviewed by the Occupational Licensing Review Commission before becoming final. Once the regulation is finalized, many expect to see a new, vibrant market emerge in the provision of emergency telemedicine services. 

A new federal grant program and an emerging technology could be the tools used by the state’s non-profit electric power associations to get high-speed internet to their customers.

On April 12, Federal Communications Commission Chairman Ajit Pai announced a proposal to award $20.4 billion over the next decade toward rural broadband networks in a program called the Rural Digital Opportunity Fund.

This would be repurposed money from the FCC’s Universal Service Fund which already provides money for extending rural broadband service in addition to low-income phone service and low-coast broadband access for schools and libraries.

Thanks to a change in state law, EPAs in mostly-rural Mississippi are well placed to enter the reverse auctions to receive grants from the new federal program. A reverse auction differs from a conventional one since it has one buyer and many potential sellers. 

It would increase Mississippi’s reliance on federal funds. 

The Mississippi Broadband Enabling Act was signed into law by Gov. Phil Bryant, went into effect immediately and it allows the state’s 26 EPAs, also known as cooperatives, to provide broadband to their primarily rural customer base.

The new law requires EPAs to conduct economic feasibility studies before providing broadband services, maintain the reliability of their electric service, maintain the same pole attachment fees for an EPA-owned broadband affiliate as for private entities wishing to use the EPA’s infrastructure and submit a publicly-available compliance audit annually.

According to data from the latest FCC wireless competition report, there is a digital divide in Mississippi. Ninety-five percent of urban residents in Mississippi have access to high-speed internet service (defined as 25 megabits per second). In rural areas, only half of residents have access to that level of internet service. In 12 of the state’s 82 counties, five percent of the population or less has access to high-speed internet.

In 27 counties, only 25 percent or less of the population has high-speed internet service available.

The technology that might bridge the divide in Mississippi and in other rural states could be 5G (fifth generation) wireless. Signals in 5G operate on three different spectrum bands that include:

• Low band — 600 megahertz, 800 megahertz and 900 megahertz. 
• Mid band — Frequency bands of 2.5 gigahertz, 3.5 gigahertz and 3.7 gigahertz to 4.2 gigahertz. 
• High band — 28 gigahertz, 24 gigahertz, 37 gigahertz, 39 gigahertz and 47 gigahertz (millimeter wave or high band). 

5G can also be supported on unused parts of the spectrum below 4 gigahertz, which is the frequency range used by present 4G LTE coverage. 

Right now, the FCC has already started auctioning bandwidths in the low band. A recent report by the watchdog group Citizens Against Government Waste recommends that FCC also conduct spectrum auctions with strong oversight for mid band, with the proceeds going to taxpayers. 

According to the report, since 1994, the FCC has conducted 101 spectrum auctions that have generated $121,672,180,000 for taxpayers with the awards of 44,499 licenses. The report also says the mid band auction could generate an additional $11 billion to $60 billion for taxpayers, depending on how much of the spectrum is put on the market.

5G will be much faster, capable in urban areas of speeds of 100 gigabits per second for the high band, which is 100 times faster than 4G. Also, 5G has the advantage of low latency, which is the time that passes between when information is received and when it can be used by the device on the network. This means it could be used to replace conventional WiFi. 

Since 5G uses shorter wavelengths, the antennas can be much smaller, which means a tower can support more antennas. This allows 1,000 more devices per meter than what’s supported by the existing 4G network.

The problem with high band is these wavelength have a much shorter effective range. They require a clear line of sight between the mobile device and the antenna. These signals can easily be blocked by solid objects, rain and even humidity, which would be a problem in sweltering Mississippi summers.

Also, 5G download speeds in rural areas would be only fractionally as quick as those in urban areas with large numbers of antennas, which would be supported by trunk lines made of fiber-optic cable.

These issues would provide complications for using 5G as the means to extend high-speed internet service to rural areas of Mississippi. 

The marketplace is already working on solutions.

AT&T has been testing a way to use power lines (Project AirGig) to deliver 5G service. The technology has already been successfully tested in Georgia and internationally. The company says it could be used to bring high-speed internet to customers in suburban and rural neighborhoods.

Mississippi has among the most limiting cottage food laws in the country. 

Passed just a few years ago, Mississippi’s cottage food operators law allows those who bake or prepare goods at home to sell them to the public without a government inspection or certificate. Because of this law, those who had long been baking without asking government now had permission from the state.

But the law limits gross annual sales to less than $20,000. This is the third lowest sales cap in the county, according to a report from the Institute for Justice. 

Among states that have cottage food laws, only South Carolina ($15,000) and Minnesota ($18,000) have lower caps. Seven other states have a similar $20,000 cap, including Alabama and Louisiana.

Our two other neighboring states, Arkansas and Tennessee, however, have no cap. They are two of 28 states that do not place a limitation on what you can earn. 

Cottage food limitations by state

Among states that have a sales cap, the average is just under $29,000.

Who are cottage food operators?

According to the IJ report, 83 percent of cottage food producers are female while more than half (55 percent) live in rural communities. 

Just a few (20 percent) consider this there main occupation. Forty-two percent say it is a supplementary occupation and 35 percent categorize it as a hobby. And the most significant benefit for most operators was the ability to be your own boss and have flexibility and control over the schedule. Indeed, the ability to balance work and family was a top consideration for female business operators, along with the low operational costs. 

This year legislation would have lifted the cap to $35,000. While there shouldn’t be a cap, that would have been an improvement. It passed the House, but failed to make it out of the Senate. 

While most cottage food operators are micro-enterprises, some do or would like to grow into sizeable operations. And we should support that. 

After all, that should be the goal of the state, to encourage growth. Cottage food businesses enhance the financial and personal well-being of their owners. They provide an in-demand product to a willing consumer. And they positively benefit sales tax collections for the state. 

There has not been evidence to suggest that lightly regulated states pose a threat to public health as some like to indicate. The limitations really just serve to limit competition for established businesses. By eliminating restrictions in Mississippi, we can give consumers new options, grow the economy, and encourage entrepreneurship. 

Men have recently started competing against women in sports, and winning. Is that fair?

If the Equality Act becomes law, it will become much more common. This bill, which is backed by nearly 300 members of Congress, will assuredly pass the House this year and be a top priority issue for any future Democratic Senate or White House. 

Under the proposed legislation, all federally funded entities would be required to interpret “sex” to include “gender identity.” If a man identities as a woman, they are to be treated as a woman. That includes, notably, high school and college sports.  

Why have men and women always competed separately when it comes to sports in the first place? And why are they still? We are in the 21st century, right? A woman can do anything a man can do and even more, right? Believe me, I am all about girlpower. 

But as equal as the sexes are, our biology will never be the same. The objective of equality of outcomes is fundamental, but the objective of the equality of outcomes is fundamentally flawed.

On a very basic level, the two genders are divided not because of their genders, but because the biological gender they are born with results in certain hormonal levels which have a lot to do with the level of athletic ability that person can achieve. One particular hormone is testosterone. You will find much more of this in men. In fact, men’s testosterone levels are around 280 to 1,100 Nano grams per deciliter while women’s normal levels are between 15 and 70 Nano grams per deciliter. This hormone increases bone density, and causes muscle mass growth and strength. It also triggers facial hair growth, so women everywhere should be thankful our bodies don’t produce more of that.  

In light of this difference, pitting genders against one another physically would not challenge either competitor to achieve their highest athletic ability.

However, there are female athletes with a much higher level of testosterone than the average female. This includes Caster Semenya, a 2016 Olympic gold medalist in middle-distance running. The International Association of Athletics Federations has attempted to regulate situations such as these by making a separate classification for athletes of Difference of Sexual Development (DSD) and will require those athletes to reduce their blood testosterone levels if they want to compete internationally. For some, situations like Semenya, justify allowing transgender women to compete with biological women. But using a statistical anomaly on the very outer bounds of the distribution mean of physiological traits to set policy for all is scientifically absurd.

What exactly happens when a male declares himself to be female? Do his hormone levels drop to match that of the average woman automatically? And as a result of that, does his athletic ability suddenly change to match that against whom he competes? Does his lung capacity decrease? How about his body fat percentage and muscle mass, does that change? No. Simply, when a man begins the process of becoming a transgender woman, he goes on hormone reducers. On the other hand, when a woman begins the transition from female to male, she is put on steroids, raising the level of testosterone. 

Over time, these hormonal changes affect the individual’s body. But it won’t change them completely. Transgender women will still have more muscle mass and higher bone density than the average cisgender female, allowing them an athletic advantage, in a way, like Semenya. These advantages are physiological. They are present as a result of nature, not as a result of societal pressures or oppressive expectations.

As a former collegiate athlete, the idea that a subpar male athlete could declare himself a female, then swoop into women’s sports, dominate, and bump girls out of the running to receive a college scholarship, or win a state title, or get to playoffs, or compete at a national level, strikes me as taking opportunities away from women, not the other way around. 

Girls and women should not be told to accept this as the new normal. In the name of progress and equal opportunity, it’s the height of irony to tell women they should just accept a scientifically un-level playing field which clearly discriminates against their gender.  

In case we have forgotten, the strides women have made in sports have been rather recent. Of those who competed in the 2014 Olympics, 40 percent were women, compared to 2.2 percent in the 1900 Olympic games. The Women’s National Basketball Association has only been in existence for 23 years. National Pro-Fastpitch was only established in 2004. The Women's Tennis Association has been around for less than 50 years. Sports have opened numerous doors for women, but those doors have not  been open long. 

Why would we let men, claiming they know what being female is like, come in and boot us out of our own opportunities? 

The attempt to allow men to compete in women’s sports, or the larger Equality Act, is simply an attempt to erase the reality of biological sex. It’s absurd.

The Mississippi Justice Institute, along with the Cato Institute, and the Pelican Institute have come to the defense of Vizaline LLC, a Mississippi tech startup that the government wants to put out of business.  

The three constitutional litigation centers filed an amicus (friend of the court) brief on May 1 that urges the U.S. Fifth Circuit Court of Appeals to reverse a wrongful dismissal of the Mississippi company’s lawsuit against the government.  Vizaline utilizes a publicly-available legal description of a bank’s property and then inputs those parameters into a computer program that generates a line drawing of the property description. The program then overlays those drawings onto a satellite photograph and the customer receives the Viza-plat within 48 hours.

Vizaline helps by giving a bank a bird's eye view of the property that is being used as collateral. This service helps smaller community banks because it allows them to identify and resolve any discrepancies that might require the assistance of a surveyor or an attorney. 

The company doesn’t send employees to job sites to conduct surveys or place markers and says on its website that its Viza-plat product is not a legal survey or intended to replace one.

The Mississippi Board of Licensure for Professional Engineers and Surveyors filed a lawsuit in Madison County Chancery Court against Vizaline in September 2017, accusing the company of engaging in the “unlicensed practice of surveying” and seeking the return of all of the fees paid to the company. 

With the help of the Institute for Justice, the company filed a counter suit on First Amendment grounds in July 2018, but the counter suit was wrongfully dismissed on December 18.

The amicus brief argues that the December decision by a federal district court contradicts several U.S. Supreme Court decisions that uphold the concept that the dissemination of public information, even done for profit, is protected under the First Amendment. 

The brief also argues that the board is another “instance of an unelected state board overreaching its authority for protectionist purposes” and that courts should apply closer scrutiny to overly broad licensing laws are used to shield existing businesses from more innovative competitors.

The District Court held that the licensing restrictions only “incidentally infringed” on Vizaline’s free speech rights and therefore did not violate the First Amendment.

The key Supreme Court decision cited in the brief is NIFLA v. Becerra, which was a landmark decision in 2018 for professional speech and the First Amendment. In that case, California regulators tried to convince the court that they were only regulating professional speech regarding Christian non-profits and state-provided contraception and abortion services. 

The court, in a 5-4 decision, held that speech is speech and there is no separation between types, such as so-called “professional speech”. The decision written by Justice Clarence Thomas also held that the consequence of not protecting professional speech would be that states would reduce a group’s First Amendment rights by imposing a licensing requirement.

The Supreme Court came to the same conclusion in two earlier cases cited in the brief — Sorrell  v. IMS  Health  Inc. in 2011 and Riley v. National Federation of the Blind of N.C. Inc. in 1988 — that professional speech was protected by the First Amendment.

Vizaline resulted from the collaboration by Mississippi entrepreneurs Scott Dow and Brent Melton. Melton retired after 42 years in the banking industry. Dow came from the networking, remote sensing and geospatial modeling worlds and started his first company while still in college.

They met at the Mississippi Enterprise for Technology at the Stennis Space Center where Melton presented his idea before a group of tech entrepreneurs. The Viza-plat arrived on the market in April 2014.

The dispute started in 2015, when the Board of Licensure asked Vizaline to place a disclaimer on their website to ensure customers knew the Viza-plat wasn’t a survey. Vizaline complied with the board’s request, but the board sued them anyway.  

Download the full amicus brief here.  

Mississippi’s economic growth lagged behind most of its neighbors in 2018 even though the state’s economy had its best year since 2008.

The report by the U.S. Bureau of Economic Analysis, which is part of the U.S. Department of Commerce, estimated the state’s real gross domestic product grew at a rate of one percent in 2018, a big improvement from 2014, when BEA estimated the state’s GDP shrunk by 1.2 percent. 

Since then, the numbers have been small, but steadily improving, with 0.4 percent growth in 2015, 0.3 percent in 2016 and 0.5 percent in 2017. 

Real domestic product is defined as the market value of goods and services produced by the labor and property located in a state.

That ranked the state 42nd nationally, with Alaska in last place with a GDP that shrunk by 0.3 percent. Delaware and Wyoming (0.3 percent) were next worst. Alaska was the only state whose GDP contracted in 2018.

The southeast — which includes Mississippi’s neighboring states plus Kentucky, North Carolina, South Carolina, Virginia and West Virginia — averaged 2.6 percent of GDP growth. 

In the region, Mississippi was ahead of only Arkansas (0.9 percent GDP growth) and was edged slightly by Louisiana (1.1 percent).

The best growth rates regionally were Florida (3.5 percent) and Tennessee (3 percent). Washington’s economy grew at a rate of 5.7 percent, best in the nation, followed by Utah (4.3 percent), Idaho (4.1 percent) and Arizona (4 percent).

The biggest sectors contributing to Mississippi’s economic improvement were wholesale trade (0.17 percent), retail trade (0.16 percent), hunting and fishing (0.13 percent) and 0.10 percent growth for both durable and non-durable goods manufacturing.

According to the report, wholesale trade increased 9.1 percent nationally and contributed to growth in all 50 states.

In 2018, Mississippi missed the boat on information services, which the BEA says increased 8.9 percent nationally. The industry’s share of the state’s gross domestic product contracted by 0.02 percent. 

Finance and insurance was the biggest downward mover in 2018, shrinking its share of Mississippi’s GDP at a rate of 0.18 percent. Construction’s share of GDP withered at a rate of 0.04 percent.

Poor fourth quarter numbers dragged Mississippi downward, according to the BEA estimate.

In the fourth quarter of 2018, Mississippi’s GDP growth was least amongst its neighbors at 0.5 percent and ranked 47th, outpaced by Alabama (2.1 percent), Arkansas (1.5 percent), Louisiana (1.3 percent) and Tennessee (1.6 percent).

Texas, which had its GDP grow at a rate of 3.3 percent in 2018, recorded the nation’s best growth in the fourth quarter of 2018 with 6.6 percent. 

The actuary for Mississippi’s defined benefit pension fund recommends the plan make some changes to the economic assumptions it uses to plan for the future.

The report submitted by the actuary of the Mississippi Public Employees Retirement System (PERS) — which serves most state, county and municipal employees — says that the plan’s administrators need to decrease its assumptions for price inflation, wage inflation, and returns on the plan’s investments and increase slightly the forecast for administrative expenses.

The report says the plan needs to reduce its price inflation assumption from 3 percent to 2.75 percent to reflect the recent trends with inflation, as estimated by the chief actuary for the U.S. Social Security Administration and other sources.

With the smaller than predicted inflation, the actuaries also recommended the plan reduce its expected return on plan investments from 7.75 percent to 7.5 percent due to changes predicted by forecast prediction models. The plan’s governing board last decreased the expected rate of return in 2015 to the present figure from 8 percent.

The report also recommends the plan reduce its assumption for wage inflation from 3.25 percent to 3 percent.

The report also says the plan needs to take into account a slight increase in administrative costs from 0.23 percent of payroll to 0.25 percent.

The actuaries also changed the plan’s predictions for the mortality of its participants, with the plan assuming that retirees will enjoy longer post-retirement lifespans.

Changing those assumptions will change predictions for the plan’s finances. The actuaries say in the report that PERS’ $16.9 billion in unfunded liabilities will increase under the new assumptions to $18.415 billion. The funding ratio will also decrease from 61.8 percent to 59.9 percent.

PERS’ bottom line has improved in recent years thanks to increased investment returns, but not enough to completely bring the plan to where it should be.

As of the last comprehensive annual financial report released on December 18, the plan’s funding ratio, which is defined as the share of future obligations covered by current assets, is up to 62.5 percent. In 2001, the plan was 87.5 percent fully funded.

The plan’s investments earned $2.385 billion in investment returns in fiscal 2018, a 9.48 percent rate of return, after earning $3.4 billion or a 14.96 percent rate of return in 2017. 

The plan has earned an average rate of return of 7.84 percent in the last 25 years, just a few ticks above the expectation of 7.75 percent. In six of those years, the rate of return was double or more from expectations.

The market is often rocked by fluctuations. Eight of those years have had returns below expectation and four of those years had the plan’s investments losing ground.

Investment income isn’t enough to fill in the plan’s financial gaps, which have increased over the past decade.

The reason is the increasing number of retirees supported by a shrinking number of contributing employees. Benefit payments added up to $2.6 billion, an increase of 5.3 percent over 2017, as the number of retirees increased from 102,260 to 104,973.

The number of contributing employees dwindled from 152,382 in 2017 to 150,687. The amount of employer (taxpayer) and employee contributions added up to $1.6 billion, about the same as the year before.

With more retirees, the plan’s payments for its cost of living increase or COLA added up to $650 million, a 7.8 increase over last year’s COLA payments of $603 million. 

The PERS board voted last summer to increase the employer (taxpayer) contributions from 15.75 percent of payroll to 17.4 percent. 

More than five years after political dignitaries broke ground in the Biloxi dirt at the corner of Highway 90 and Interstate 110, minor league baseball is not working out quite as well in the Gulf Coast town as some had hoped. Or had been sold by consultants.

In 2013, the city of Biloxi conducted a feasibility study that predicted the stadium would draw 280,000 fans annually, or a little more than 4,000 per game. 

The study, a common exercise in such municipal financing plans, provided city leaders with what they needed to move forward. The city borrowed $21 million to help build the stadium. Unfortunately, for the city – and taxpayers – the hopeful projections of that $25,000 study have not panned out. 

The Shuckers have never drawn more than 180,000 fans in a year, and last year they were down to just over 160,000 in attendance. 

As a result of the lower than predicted numbers, the city is forced to reach into its general fund for about half of the $1.2 million they owe each year on the debt. Many leaders hold out hope that if more development comes to the area, it will increase attendance and revenue.

In another minor league town in Mississippi, there is plenty of development around Trustmark Park in Pearl. An outlet mall, funded in part by the state’s Cultural Retail Attractions Program, Bass Pro Shop, Sam’s Club, and a Holiday Inn all surround the park on land that was mostly swamps not so long ago.

Still, the Mississippi Braves, who play in the Southern League with the Shuckers, drew just over 150,000 last year fans last year. This is down considerably from the 190,000 they averaged in 2016 and 2017, and from 2013 through 2015 when their attendance was over 200,000 each year. 

What has this meant for Pearl? The money from this new revenue stream hasn't been enough to cover the debt on the shopping center and ballpark complex. In 2013, the city paid $967,944 to cover the shortfall, though that amount has declined in recent years, shrinking from $911,748 in 2014 to payments of $589,902 in 2015 and 2016 and $619,048 in 2017, the last year records were available.

The city also has to pay $651,852 annually until 2024 to cover a $4,433,165 agreement with the site developers. These outlays are covering underpayments from 2011, 2012 and 2013 on sales tax diversions from the Mississippi Department of Revenue that the city didn't give to the developer.

The Braves have turned the game of pitting city against city into an art form. They moved their Single-A franchise from Macon, Georgia to Rome, Georgia after securing $15 million to build a new stadium. They received $28 million from Pearl when the Double-A team moved from Greenville, South Carolina. And they were able to secure $64 million from Gwinnett county, Georgia when they moved the Triple-A franchise from Richmond, Virginia.  

But their biggest win, if you will, was in Cobb County, Georgia. The Braves were able to receive $722 million from the county to move the big league team just north of the city in 2017. 

It’s hard to blame the Braves, or any team that receives taxpayer subsidies. Their owner, Liberty Media, is doing what any good owner does; negotiating the best deal for its company and shareholders. And the attraction for mid-sized cities to have a minor league ballpark is understandable. We buy into the glitz or maybe the community pride that comes with having a professional franchise in your hometown. It gives local politicians something to highlight as everyone is convinced that minor league baseball is good for tourism and no matter what the taxpayer cost, the community is better off. Yet, we have mounds of economic data that tell us that simply isn’t true.

As the years pass and as more become aware of just how big of a raw deal sports subsides – minor league or professional – often are for cities, perhaps more local officials will choose not to give in to the economic development game. Or maybe local communities will rise up.

As for Biloxi and Pearl, the best they can do is hope the numbers turn around…and that the Braves and the Brewers don’t go looking for a new ballpark when their leases run out. 

This column appeared in the Madison County Journal on May 1, 2019.