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Gov. Tate Reeves announced today that the state will be taking a measured approach to reopen Mississippi as the current shelter-in-place order is replaced with a new, safer-at-home order. The new order will be in effect Monday at 8 a.m.

“We are facing a historic economic crisis,” Reeves said. “The economic damage has been particularly cruel to the working class. Those who work on their feet, those who don’t have a home office, or paid leave.”

Many currently closed businesses will be allowed to open under certain circumstances. Retail stores can reopen, but they must reduce capacity by 50 percent based on their designated full capacity. Masks are highly recommended, but not mandated.

A large grouping of currently closed businesses – including movie theaters, bars, museums, casinos, salons and barber shops, gyms, and clubs – will remain closed. Restaurants remain limited to curbside, take out, or delivery as dining rooms are still closed. 

Gatherings of 10 or more remain prohibited, and Reeves said this will be enforced. There is also a classification of the most vulnerable, including the elderly and those with pre-existing health conditions, who are required to continue sheltering in place. 

Still, Reeves continued to stress personal responsibility asking all Mississippi to stay at home except for essential travel.

“That’s still the safest behavior,” Reeves added. “You still have to be smart. You are responsible for your safety and the safety of your loved ones. We trust Mississippians to make good, personal decisions.

“There is not a government replacement for wisdom. We believe in personal responsibility. You should do what you think is best for your family.”

Municipalities are allowed to be more strict, but they are not allowed to be in conflict with the state order as it relates to designated essential businesses.

The order is in effect for two weeks, though Reeves sounded very confident that they may review the order prior to see if more of the state can open up. 

Medicaid is a joint state-federal health insurance program partially funded by each state and the federal government. The program, in fact, provides little opportunity for states to adapt to diverse healthcare challenges, such as changing demographics and rising healthcare costs.

During the initial COVID-19 outbreak, however, the federal Centers for Medicaid and Medicare Services (CMS) offered states some flexibility via three different types of waivers. In turn, the Mississippi Division of Medicaid took advantage of these opportunities, pivoting quickly to get existing Medicaid resources to the elderly and the disabled. This brief will examine the three different types of waivers – 1115 waivers, 1915 waivers and 1135 waivers – that are available to increase access during pandemic outbreaks like that brought on by COVID-19.

Use 1115 Waivers to Expand the Supply of Healthcare

An 1115 waiver allows states to waive certain statutory requirements related to their Medicaid programs. Typically, 1115 waivers have been used to expand Medicaid services or enrollment to new populations, but the Trump administration has rightfully urged states to consider reforms aimed at channeling care to the most vulnerable of the uninsured.

Effective March 1, 2020, CMS created a fast track process that allowed states to “focus agency operations on addressing the COVID-19 pandemic” by using “established” waivers with “proven program outcomes.” The waivers expire no later than 60 days after the initial coronavirus health emergency ends.

One of the available waivers would extend home-based services to individuals who would otherwise require care in an institutional setting. The target populations are the elderly and the disabled who have functional and chronic illnesses or disabilities. This waiver interacts with the 1915 waiver discussed below. 

A second 1115 waiver enables states to “accept self-attestation of applicant resources.” In effect, this waiver suspends verification tools (such as those created by the HOPE Act) that ensure Medicaid resources are being used by those who actually need them. At the same time, the waiver blunts the arguments of those who might claim we need to expand Medicaid during the current crisis. In any event, CMS also seems to be fast tracking Healthy Adult Opportunity waivers meant to encourage Medicaid expansion to able-bodied, childless adults. 

In what follows, we wish to suggest 4 additional 1115 waivers the Mississippi Division of Medicaid should adopt as we recover from the current COVID outbreak and prepare for additional outbreaks. These waivers will help increase access for patients in urgent care situations as well as provide additional options to existing Medicaid beneficiaries. 

--> Increase cost sharing for unnecessary emergency room visits and missed appointments

Hospitals and other medical providers are already strained to the breaking point by COVID-19. In recognition of this, the Trump administration is allowing some flexibility regarding EMTALA requirements. (The Emergency Medical Treatment and Labor Act (EMTALA) requires hospitals that accept Medicare funding to screen and treat or stabilize any individual seeking emergency care, regardless of ability to pay.)

Likewise, Mississippi Medicaid should discourage unnecessary emergency room visits by using an 1115 waiver to require a higher copay.[1] At least one state, Arizona, has a limited waiver to charge a copay for non-emergent ER visits. Mississippi should do the same.  

Clearly, hospital emergency rooms must be able to fully focus on medical emergencies, both COVID and non-COVID related. Charging a copay for non-emergent visits will preserve scarce resources for those who need them. This is especially the case as we are seeing hospitals hit capacity limits in hot spot areas. This policy will also reduce the exposure of Medicaid patients to the coronavirus.   

Likewise, Medicaid patients who miss medical appointments should be charged a copay. Studies show that Medicaid patient no-show rates are almost twice as high than it is for other patients and, in one study, five times higher than for uninsured patients.

CMS has yet to allow states to charge a copay for Medicaid beneficiaries who fail to cancel an appointment.[2]During the COVID-19 outbreak, however, such a waiver makes good sense. Moreover, we need to set in motion policies that will encourage an efficient use of resources in a post-COVID healthcare landscape. Such policies will enable providers to give targeted care to patients who actually need to see a doctor. 

--> Innovate Medicaid transportation services

One reason some Medicaid patients miss appointments is because of inefficiencies related to Medicaid transportation providers. Thanks to a 2017 rule change from the Trump administration, healthcare providers may now 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.  

Mississippi already offers generous transportation services for Medicaid insurance beneficiaries, with no copay required. The state is currently using a broker to supply transportation. It is unclear what cost savings is being derived from this arrangement. In any case, states need to be incentivized to work with rideshare services like Veyo, Uber Health and Lyft. An 1115 waiver could be crafted that allows the state to divert savings from non-emergency transportation to high-need areas, such as home and community based services waiting lists. Administrative changes might also make this possible. The thing to keep in mind is that the state needs to be able to pocket the savings that comes from using innovative ridesharing services.  

In light of the COVID-19 crisis, it is also important to reduce instances of missed appointments, which would help protect providers from financial losses.

It’s time for Medicaid to start to use existing transportation technology more effectively. As we have discovered during the coronavirus outbreak, healthcare resources are not infinite.   

--> Encourage more use of telemedicine

Telemedicine is a technology a patient can use to access a healthcare provider even when the provider is not physically present. This can be done through a variety of electronic services that enable providers to remotely offer care to their patients without the overhead costs associated with the traditional medical office model. In response to the current coronavirus outbreak, the Mississippi Division of Medicaid expanded telemedicine availability. Not only do these changes need to be made permanent, they need to be expanded upon.

The COVID-19 outbreak has exploded the myth of infinite supply in healthcare. Supply is not limited. It never has been, which is one reason healthcare in the United States is so expensive. But the supply of quality healthcare can be increased by cutting red tape. For instance, multiple rules and regulations have been hindering the supply of telemedicine in Mississippi.

Even before the coronavirus outbreak, Mississippi Medicaid was expanding access to telemed. More can be done. In particular, Governor Tate Reeves should pursue reforms that allow healthcare providers licensed in other states to offer telehealth services to Medicaid beneficiaries in Mississippi.

A study published by the American Journal of Emergency Medicine found that telemedicine substantially lowered healthcare costs, diverting patients away from “more expensive care settings.” In the current COVID world, such diversions can also lower potential exposure, reducing the need for even more expensive interventions. Mississippi Medicaid should do all it can to expand the use of telemedicine so as to provide relief for over-burdened hospitals and provide safe, high-quality care to patients.

--> Incentivize high-quality alternative surgical options 

Mississippi has among the highest COVID-19 hospitalization rates in the country. With this in mind, it is vital that the state Medicaid program incentivize the utilization of ambulatory surgery centers (ASC) in order to reduce pressure on hospitals struggling to respond to the coronavirus pandemic. The use of ASC has great potential in further mobilizing all medical resources to respond to future outbreaks.

This move to incentivize ASC could be accomplished through an 1115 waiver (or, as applicable, administrative changes) that increases the current copay for hospital outpatient department (HOPD) use. (The current copay for both ASC and HOPD is $3.00 per visit.)[3] Prior authorization requirements should also be reviewed so as to encourage the usage of ASCs over HOPDs.

Diverting patients from more expensive hospital settings would preserve hospital resources for high-risk patients. Additionally, prior-authorization requirements for HOPD would make sure that these settings are being utilized by the patients who need them most. 

Ambulatory surgery centers have saved billions of dollars for both commercial insurance and Medicare insurance beneficiaries. In the state of Mississippi alone, Medicare saved $70.1 million from ASC use in 2017. It’s time for Medicaid to follow private and Medicare insurance providers in obtaining similar efficiencies.

Use 1915 Waivers to Help the Elderly and the Disabled

A second type of federal waiver being used to provide assistance to high-risk populations during the coronavirus outbreak is a 1915(c) waiver. These waivers are issued under the authority of section 1915(c) of the Social Security Act. The so-called Appendix K addendum allows for the expansion and or modification of Medicaid-funded home and community based services (HCBS) during an emergency.

Mississippi has approximately 23,000 people enrolled in HCBS waivers. The purpose of the waivers is to provide home-based care that allows people to avoid being placed in an institutional setting, such as a hospital or nursing home. The primary beneficiaries are the elderly and the disabled.   

Mississippi is using the 1915(c), Appendix K waiver to increase the availability of home-delivered meals and home-based services, among other things. The waiver will be in place until January 26, 2021.  

Monitor the Use of 1135 Waivers

Mississippi was one of the first states to obtain an 1135 waiver in response to the coronavirus outbreak. The policy essentially waives various compliance requirements. The 1135 waiver for the state of Mississippi allows the following, among other things:

Waives/modifies pre-authorization requirements for fee-for-service benefits covered by Medicaid. … The state is allowed to temporarily waive or modify requirements that certain fee-for-service benefits receive preapproval. Pre-existing authorizations are also extended. Some examples of fee-for-service medical services that ordinarily require preapproval include:

Allows Medicaid providers not located in Mississippi to enroll in Mississippi Medicaid as long as they are already enrolled in another state’s CMS program. … This waiver is only in effect as long as the current public health emergency lasts. It facilitates reimbursement to out-of-state providers.

Allows reimbursement to unlicensed medical facilities in the state of Mississippi due to emergency evacuations, as long as the facility is not utilized for more than 30 days. … The state must ensure that the setting meets reasonable standards of care.

Conclusion

While the 1915 and 1135 waivers discussed here are of limited duration, Medicaid needs to be transformed to better respond to an evolving healthcare landscape. Coronavirus and other outbreaks are likely going to return. The most pressing need for the long-term is to flatten the healthcare cost curve that plagues both private and public insurance beneficiaries in the United States. Flattening this curve while still providing quality insurance coverage to vulnerable patients should be the primary mission of Mississippi Medicaid. Utilizing the 1115 waivers discussed above would enable the Division to obtain some flexibility (with federal permission) to accomplish this task. 

[1]The federal copay maximum for non-emergency use of an emergency room is $8.00 for those who earn up to 150 percent of the federal poverty level (FPL). A waiver is not necessary to charge a higher copay to those earning more than 150 percent FPL, unless the cost exceeds 5 percent of household income. 

[2]CMS does allow providers to charge Medicare beneficiaries for no shows. Attempting to collect no-show fees from Medicaid beneficiaries might prove difficult, unless Mississippi Medicaid administered the fee directly, utilizing appropriate penalties.

[3]Federal law prohibits any kind of cost sharing for emergency services, pregnancy-related services, preventive services for children and contraceptive services. Individuals who earn less than 100 percent of the federal poverty level (FPL) are subject to federal cost-sharing limitations, but states have some flexibility in increasing copays for those who earn more. The federal maximums for outpatient services are 10 percent of the state’s cost for those earning between 100 percent and 150 percent of FPL and 20 percent of the cost for those earning more than 150 percent FPL.

Mississippi’s certificate of need program might have a chilling effect on out-of-state healthcare operators trying to bring services to the state.

Scrutinizing staff analyses dating back to 2001 from the state Department of Health shows that the majority (more than 75 percent) of the 284 applications for a CON were from in-state companies. 

Mississippi regulators approved 244 CON applications, rejected 37, gave conditional approval to two projects and approved one application partially.

While 49 out-of-state healthcare providers received approval (20.8 percent of all approvals), 10 operators (out of 37 denials or 27 percent) didn’t receive approval.

Mississippi’s CON program is largely a rubber stamp, since 85.61 percent of all applicants received approval since 2001. 

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 expensive 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. This requirement for healthcare providers to seek CON approval for post-disaster repairs was removed in 20

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. 

Thirty seven requests for a CON were related to cost overruns on capital projects since 2001 or 13 percent of all applications.

Twenty providers applied for certificates of need for diagnostic equipment and all but one was approved. Forty six applications were for construction projects while 16 applications requested a CON to add beds to an existing facility.

When providers apply for a CON or an amendment to an existing one, this initiates 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. 

Gov. Tate Reeves announced today that he was extending the state's shelter-in-place for one week as the coronavirus pandemic continues to spread in Mississippi. The original order was set to expire on Monday.

"Right now, I have to ask you for one more week," Reeves said. "One more week of vigilance. One more week of sheltering in place. And then we can begin to reopen our state."

Reeves spoke about the financial hardship caused by the outbreak, noting that government resources have not kept up with demand.

"There is no replacement for paid work," Reeves said. "There is no replacement for providing for yourself and your family. We've pumped trillions into our economy and many small businesses are about to fold. I want this to end as quickly as possible."

The lockdown on non-essential businesses is easing some, with extended options for drive-thru, curbside, and delivery services now available for industries including clothing, florists, or sporting good stores. Lakes and beaches will also be able to reopen.

The new order will be in effect Monday at 8 a.m.

Jackson Mayor Chokwe Antar Lumumba has extended the city's stay-at-home order.

Initially implemented at the end of March, the order has been extended until April 30. Hinds county has also extended their closure until May 1. Hinds county has the most coronavirus cases in the state at 301, as of April 16.

Generally speaking, these orders close nonessential businesses and only allow residents to leave their home for specific, approved needs.

Under an order, you can still shop for groceries, pick up medications, pick up food from a restaurant, help family members in need, and exercise outdoors. 

Essential businesses include hospitals, healthcare facilities, grocery stores, pharmacies, child-care centers, as well as a variety of sectors such as utilities, transportation, and finance and banking. 

As a virus sweeps across the nation, the American people have been forced to undergo a radical shift in daily routines. Our lives have been upended and so too has the conduction of critical practices such as work and education.

Many worried over the potential gaps in existing resources vital for continued societal operation, both in terms of physical resources such as masks and intellectual resources such as the effective educational instruction of our state’s children.

Thankfully, private enterprise has stepped up to the plate in a historic way. Businesses are transitioning to fill the existing gaps and provide the supplies and information that the country needs. In Mississippi, we have seen local business leaders bravely take risks in order to fill critical needs. 

A few days ago, I had the chance to talk with leaders of the Bailey Education Group, including founder, Gary Bailey, and Vice President, Pat Ross. The organization is committed to offering high level coaching and instruction to teachers and leaders as they seek to better the education of their students. Today, they have played a leading role in supporting schools as they transition to alternative education initiatives in this unique situation by offering digital coaching resources, online content, and webinars that allow teachers and administrative leaders to discuss existing problems and potential solutions.

Bailey recognized that “education is a vital part of every child’s life.” In so doing, he wanted to develop a company that was committed to helping kids learn more effectively. This passion drove him to found the Bailey Education Group in 2007. Since then, he has brought together a team of effective educational leaders with a great depth of experience to further this mission.

The Bailey Education Group is a results-oriented company, and Bailey even noted to me that their ultimate goal is to work themselves out of a job. Indeed they focus their work on schools that have room for improvement as they attempt to imitate pathways to success that have been found in other districts around the state.

Today, the coronavirus pandemic has necessitated a foundational reevaluation of our societal approach to education as new methods of instruction have been needed amidst mandated social distancing and shelter-in-place orders. 

With about 85 percent of the Bailey Education Group’s work being focused on teacher and school leader instruction and training, they needed to quickly adapt. While this transition was not easy, Ross noted that the organization “knew [they] needed to turn the company into a virtual operation.” They have now transitioned all their coaching sessions to online video calls. This has allowed teachers to both continue their training initiatives while also being provided a digital recording that they can look back on and use as a resource to review and continue seeking improvement moving forward.

The integration of technology into the classroom has become a critical component of many education models. Bailey noted that, “[t]echnology changed education to a great degree, but many school districts have not caught up.” While some schools already readily use digital tools to supplement the students’ education, others have not made these strides yet. This reality has made the current crisis all the more difficult for many previously struggling schools and has highlighted the need for support during this time of transition. 

The Bailey Education Group has created electronic and live content to help schools teach certain subjects when they may be lacking in an area. With the wealth of education experience collected through the Group, this initiative now empowers almost every district across Mississippi to have a student learn algebra or other courses from one of the best teachers in the state.

This model can be used to supplement existing classrooms and also support long-term substitutes in classrooms which lack a highly qualified teacher, due to the critical teacher shortage.

Ross noted how BEG has taken on the responsibility of networking education leaders across the state in order to solve problems together. They are hosting video conference sessions that give teachers and administrative leaders the opportunity to discuss ongoing issues and challenges. Ross offered hope that these sessions could become more regular and even break down into smaller regional groups so that individuals could hold more personal discuss with colleagues facing similar issues in their fields.

Bailey and Ross noted that these sessions have offered a place for school leaders to talk about a variety of ongoing challenges, including the continued provision of food to students, access to technology, and budgeting.

For many students, school is the one place where they are sure to get a reliable meal each day. Every school in the state is working to continue providing this critical resource and this has been one of the widely discussed challenges that the Bailey Education Group’s virtual sessions have brought administrative leaders together to discuss.

Not every kid has a computer, internet service, or cellphone access. Thus, while some schools have students tuning into class digitally, others have no option but to print off workbooks and send them to students. Students then complete the work and send them back in to teachers so they can be reviewed and graded. The coronavirus has put these additional challenges on full display and highlighted the need to facilitate technology access across the state.

As we transition out of this crisis, many facets of society are likely to change, including our approach to education. The Bailey Education Group leaders expressed hope that we can continue to use technology as a positive educational supplement. No matter what new approaches are taken, Bailey noted to me that, “[m]ath is still math and algebra is still algebra, but how one teaches it will change”

When it comes to technology, Ross noted his fundamental optimism that kids are flexible and would readily be able to make further transitions. Having grown up in a digital age, they are in a position where they can quickly adapt to new changes in the classroom. Thankfully the Bailey Education Group is there to ease that transition for teachers and district leaders as well.

Bailey pointed to the critical importance of personal interaction in the teaching process stating that, “human interaction is the best way to learn, be it over computer or face-to-face. This interaction is central to a child’s livelihood and improvement.” By helping to guide a more effective conversion to digital instruction, Bailey’s organization has assisted in the continuing of Mississippi children’s education.

With hope, we will be able to transition out of our current situation sooner rather than later. However, whatever the timeline ends up being, we will never fully return to the world we knew in January. As a state and as a nation, we will be tasked with making fundamental changes to many critical parts of our society, including education.

This situation has hastened the integration of technology and digital learning platforms into the classroom. Students and teachers have been forced to adjust to this, but in so doing have opened up a world of opportunity for future innovative changes to our existing education structures. As we move forward, undoubtedly the leaders who supported our students and teachers in this trying time, such as the Bailey Education Group, will be remembered.

These businesses that are stepping up deserve to be highlighted, and so the Mississippi Center for Public Policy is publishing a series dedicated to doing just that. Over the coming weeks, we aim to continue showcasing the stories of these local businesses, including Blue Delta Jeans in Tupelo, Rich Grain Distilling Company, and now the Bailey Education Group who have willingly given up their normal operating procedures to help people.

If you know of a local Mississippi business that is helping those in need during this critical time, we’d love to highlight the work that they’re doing. Please email Hunter Estes via [email protected] to discuss further.

Now is the time to put the economic pieces back together, but it won’t be easy.

We are called “These United States” because a one-size-fits-all solution rarely works. There are massive differences between our states. Some are largely metropolitan, some are mostly rural. Some have mostly warm climates, some are Alaska. Ultimately, the states are best equipped, and constitutionally empowered, to make decisions about public policy in their own sovereign spheres.

We didn’t abide by these fundamentals over the past couple of months and our demolished economy is the result. Now that we know much more about the coronavirus, we’ll need to move quickly back to federalism and capitalism if we hope to rebuild an economy that was enjoying unprecedented growth and job participation before the pandemic.

Unsurprisingly, the data is showing us that the most vulnerable are those 65 and over with comorbidities like cardiovascular disease, diabetes, and obesity. And old age determined hospitalization and death to a greater degree than any of these underlying conditions. This information comes from a New York City Langone Health Center study of coronavirus patients, the largest one to date. Despite how desperately some journalists want us to see COVID-19 as an example of implicit racism, the study found “less influence” with regard to race. In other words, we know who really needs the attention of our resources and quarantine measures and it’s not healthy Americans and their school-age children.

The data is also overwhelming in terms of the vulnerability of elderly care facility residents. It’s only common sense that elderly people living in facilities without lots of sunlight and fresh air and in close proximity, are going to be even more vulnerable. It seems this group of Americans needed our care, our technology, and our quarantine.

Helping the sick should not mean controlling the healthy. We can help the sick without violating civil liberties and without disintegrating our economy. We can choose to use a scalpel or a knife instead of a sledgehammer. We can honor the personal responsibility and common sense of citizens rather than impose a virtual martial law in the name of preventing every person, including healthy citizens, from getting sick. But this is what happens when we demand our government solve all our problems and cure all our diseases. Why would we ask this of the same government that manages the USPS, the IRS, and the DMV?

On the day most Americans are normally mailing off their tax payments to the IRS, most Americans are receiving a payment from the IRS, or will later this week. What an upside-down world it is!

Millions of small business owners and nonprofits are anxiously awaiting Payroll Protection loans from the Small Business Administration, through their local banks, in an effort to keep employees employed. The $350 billion allocated from Congress is supposedly flowing through the system and will be exhausted by week’s end and Congress is debating another $250 billion for small businesses. Expect a lot of pork to be added to the plan. It’s clear that certain ideological partisans are not about to let a pandemic go by without attempting to leverage it to the max. They see this as a rare gift to justify massive and permanent government spending and control of the economy. This puts us at something near $6 trillion in costs to “compensate” for the sledgehammer approach. And the various “stimulants” are only getting started. 

Industries are being bailed out, states are receiving billions to compensate for lost revenue, and the Federal Reserve is now a crisis lender. These types of actions lead us toward a dangerous precipice. The American economic system is based largely on the energy and interplay of private businesses, private banks, capital providers, and consumers. If our federal government continues to add massive spending and its related borrowing, it could crowd out free enterprise and capitalism as the preferred recovery mechanism. That’s not a future we should want.

According to the Committee for a Responsible Federal Budget, all of this spending will produce a deficit of $3.8 trillion this fiscal year. That is three times the largest deficit in U.S. history. Interest on our national debt is now the fourth largest item in the federal budget. Just wait until we calculate the intertest costs on the ballooning debt after all of these measures to counter the effect of the sledgehammer!

The best way to counter our cratering economy is to get people back to work.

Americans love to work hard and play hard. We can’t do either right now. We can’t even watch others play hard. The governors should take the lead here, with some general guidance from the White House and the President’s healthcare and economic advisors. Governors know what things look like on the ground in their states. It makes no sense for Mississippi and New York to be using the same strategy. And we need action now.

Small business owners are running out of savings and cash to keep employees. White collar workers, like lawyers, doctors, marketers, and accountants, are feeling the same pain that many service level workers felt six weeks ago. Formerly healthy companies are rapidly filing bankruptcies. Banks are setting aside billions to deal with defaults and bad loans. Consumers are maxing out credit cards and missing mortgage payments. This cannot continue.

Mississippi has just under three million residents. As of today, 122 Mississippians have died. While there will be more, and every life is precious, we should recognize our numbers of confirmed cases and confirmed deaths are quite small. Our testing numbers and our capacity for hospital beds and emergency equipment compare well to most of our neighbors and other states.

We need to stay vigilant and listen carefully to healthcare experts, but we can do this while we start opening up our economy. These are not mutually exclusive actions. Keeping nearly three million people in quarantine for much longer is not the correct public policy.

Gov. Tate Reeves should be given credit for his approach to date. He has resisted the urge to act like an authoritarian and given local leaders the flexibility to govern, until such time as a statewide approach was required. And his instinct on not trying to force churches to close was correct. Now let’s see how his instincts are on how to reopen the economy. We know Reeves will have loud detractors on social media, but it’s time to put the pieces of our economy back together. It just won’t be easy.

Gov. Tate Reeves has named a team of business leaders to help guide the recovery from the coronavirus pandemic that has devastated the state’s economy. 

The state has seen a 9000 percent increase in unemployment claims over the past month while businesses that have been forced to close fight for their survival during the statewide shelter-in-place. 

Reeves issued the order on April 1. It is set to expire on Monday, though Reeves could extend it. Prior to Reeves, numerous local governments issued similar orders closing restaurants and numerous businesses, while only allowing people to leave their house for essential travel. 

“We need Mississippians helping Mississippians. I have asked a trusted group of our state’s top business minds to do just that. Under the ‘Restart Mississippi’ umbrella, they are going to develop a series of recommendations and goals for our new economy. They will study the impact of COVID-19 on our workforce and small businesses. And they will help us recover—day by day,” Reeves said in a press release.

The committee is chaired by Joe Sanderson of Sanderson Farms. Also serving on the executive team are Tom Gresham, president of Delta Council, John Hairston of Hancock Whitney, Jonathan Jones of Jones Capital, Colby Lane of Veriforce, and Tim Smith of Avectus Healthcare Solutions. 

The spread of the coronavirus pandemic has uprooted many in this country, and all over the world. Kids are at home. The same place many of us are working. If you still have a job at all. Things are being done differently. We watch church online. We use Zoom video conferencing instead of face-to-face meetings. We pick up our groceries and restaurant orders, or we get them delivered to our house. 

With time, normalcy in our day-to-day lives will return. Schools will open. Sporting events will come back. Toilet paper will be in stock. And perhaps the way government functions will change as well. Before we have another crisis on our hands.   

Because as the current pandemic crystalized, we witnessed how government regulations often got in the way and stymied the help they are designed to provide. This was true in the past, it is true today, and will be true in the future. 

Once the coronavirus began to spread, we saw numerous regulations repealed almost overnight. Particularly regulations that limit access to healthcare and seem to do nothing but protect the interest of market incumbents.

One of those regulations is Certificate of Need laws, something the federal government repealed more than three decades ago but they are still on the books in Mississippi. These laws circumvent the normal supply and demand process and require would-be medical providers to prove — essentially to their competitors —that their community needs a new facility or service. And they are one of the reasons we see a shortage of hospital beds during a time of crisis. That is why we have seen both Republican and Democratic governors in other states roll back such regulations during this time. Bills have been introduced virtually every year to repeal CONs in Mississippi, and 2020 was no different than prior years. The issue wasn’t even considered, and it died in committee without a vote or a discussion.

A positive change that we have seen in virtually every state was an expansion of telemedicine, something that is vitally important in a rural state like Mississippi, pandemic or not. And the state has been recognized as an early leader in this technology. Yet that doesn’t mean we don’t have restrictions in place. Almost immediately, we began to see states waive the requirement that you can only use an in-state physician. Mississippi did that. And then just as quickly walked back that change to only allow this if you have a prior patient-physician relationship, greatly limiting your options as a consumer. Mississippians should be able to access the doctor or nurse practitioner of their choosing, regardless of the state they are licensed. 

Speaking of nurse practitioners, if we want to increase healthcare access, the state should move to allow nurse practitioners to practice to their full practice authority. Today, they are required to enter into a “collaborative agreement” with a physician if a nurse practitioner wishes to open their own clinic. Particularly in rural communities where we see a shortage of doctors, nurse practitioners could fill that role. If the state would let them. 

Another bill that the legislature let quietly die in committee was universal recognition of occupational licenses. Meaning, if you received a license in Tennessee, you can work in Mississippi without jumping through the normal bureaucratic hoops. After all, just because you move doesn’t mean you forget how to practice your skill. To increase the supply or nurses, many states, including Mississippi, said they would allow nurses licensed in other states to work in their state. 

This should be standard practice. Not something that requires an emergency declaration. If someone has received an occupational license in another state, the state should recognize that license and allow them to immediately work in Mississippi. We don’t know what the economy is going to look like when the pandemic passes, but one of our main goals should be to make it easier to work. 

As we’ve seen, it is the overburdensome government rules and regulations that tend to get in the way. If may be something as serious as healthcare access or as simple as alcohol delivery, another bill the legislature killed this year.

The truth is this happens every day of the year. Rather than waiting for the next crisis, now is the time to roll back regulations that prevent people from earning a living, accessing the healthcare they need, or using technology to make our lives easier and better. 

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