Economy Archives - Page 14 of 43 - Mississippi Center for Public Policy

As the recent coronavirus pandemic has demonstrated, the healthcare system needs some rethinking and retooling. We are in great need of solutions that increase efficiency and quality while also lowering costs for providers and patients.

One such example is the problem of non-emergency medical transportation for Medicaid recipients. Millions of Americans miss their medical appointments each year. These no-shows reduce access for other patients. They also cost an estimated $150 billion a year by increasing administrative costs related to scheduling and rescheduling. In the context of Medicaid, these costs increase the price tag of Medicaid, which is a form of subsidized health insurance paid for by state and federal taxpayers.

Mississippi already offers generous transportation services for Medicaid beneficiaries, with no copay required. The amount allocated for the current Mississippi Medicaid non-emergency transport contract is $96.8 million for the period from October 2018 to September 2021. Total federal spending on non-emergency Medicaid transportation averages $3 billion a year. Could there be a way to reduce federal and state spending on non-emergency transport while also reducing the number of missed appointments?

Mississippi has used the same broker for years to facilitate Medicaid transportation, but the vast majority of Medicaid recipients are not using the service. The current arrangement may be saving some money over more traditional options, but the real question is whether mobile app technology now affords a much better and cheaper way to provide transport.

Thanks to a 2017 rule change by the Trump administration, healthcare providers are allowed to provide free or low-cost transportation services to patients. The administration is also looking at an additional rule change that would provide more flexibility in this area. An obvious solution is to use ridesharing services, like Veyo, Uber Health and Lyft, to lower costs.

Ridesharing is commonplace all across America. It works by allowing qualified drivers to use their own vehicle to transport other people. As in many other areas, the public health insurance system – Medicaid and Medicare – has yet to really catch on. But ridesharing is an innovative way of harnessing technology.

A recent study in the American Journal of Public Health estimates that adopting a ridesharing model would generate $537 million in total Medicaid savings, with an average annual savings of $268 per user. The authors also conclude that ridesharing could improve the patient experience by allowing for “on-demand scheduling, electronic records for monitoring, more-direct routes, greater reliability, and operational simplicity.”

Last year, Arizona became the first state to use ridesharing for non-emergency Medicaid transport. Multiple states have followed suit, including Florida, Georgia, Missouri, Tennessee, and Texas. A 2018 PEER report likewise recommends that the Mississippi Division of Medicaid explore ridesharing options. A conservative estimate is that Mississippi Medicaid could save millions annually from ridesharing.

At a minimum, early evidence suggests that ridesharing results in fewer missed appointments and reduced waiting times, saving money for hospitals and other providers and increasing patient satisfaction. In addition, it is less expensive than traditional transportation models and costs less per trip on average.

Another opportunity that has arisen since the 2017 Trump rule change is that nonprofit hospitals are offering no-cost transportation using ridesharing services. This service is being provided as part of each hospital’s mandated “community-benefit” requirement. Under federal and state laws, nonprofit hospitals receive billions of dollars in tax breaks in exchange for providing some kind of “community benefit,” a loophole that seems to be more of an accounting gimmick than a concrete form of help to those who most need it. Allowing ridesharing to count toward a hospital’s community-benefit activities at least provides some savings to taxpayers while affording more reliable transportation for Medicaid recipients.

Josh Komenda, the president of Veyo, observed that “there's been a huge opportunity to further develop much more modern technologies, automation, and tracking…Think about all the technologies that have been invented: cloud-based technology, mobile technology, GPS tracking, web portals, and mobile apps. These are ways that we have basically built a new management system.”

These technological innovations are revolutionizing the non-emergency medical transportation industry. For instance, legacy medical transport vendors have higher costs and less flexibility because they must maintain and house a fleet of vehicles. Ridesharing avoids this expense and can adapt more easily to spikes in unexpected demand. Ridesharing also employs the latest tracking and monitoring software in order to keep patients safe and reduce waste, fraud and abuse.

In an era of budget cuts where lawmakers are forced to prioritize services and look for more efficient ways of doing things, they should consider that other states are saving money and boosting patient satisfaction by adopting a ridesharing model for Medicaid transport. Consumer-driven and consumer-friendly technological innovations are saving taxpayers millions of dollars every year.

Why should Medicaid patients – and Mississippi taxpayers – miss out?

This column appeared in the Northside Sun.

Mississippi is doing better than most states when it comes to recovering from the economic shutdowns caused by the coronavirus pandemic.

Mississippi’s unemployment rate, which was the highest in the nation at 5.4 percent one year ago, is now more middle-of-the-pack at 8.7 percent. This is down from 10.5 percent in May, and better than the national average of 11.1 percent.

Notably, the increase of just 3.3 percent over the past year is one the lowest jumps in the country. That contrasts with the state’s that were at the center of the COVID-19 pandemic in the spring, including Illinois, Massachusetts, Michigan, New Jersey, and New York. They subsequently made the most draconian moves to shut down businesses and they have seen their unemployment rates jump by 10.6 to 14.5 percent since last June.

Mississippi's relatively low unemployment rate is due to the fact that Mississippi is doing better than most when it comes to the state’s jobs rebound.

February-April job losses that returned in May and June

Almost half of the jobs that were lost from February through April have returned in May and June in Mississippi. The South has been stronger than most other regions of the country, and Mississippi’s rebound of more than 49 percent is seventh best in the nation.

Neighboring Tennessee came in slightly ahead at 52 percent, placing the Volunteer State third nationally. Louisiana, which has seen a rebound of just 32.8 percent of jobs lost, is the only state in the Southeast not in the top half of the recovery.

Still, we know the recovery hasn’t been even, and many businesses – particularly small businesses – continue to struggle. Especially when promised relief funds never show up.

“They promised us all kinds of grants and loans," said Edward Ferrell, owner of the Little Yazoo Sports Bar and Grill in Yazoo City. "Nothing’s happened. I have not received a dime of that money. I’ve had to let good friends go who had worked for me for the last five years because I can’t afford to pay them. I can’t afford to pay the bills. I’m dipping into my savings that we were going to use to update the bar. We can’t do it now.”

That is why the continued focus on the use of federal funds for the recovery efforts in the state should be on private sector needs, not public sector wants.

As Mississippi marks the 54th anniversary of legal liquor sales in the state, the state run liquor warehouse is still not able to meet consumer demand.

In a recent story from WLBT, local liquor store owners are complaining that liquor shipment are still delayed at least two weeks. There was a run on liquor at the beginning of the pandemic, but that has eased off. Sean Summers, owner of Calistoga Wine and Spirits in Ridgeland, said his business is down 50 percent since December.

Yet, Alcohol Beverage Control is unable to complete basic orders. This raises numerous questions, such as, why do we need the state to control alcohol?

But what makes the recent news about shortages more ironic is that yesterday marked the 54th anniversary of the first legal liquor store in the state. On that day, Jigger and Jug opened in Greenville. That happened more than 30 years after the federal government repealed prohibition.

Mississippi has a long history of attempting to control alcohol consumption. It was the first state to pass some form of prohibition in 1908, and then was the first state to ratify the 18th amendment, creating a federal prohibition in 1918.

While prohibition inspired some great blues songs and classic literary characters it was bad public policy. For years before 1966, many establishments openly sold alcohol to customers, and the state even placed a 10 percent tax on the sale of alcohol, essentially making a mockery of its own prohibition laws.

Public policy ought to be rational and easily comprehendible by the public. Our modern laws governing the control of alcohol are anything but that, and continue a long tradition of excess government control.

We have over empowered individual counties to define their own laws, and in so doing have created a chaotic state of regulation, difficult to understand by the average residential citizen, let alone internal and external businesses hoping to sell. Though residents in dry counties or those passing through will soon be allowed to legally posses alcohol.

Furthermore, the state has retained an egregious amount of control of the distribution process. Mississippi has decided that, rather than allow private businesses to control the market, it will run a large warehouse in the central part of the state which will have a complete monopoly over the distribution of all spirits and wines.

As the Department of Revenue states on its own site, “the ABC imports, stores, and sells 2,850,000 cases of spirits and wines annually from its 211,000 square foot warehouse located in South Madison County Industrial Park.”

This warehouse consistently operates at capacity, and government leaders are considering a $35 million expansion. Perhaps our politicians ought to consider giving the free market a chance?

There is no reason that our government should be so deeply involved in controlling the distribution for a product. They hike up prices by a tremendous rate, limit access to the product, and determine which brands are allowed to sell in the state, leaving businesses in the dark and unable to control their own wares.

Private businesses are barred from distributing alcohol in Mississippi. While UberEats, DoorDash, and GrubHub have created thousands of jobs in other states through their delivery systems, our legislative leaders have shut down this opportunity for individuals to order alcohol with their delivery.

And while a variety of companies sell and ship wine, whiskey, and other alcoholic beverages around the country, our legislative leaders have determined that we shouldn’t have this freedom of access.

The excess regulation has made Mississippi last in the nation for craft beer development. For comparison, craft brewers currently produce $150 per capita in Mississippi, while they produce $650 per capita in Vermont. Imagine the difference such an industry could make in our state. This is thousands of tangible new jobs which are being discouraged from coming into existence by our government.

Existing policies have led Mississippi to have the largest shadow economy in the nation (referring to the exchange of products that are not taxed or recorded) at 9.54 percent of GDP. Moonshine is either produced or is available in every single county, which many link to the strict regulation of the alcohol industry. Our egregious taxation of alcohol products displayed here by the Department of Revenue has encouraged many companies such as Costco and Trader Joes to avoid opening locations in the state due to the lack of revenue potential on alcoholic products.

Prohibition is alive and well in Mississippi. Our government has decided we apparently can’t be trusted to make basic purchasing decisions for ourselves, so they must control what alcoholic drinks we’re allowed to have access to, how we’re allowed to receive these drinks, and from whom we’re allowed to purchase these drinks.

Be not fooled by the government “do gooders” who proclaim that they carry out policies like this for our own protection. Too many of our political leaders refuse to give freedom a chance, and instead have decided that they know better than we do when it comes to running our lives.

The fact is that while Mississippi prides itself on having a relatively low income tax, it finds dozens of other ways to tax and control its citizens.

Companies are discouraged from entering into business in the state because we have established covert taxes which discourage entrepreneurial risk taking.

Mississippi controls, regulates, and taxes alcohol worse than New York or California, so imagine what other discrete ways it is shutting down job opportunities and discouraging new business.

For now, the premise is simple: Get the state out of the alcohol business. Alcohol sales shouldn't be another excuse to take from taxpayers. That is not the role of government. Instead, Mississippi leaders should trust in the free market.

“The government shutdown pretty much devastated my business. Today, my business is in financial jeopardy.”

Edward Ferrell and his wife Kristi own Little Yazoo Sports Bar and Grill on Highway 49 in Yazoo City. They purchased it in 2014 when the opportunity occurred.

“It’s always been a bar here,” Ferrell said. “It’s always been lucrative, so we took a chance on it. We’ve owned it for the last six years, and every year we stayed in the black until this year when they decided we needed to shut down for the COVID 19 outbreak.”

Back in March, the bar was forced to shut down by the state. As opposed to restaurants that could hang on by offering curbside or take out, they couldn’t. The bar would stay locked down for more than two months.

“They promised us all kinds of grants and loans. Nothing’s happened. I have not received a dime of that money. I’ve had to let good friends go who had worked for me for the last five years because I can’t afford to pay them. I can’t afford to pay the bills. I’m dipping into my savings that we were going to use to update the bar. We can’t do it now.”

Today, Ferrell has to use his income from his other job to pay the bills at the bar because they aren’t making the money needed to cover costs.

Because even though bars are limited to 50 percent capacity, it doesn’t mean bills have been cut in half.

“My bills are not 50 percent. I still have to pay the same amount of rent, same amount of lights, same amount of water, same amount of insurance. I try to make a dollar for myself, and there’s just no way to do that. We had a full-time kitchen. Now we can’t afford to pay a cook, so we had to shut the kitchen down. You can’t order half stock, you have to order full stock, and you’re going to lose half of it because you’re not selling it. They don’t split the packages in half because were at 50 percent.

“We’re limited to 50 percent, but it took 90 percent at full capacity just to pay the bills.”

To the Ferrell’s, and those that frequent the bar, it’s more than a place to get a drink.

“We firmly believe in giving back to our community. Every year we hold a womanless beauty pageant. We take that money raised, and we take care of the DHS foster kids. Anytime someone comes down with cancer, a friend of ours, a patron of our bar, we jump in and do benefits for them, we raise money to help them. We recently had a nurse who had to have emergency surgery, and she’s out for eight weeks. We did a plate cooking here and raised a lot of money that’s going to help pay her bills while she’s out.”

“We love them, they’re family, we’re all family.”

And so, Edward and Kristi will keep fighting. Even at 50 percent.

Now would be a great time for the Occupational Licensing Review Commission to take a deep dive into Mississippi’s regulatory burden and cut what is unnecessary, duplicative, outdated, or that stifles economic growth.

Enacted four years ago, the OLRC is made up of the governor, secretary of state, and attorney general. In their original form, they were tasked with reviewing all new regulations from boards and commissions that are run by active market participants. Meaning, a Board that is comprised of individuals who work in that field. For example, the Board of Medical Licensure is made up of medical doctors, the definition of market participants and any new regulations or changes they propose have to go through OLRC.

The premise is basic: A board should not be able to design regulations to stifle competition and benefit individual members in that field.

The Board of Health, on the other hand, has various members and the department has their hand in numerous industries. Therefore, they are not subject to OLRC, which is unfortunate because they make up about 15 percent of all regulations in the state.

So, the OLRC is limited in what they can do, but their power has now been expanded. Instead of just reviewing new regulations, they can now go back and review – and potentially remove – current regulations. That came through House Bill 1104, a bill MCPP championed this year as part of our push to decrease burdensome regulations in the state.

Secretary of State Michael Watson, one of the members of the OLRC, recently unveiled his office’s new ‘Tackle the Tape’ initiative, a first step in addressing these problems.

“I’ve heard too many stories and witnessed numerous Mississippi businesses suffer from the unfortunate consequences of overregulation,” said Watson. “If we truly want to create more opportunities and breed renown entrepreneurs, we have to get government out of the way. As promised when I ran for office, cutting the regulatory burden on Mississippi businesses was, is, and will continue to be a priority for our team. Our voluminous regulation costs us 13,000 jobs per year, which is the equivalent of a new Ingalls Shipbuilding or Nissan locating here on an annual basis. We must do better!”

Watson’s office has reached out to the various licensing boards under OLRC’s jurisdiction in an attempt to partner with the boards in reducing the state’s regulatory burden. We can hope that will have an interest in this process.

In 2018, as part of a national review of state regulations, the Mercatus Center at George Mason University found Mississippi has nearly 118,000 regulatory restrictions on the books. All told, the state code book includes 9.3 million words, and it would take about 13 weeks to read if all one did was read regulations as a full time job.

Overall, Mississippi’s regulatory load is about average for a typical state, but when compared to some of its neighbors, a clearer picture emerges. A new Mercatus Center analysis summarizes data from eight southern states stretching from Kentucky down to Florida and over to Louisiana. Of these states, Florida has the most regulatory restrictions at 171,000. However, if one adjusts for the fact that a bigger population tends to generate more regulation, Florida is, by that measure, actually the least regulated. Of the group, Mississippi has the most regulations per capita (and the lowest GDP per capita).

More populous states tend to have more industries, denser urban areas, and other factors that generally contribute to a higher number of regulations. This explains why California, Ohio, New York, and Texas are all among the five-most regulated states in America, despite having very different political environments.

The coronavirus pandemic has revealed deep shortcomings in the regulatory system. To ensure an adequate amount of health care coverage, governors around the country have been relaxing—not increasing—regulations. This includes easing restrictions on telemedicine, recognizing medical licenses from other states, and in some states, rolling back requirements that health care facilities obtain permission from regulators before adding new equipment like hospital beds.

But much more is needed.

As the pandemic continues to ravage the country, and the nation’s regulatory system is simply not up to the task. There is an opportunity to rectify the situation if our leaders will heed the call.

When it comes to education, the private sector and individual families generally do a much better job of innovating than the government. That will remain true during the coronavirus pandemic.

In a world when many government schools are moving to online learning only or implementing rigid policies concerning face masks, social distancing, and extracurricular activities, we have seen an interest in something else. For many that has been homeschooling, but that might not be for everyone.

Enter microschooling, or more simply, pods. This isn’t exactly new. Just much more relevant today than years past.

While this may take many shapes and sizes, the premise is that a small group of families pool their resources to hire a teacher for their children. With this, children are able to get a “school setting,” have a teacher hired by the parents, and parents are able to work outside of the house. And by being in a smaller setting, the thinking is you are less likely contract COVID.

All the while, you have the ability to customize your child’s education in choosing a learning style that you feel best meets their needs and interests. Much like private school, you opt-in after reviewing the various options available and what the specific schooling entails.

How do people find out about local pods and get help in starting one? There are structured microschooling organizations, but if you’d like something more informal, Facebook groups are a great starting point to find the right fit. The Pandemic Pods group now has 30,000 members asking questions and sharing ideas.

Pods can also be a great option for current teachers who either don’t want to go back to school under current conditions or are looking for something different. In this setting, teachers would have a significant amount of autonomy to teach children without the current reliance on test scores and restraints of the state and federal government mandates.

In many ways, pods are similar to co-ops, which have long served homeschool families, but come with some differences. Co-ops largely rely on parents to take turns with instruction and are generally only one or two days per week, with parents filing in the rest of their child’s education. The pod allows an outside source to handle all (or most) of the education during the day similar to a traditional school.

The best part about what we are experiencing with education today is that we are finally seeing a move toward individualism to meet a child’s needs at a large scale. So much of education is just a closed decision. You send your kids to a school when they are five. Thirteen years later they graduate with a certificate saying they learned…something. It requires as little effort as you’d like to make. Usually the hardest decision is finding a place to live within government created lines that dictate school zones or districts.

Today, we’re making hard decisions about our child’s education. A lot of this is about safety and socialization, but it’s about what’s best for them, and what will lead to the best outcomes. That is good. Because the one thing we’ve always said is there is no one-size-fits-all approach that is going to work the same for every child.

For you, that might be a pod.

“My name is Danielle Russell and my business in Craveable Creations.

“You could say I got started when I was 8 years old. My mom and dad were both Navy, so I wasn’t raised by a traditional mom. She didn’t cook much, and she hated it when she did. But my aunt loved to cook, and I loved being with her learning. After she taught me how to make pancakes, I fell in love with cooking everything. I especially love old timey recipes.

“Fast Forward to 20015, a friend of mine asked me to make mini pies for her wedding and I did – 300 mini pies of all sort for the grooms table. After that I researched what I could do from home and found out about the cottage food guidelines. To be honest I do not like having my hands tied by such restrictions.

“I sell baked goods and custom snacks. I have a very eclectic clientele. I have been blessed to be a small part in several weddings, birthday parties – the most recent was for a 99-year young gentleman in our community. I have participated in baby showers, snack foods for football parties. I even had the privilege of making cinnamon rolls for former First Lady Deborah Bryant.

“Because of this business, we’re able to prepare for retirement. I am 46 years old and I have worked in a hospital laboratory as a Med Tech my entire adult life. I was so excited to see the ability to advertise cottage food products online. And the increase income of $35,000 will also be a big help!”

Danielle Russell
Craveable Creations
Newton, Mississippi

“My name is Leslie Stingley and I operate Homestead by the Brambles.

“Currently I make homemade breads, and syrups that can be added to teas, lemonades, and cocktails. I have a garden, we make pickles, and I have wild chanterelles mushrooms growing on the property.

“I started this business when I lost my job at a food manufacturing company in May. I worked 55-60 hours per week before. But because of the new business, I’m now able to be at home with my daughter.

“We are still really in its startup phase, but I know there is a market for fresh, preservative free goods. I’ve seen and experienced the beginning of the failure of the food system. I feel strongly that my purpose is to help change the food system.

“I want to change our culture to one of true sustainability, not this fake sustainability that has been preached by the major food companies the past 10 years. I strongly fear if we have a worse food shortage than we did over the coronavirus pandemic, people will not know how to eat.

“The legislature allowing cottage food businesses to earn more and advertise online will be a big help.”

Leslie Stingley
Homestead by the Brambles
Morton, Mississippi

Mississippi has a ways to go before challenging some of the South’s strongest economies, and one key reason is more regulation and red tape than its neighbors. New legislation proposed this session could have helped rein in government red tape, but the most significant bills failed to gain enough traction. Thus, Mississippi has a long way to go if it wants to unburden itself of the moniker “the most regulated state in the South.”

The biggest regulator in Mississippi, by far, is the Department of Health, with more than 20,000 restrictions. Coming in second is the Department of Human Services, with over 12,000 restrictions. Various state boards, commissions, and examiners have a combined 10,000 restrictions.

These regulations touch every industry in the state and impact each Mississippian in some form or fashion. The health care and assisted living sectors are particularly highly regulated. Some of these rules keep our senior citizens safe, but surely others, like restrictions on relocating or renovating medical facilities, just make the system inflexible, especially during an emergency.

Mississippi lawmakers recently had an opportunity to reduce regulatory burdens. Several bills were proposed that would have created regulatory reduction pilot programs at various state agencies. The idea is that a small consortium of agencies should have to measure and track how much regulation they impose, and then make sensible cuts based on those measurements. If all goes well, the pilot program can be expanded to other agencies. The state of Virginia has already implemented a pilot program like this, demonstrating that the idea is feasible, affordable, and even bipartisan.

None of the various Mississippi proposals made it into law this year. However, governors around the country have taken action by issuing red-tape reduction executive orders. Gov. Tate Reeves could start by reviewing regulations suspended in response to COVID-19, as Idaho has recently done. Or he could take a more aggressive approach, like Gov. Kevin Stitt of Oklahoma, who earlier this year ordered a 25 percent across-the-board regulatory reduction.

Whatever approach is taken, Mississippians need regulatory relief now. The pandemic continues to ravage the country, and the nation’s regulatory system is simply not up to the task. There is an opportunity to rectify the situation if our leaders will heed the call.

This column appeared in the Clarion Ledger on July 7, 2020.