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A group of physicians in Mississippi responded to the Mississippi State Board of Health’s resolution opposing medical marijuana. A ballot initiative will be in front of voters in November after Mississippians for Compassionate Care gathered more than 105,000 certified signatures. 

“Sick people all across our state have waited for a long time for this option to be made available to them,” said Jamie Grantham, Communications Director for Mississippians for Compassionate Care. “The Board of Health is telling them to keep waiting, but with the medical research that’s been published concerning medical marijuana as well as countless patient testimonials across the country in the 34 other states that have medical marijuana programs, there’s no reason these patients in Mississippi should suffer any longer. They deserve better.” 

The response from a group of physicians says the resolution is “filled with misinformation and outdated arguments.”

“As you know, the initiative does not require physicians to treat patients with medical marijuana, the response says. “The initiative, that was signed by more than 105,000 Mississippians, simply gives doctors in our state the opportunity to certify its use from regulated treatment centers. Your resolution offers no compelling reason why the ten members of the Board should try to stop the more than 5,700 physicians in our state from using our experiences, training, and research to consider treating our patients with medical marijuana. 

“While medical marijuana is certainly not a cure-all, Mississippians with debilitating medical conditions deserve to have this option available to them. The experiences in 34 other states show that it can be effective, and we believe the benefits of medical marijuana make it a viable treatment option for many in our state who are suffering.”

The physicians signing the letter then provide a point-by-point response to the issues raised by the Board. 

According to an analysis of data by the Mississippi Center for Public Policy, an overwhelming majority of certificate of need applications were recommended for approval by the state Department of Health in the last decade.

From 2009 to 2018, 91.45 percent of the applications passed the first hurdle of a health department staff review. 

During the 2009 to 2018 timeframe, there were 234 analyses performed by department staff for CON applications. The Department of Health recommended authorization on 214 without conditions, two received conditional approval and one received a partial approval.

Only 17 applications were recommended for disapproval (7.26 percent) and most of these were for new providers, largely from out of state, seeking to provide services in the state.

Mississippi is one of 35 states that requires a certificate of need, which requires health care providers to seek approval from the state Department of Health to build a new facility, add beds or diagnostic equipment to an existing facility, or any other capital-related project. 

The regulated areas include:

CON approval is even mandated for non-care related capital projects such as medical office buildings, the installation of hurricane wind-resistant windows at one hospital on the Gulf Coast and authorization for a hospital to repair damage from a tornado. Thirty six applications (15.3 percent) were from providers seeking approval for cost overruns on capital projects.

Providers are also required to provide updates on whether a project goes over budget. Any capital project by a provider is mandated to provide updates on progress every six months and at the project’s completion.

When providers apply for a CON or an amendment to an existing one, this starts a 90-day process. First, the application is reviewed by the Department of Health’s Division of Health Planning and Resource Development to see if it is in compliance with the State Health Plan. This document is a blueprint composed by health department officials to centrally plan the health care needs of the state’s population. 

Among the criteria reviewed by the division include:

Then the division staff makes a recommendation on whether the CON should be awarded. The provider appears before an independent hearing officer who makes findings of fact and issues a second recommendation. The state’s health officer makes the final call on whether a provider receives a CON. 

The only way to dispute the decision is to file an appeal in chancery court within 20 days.

CONS originated from the National Health Planning and Resources Development Act of 1974 that was signed into law by then-President Gerald Ford. This act was intended to reduce annual increases in federal health care spending and one of the cost control measures was to require states to institute CON laws to regulate health care facilities. 

This requirement was later done away with by Congress. Florida was the most recent state to eliminate its certificate of need regime in June. Florida’s House Bill 21 was signed into law by Gov. Ron DeSantis on June 26 and repealed CONs for general hospitals, complex medical rehab beds and tertiary hospital services such as neonatal intensive care units and organ transplant centers. 

The new law also sunsets CON requirements for specialty hospitals on July 1, 2021. The state’s CON requirements on nursing homes and hospices were not affected by the new law.

With this year’s session just a week old, the Mississippi Senate has already filed two bills that would increase teacher pay after the legislature passed one in last year’s session.

Senate Bill 2001, authored by state Sen. Dennis DeBar (R-Leakesville), would provide a 2.27 percent increase on average for teachers over the present pay scale or about a $1,000 hike for most teachers. 

With Lt. Gov. Delbert Hosemann having already announced Senate chairmanships, the chamber has the advantage in getting legislation onto the calendar. The House will announce theirs this week.

With DeBar recently appointed as Senate Education Committee chairman, SB2001 could be headed to the floor as soon as next week.

The biggest increases would be for the lowest base pay scale, with those with one to four years of experience receiving a 3.09 percent pay hike, improving from $35,890 to $37,000 or a boost of $1,110.

Using the previous pay hike as a guide ($76.9 million for $1,500), this pay hike could cost taxpayers about $51.3 million annually. 

Another bill, SB2024, authored by state Sen. David Jordan (D-Greenwood), would increase teacher pay to the Southeastern average. A starting teacher at the lowest certification level would have their pay increase from $35,890 to $40,000 by the 2023-2024 school year. 

Teachers are paid according to their certification level and experience and districts can offer more than the base pay. Teachers also receive small annual increases in their base salary and bigger ones when they earn higher certification levels.

These bills are under consideration as the legislature tries to appropriate funds to cover the teacher pay hike from last year.

The Senate has referred a bill, House Bill 1, to the Senate Appropriation Committee that was passed by the House last week. The bill would provide a deficit appropriation of $18.5 million. 

The legislature appropriated $58,442,743 in last year’s session based on calculations submitted by the MDE. Those original calculations said there were 31,157 teaching positions. The actual number was 40,991.

A raise passed by the legislature this year would mark the fourth pay hike for teachers since 2000. In 2000, a $337 million plan was enacted over a six-year span. In 2014, a two-year, $100 million plan passed by the legislature increased teacher pay $1,500 in the first year and $1,000 in second.

Gov. Tate Reeves was sworn in as Mississippi’s 65th governor today, succeeding Gov. Phil Bryant, who was term limited. 

During a ceremony that was moved to the House chamber because of rain, Reeves, who previously served two terms as treasurer and lieutenant governor, delivered an inaugural address that struck a conciliatory tone in saying this will be an administration for all Mississippians.  

Reeves said his priority was to grow the economy. 

"A growing, vibrant economy solves more problems than any government giveaway ever could," Reeves said. "A government program helps for a month, but a good-paying career helps a family for generations. It is my mission to spend every single day creating a climate where good careers are plentiful — with every Mississippian prepared to pursue them."

Reeves said he wanted to make sure the state is not causing more problems than it solves and that it does not stand in the way of opportunity. 

“We will lower barriers to innovation,” Reeves said. “We will do everything in our power to make sure this is the easiest place in America to start and grow a business…We must open doors of generational opportunity to more people in our state.”

Reeves highlighted workforce development, which has been top of the mind for seemingly every politician in the state.

“It must be our goal to compete for the very best jobs in all the world. It starts with workforce training,” Reeves added. He then called for a “history making” increase in workforce training. 

Other issues Reeves outlined:

- He said we must clean up corrections “to provide for the safety of our citizens and human dignity of all in the system.”

- He called for a teacher pay raise and a new mission to have more national board certified teachers per capita than any state in the nation.

- He said we must “take care of foster kids” and help “special needs kids get the help they need.”

The push to reduce our regulatory burden has picked up steam in the states, and even Washington, D.C. Will Mississippi join the mix in 2020?

Regulations are restrictions written in Mississippi code. Some are statutory, some are administrative. And these regulations often operate in the dark. We know Mississippi has a code book that consists of 9.3 million words and 117,558 restrictions, but that is only because of the work of James Broughel and Jonathan Nelson at the Mercatus Center at George Mason University.

Why does this matter?

Regulatory growth has a detrimental effect on economic growth. We have a history of empirical data on the relationship between regulations and economic growth. A 2013 study in the Journal of Economic Growth estimates that federal regulations have slowed the U.S. growth rate by 2 percentage points a year, going back to 1949. A recent study by the Mercatus Center estimates that federal regulations have slowed growth by 0.8 percent since 1980. If we had imposed a cap on regulations in 1980, the economy would be $4 trillion larger, or about $13,000 per person. 

On the international side, researchers at the World Bank have estimated that countries with a lighter regulatory touch grow 2.3 percentage points faster than countries with the most burdensome regulations. And yet another study, this published by the Quarterly Journal of Economics, found that heavy regulation leads to more corruption, larger unofficial economies, and less competition, with no improvement in public or private goods. 

What are we seeing throughout the country?

In Arizona, Gov. Doug Ducey has issued a new executive order requiring three regulations to be eliminated for every new regulation created. 

“Since 2015, Arizona has eliminated 2,289 regulations, saving taxpayers over $134 million,” according to the press release. “Today’s executive order also renewed a moratorium on all new regulatory rulemaking by state agencies in Arizona - the sixth year in a row the moratorium has been issued. Agencies may seek exceptions for limited reasons, such as protecting public health or safety, advancing job creation or economic development, or reducing or eliminating burdens or government waste.”

Prior to Ducey’s three out/ one in executive order, the standard had been two out/ one in. The Trump administration issued such a regulation shortly after his inauguration in 2017. In three years, we have seen a 3.5 to 1 ratio when it comes to a reduction in significant regulatory actions. This has eliminated over $50 billion in regulatory costs, according to the administration.

Idaho is the gold standard

In the past year, Idaho has  cut 75 percent of its regulationsaccording to Gov. Brad Little’s office to become the least regulated state in the country. Their regulatory count is now just 41,000 restrictions (compared to Mississippi’s 117,000+). 

Idaho was in a unique situation because the state legislature essentially repealed their entire state code book when the legislature adjourned without renewing the regulations, something they are required to do each session because the state has an automatic sunset provision. That gave Little’s office the ability to review every regulation and decide what should stay and what could go. The legislature will now have the ability to give approval to the governor’s new administrative code. 

Idaho found itself in this position because of an automatic sunset in its law; something that is usually renewed but was not in 2019. 

What can Mississippi do?

Mississippi can – and should – join the regulatory cutting game. Here are three actions we can take this year:

- Require each agency to conduct an audit of their own administrative code.

- Require that two regulations be removed from the administrative code for every new regulation that is proposed. 

- Enact a sunset provision on every administrative code that requires the legislature to decide whether each regulation should stay or go. 

Mississippi’s biggest regulators

Mississippi legislators are contemplating bringing back an anti-gang bill from last year, but most people don’t realize that Mississippi already has an anti-gang law.

The Mississippi Street Gang Act was passed in 1997 and allows the state Attorney General, district attorneys or a county attorney to bring a civil case against any gang (defined as three or more persons with an established hierarchy that engages in felonious criminal activity). 

The existing law also proscribes that anyone convicted a felony committed for, directed by or in association with a criminal street gang would be imprisoned for no less than one year and no more than one half of the maximum imprisonment term for that offense.

Those selling or buying goods or performing services for a gang could face the same punishment as above and an a possible fine of up to $10,000.

Both the House and Senate versions of the gang bill would’ve expanded the definition of a gang to include:

Some critics have said this would lead to profiling. State Rep. Bill Kinkade (R-Byhalia) told WLBT that a new bill would need to have the language cleaned up to narrow the definition of a gang.

Both bills would’ve increased the prison term in the original law to five years or less and a fine of no more than $15,000 and no less than $10,000. Both would’ve authorized injunctive relief for people seeking the eviction of gang members on their property and provided for the forfeiture of gang member property.

Senate Bill 2728, authored by state Sen. Brice Wiggins (R-Pascagoula) and it died in committee. The Senate bill differed from its House counterpart in that it would’ve prohibited convicted gang members from parole or any early release program.

State Rep. Fred Shanks (R-Brandon) authored the House version, HB 685 and it also died in committee.

Barely three days into session, the Mississippi House of Representatives passed a bill that would fully fund the teacher pay hike passed last session.

House Bill 1 will appropriate $18,446,578 to ensure that the $1,500 pay hike for the state’s 40,991 public school teachers is fully funded through the end of the fiscal year (June 30).

The deficit appropriation bill was passed out of the appropriations committee Wednesday with a vote by the full chamber on Thursday.

The legislature appropriated $58,442,743 in last year’s session based on calculations submitted by the MDE. Those original calculations said there were 31,157 teaching positions. The actual number was 40,991 and the raise will cost taxpayers $76.9 million annually.

The Mississippi Department of Education said in July it conducted an additional review of the number of state-funded teaching positions. MDE officials found that there were additional positions eligible for the increase that weren’t in the Mississippi Student Information System as ones funded by the Mississippi Adequate Education Program, the funding formula that determines how state funds are distributed to the school districts. Only MAEP-funded positions were eligible for the pay hike.

The problem lies in the antiquated MSIS system, which has issues with its interoperability with district systems for data. The issues forced MDE to recount the number of raise-eligible teaching positions by hand.

The legislature appropriated $500,000 as part of MDE’s appropriation to start the process on upgrading it.

The expanded list of teaching positions in addition to classroom teachers, counselors, teacher assistants, and librarians includes specialized positions such as dyslexia therapists, audiologists, and psychologists.

Since 2000, Mississippi teachers have received three pay increases beyond annual step increases. In 2000, a $337 million plan was enacted over a six-year span. In 2014, a two-year, $100 million plan passed by the legislature increased teacher pay $1,500 in the first year and $1,000 in second.

City of Jackson officials are hoping the state will provide $3 million to purchase additional crime prevention surveillance cameras in the city.

The city council passed a motion to request the bond money from the state on Tuesday, according to WLBT.

The city currently has 30 cameras in operation. These were purchased through a $200,000 grant. The Real Time Crime Center allows the city to monitor activity on the streets.

If the city receives the new funding, they would have four to six people monitor cameras around the clock throughout the city. Currently, the cameras are located in south Jackson.

Mississippi’s certificate of need program needs some reform, but the legislature has been largely unsuccessful in the last four years in changing the system in a meaningful way.

Mississippi is one of 35 states that require a certificate of need for healthcare providers. They must receive approval from the state Department of Health to build a new facility, add beds or diagnostic equipment to an existing facility, or even when a capital project goes over budget.

Every major attempt at reform in the past four years for Mississippi’s certificate of need program has failed. Former state Rep. Mark Baker (R-Brandon) tried three times to completely eliminate the state’s CON regime in 2015, 2016 and  2017 and all three bills died in committee without a floor vote.  

Former state Rep. Robert Foster (R-Hernando) also filed a reform bill in 2016 that would’ve removed most health care services and equipment from CON oversight. It also failed in committee.

The only CON reform passed by the legislature and signed into law in the last four years was a bill authored by state Sen. Josh Harkins (R-Flowood) that revised the time requirements and required public notices be issued before CON approval.

CONs originated from the National Health Planning and Resources Development Act of 1974 that was signed into law by then-President Gerald Ford. The goal was to curtail constant increases in federal health care spending by inexplicably regulating the number and services rendered by providers. 

One of the cost control measures was to require states to institute CON laws to regulate health care facilities, with Mississippi passing its CON law in 1979. 

The CON program in Mississippi regulates:

The way the process works is a provider submits an application for a new CON or an amendment to an existing CON. Officials use a document called the State Health Plan to determine whether to authorize the CON. 

This state health plan determines the health care needs of the state’s population, a classic case of central planning.

Where the CON hurts most is rural hospitals. According to a national report of rural hospitals, 31 of Mississippi’s 64 rural hospitals are at high financial risk. Nationally, 21 percent are listed in danger of closing their doors. 

Scholars at the free-market Mercatus Center at George Mason University found that patients were more likely in states with a CON regime to have to travel outside their county for care. Using 25 years of data and controlling for factors that might influence the numbers of hospitals, states with CONs have 30 percent fewer rural hospitals per 100,000 residents.

Eliminating the CON could also reduce healthcare costs, according to some research.

A 2016 study by the federal National Institutes of Health showed that Medicaid and Medicare spending per enrollee in nursing homes declined in all states during the study, but the rate of decline was higher in states without CON policies. 

The study examined Medicare and Medicaid spending on nursing homes and home health care in 44 states that didn’t change their CON laws from 1992 to 2009.

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