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As the coronavirus pandemic sweeps across the nation, it was revealed that we were critically short on certain medical necessities including hand sanitizer, masks, and ventilators. 

Many feared for what would be a soon to come shortfall on these items that are medically critical to prevent further spread of the virus and effectively treat those who have it. 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 that the country needs. In Mississippi, we have seen local business leaders bravely take risks in order to fill critical medical needs. 

A few days ago, I had the chance to speak with David Rich of Rich Grain Distilling Company in Canton. He has shifted his entire company from making bourbon to producing hand sanitizer en masse.

When it comes to sanitizer, it has proven a vital and yet over-purchased resource, leaving many fire departments, police units, hospices, hospitals and more in serious need. Hand sanitizer is an incredibly important tool for countering this virus and deterring its spread.

Unfortunately, many folks are finding their local providers’ shelves to be empty. While in a local drug store a few weeks ago, David noticed that the store was running out of hand sanitizer, so he offered to try making some.

What began as a hobby years ago, led to a distillery, and now is the reason that thousands in Canton, including many emergency service providers still have access to hand sanitizer today. A Madison County native, David was working in mechanical engineering for a defense contractor while researching bourbon and its production in his free time. Ultimately, he decided to pursue his dream and opened the doors of Rich Grain Distilling in 2016.

In a normal situation, burdensome regulations would have prohibited distilleries such as Rich Grain Distilling from being able to make this transition. Luckily, as David noted, the “federal government decided to lift certain regulations,” allowing for specific companies such as distilleries to move their operations into the production of much-needed resources like hand sanitizer.

The Alcohol and Tobacco Tax and Trade Bureau waived requirements to obtain permits to legally manufacture hand sanitizer and removed the excise tax for alcohol-based hand sanitizer products. That wasn’t all. The Food and Drug Administration then had to issue guidance saying they do not “intend to take action against manufacturing firms that prepare alcohol‐​based hand sanitizers for consumer use and for use as health care personnel hand rubs during this ongoing public health emergency.”

The difficult element of the transition was processing ingredients and working with suppliers to secure necessary bottles and other resources. High proof alcohol is then mixed with other products in the necessary process to create sanitizer.

While he’s making less per unit, demand has been high, and this has allowed him to retain his staff and even bring on a few new employees. Thus, he is not only fulfilling the critical needs of his community by helping local providers but is also able to continue offering a steady paycheck in a time of dire economic need for many.

I asked David if he had any plans for continued sanitizer production once the coronavirus crisis is over and he noted to me that, he doesn’t “want to be in the hand sanitizer business.” Naturally, he’d greatly prefer to be making the bourbon that first inspired his distillery to open. But, for now he’s happy that he’s been able to help people in his community. Indeed, I think while some are currently missing the taste of Rich Grain Distilling bourbon, it will be appreciated all the more in the future, especially knowing how David Rich took business risks to help his community when it was most in need.

David is currently operating at capacity, and so unless you are a representative of an emergency service or essential business, please do not attempt to place any current additional orders of sanitizer.

These businesses that are stepping up deserve to be highlighted, and so the Mississippi Center for Public Policy is launching 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 Oxford and now Rich Grain Distilling Company, who have willingly given up their normal operating procedures to help as many people as they possibly can.

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.

Healthcare is complicated. But during the current coronavirus outbreak, healthcare policy goals are very simple: How do we increase the supply of healthcare for those who need it most? And how do we increase access to healthcare to those who need it most?

Right now, the real challenge is prioritizing very limited healthcare resources. The people who need care the most are, obviously, patients who are suffering life-threatening complications from the coronavirus. Care must also be prioritized for those who have other life-threatening events, such as a heart attack, a stroke or an auto accident.

Seen in this light, it becomes clear that calls to expand Medicaid to able-bodied adults are, not only a sorry example of political opportunism, but an immoral and wasteful redistribution of healthcare resources that need to be safeguarded for more vulnerable populations.

One of the most regrettable things about the Obamacare Medicaid expansion is that it provides a 90 percent federal match to states that expand Medicaid insurance to low-income, able-bodied, working-age adults. That’s right – the expansion only applies to adults who either can work or are working and who are not disabled, not elderly and who do not have children. Given that we have disabled children and elderly people on a Medicaid services waiting list, one would have thought that D.C. would have provided a 90 percent match to cover these patients. 

No doubt, able-bodied adults without insurance are at-risk of catching the coronavirus. But they are not, by definition, a high-risk category. Moreover, these individuals already have access to a vast array of other government welfare programs, such as SNAP (food stamps), Obamacare health insurance exchange coverage, and the federal earned income tax credit (EITC). The federal government fully funds each of these three programs.

Consider also that subsidized health insurance exchange coverage is already available to people who earn between 100 percent and 400 percent of the federal poverty level. If Mississippi were to expand Medicaid, this subsidized coverage would disappear for anyone earning between 100 percent and 138 percent of the federal poverty level. Again, this coverage is fully funded by the federal government. In addition, Mississippi has one of the highest EITC participation rates in the country. As of December 2019, more than 350,000 Mississippi individuals and families received $1 billion in ETIC subsidies. This number will only increase as 2020 wears on.  

Likewise, able-bodied, working-age adults will be benefitting in numerous ways from generous waivers and payments being offered by federal and state governments in response to the coronavirus, including a massive increase in unemployment benefits as well as direct cash payments to every American. The federal government is also waiving all current SNAP work requirements, providing supplemental SNAP benefits, expanding school meal and other food service programs, providing hundreds of millions more for the WIC food program, and sending tens of billions more to states to help pay for higher Medicaid costs. The Trump administration even withdrew a proposed rule aimed at reducing improper Medicaid enrollment and fraud. 

Already, the second coronavirus relief package, passed by Congress on March 18, increased the federal share of Mississippi Medicaid payments by 6.2 percent. This means that the current federal match for Medicaid has increased from a highest-in-the-nation 76.98 percent to a still highest-in-the-nation 83.18 percent. Medicaid, Medicare and private insurers are also being reimbursed to offer free COVID-19 testing and related services. Uninsured patients can get tested at no-cost, thanks to an additional $1 billion set aside. 

These payouts are dwarfed by the third $2 trillion relief package which includes more than $100 billion for hospitals. The American Hospital Association is demanding billions more and is likely to get it.

Time will tell whether these investments will stimulate the economy or bankrupt the country. What is clear is that states, like Mississippi, will be experiencing budget shortfalls. What is also clear, as demonstrated in state after state that has expanded Medicaid, is that the cost will be far more than projected. These costs, however, are only monetary. We have to acknowledge the human cost of expanding Medicaid.

Gold-standard research shows that expanding Medicaid increases the demand for healthcare services while delivering no improved physical health outcomes. Expanding Medicaid won’t make people healthier. And it won’t get better care to people who have the coronavirus. Let’s save the debate over Medicaid expansion for after this crisis passes and instead focus on solutions we know will work.  

This column appeared in the Clarion Ledger on April 5, 2020.

In this episode of Unlicensed, we talk with Josh Archambault of FGA about how many states are responding to the coronavirus pandemic by expanding telemedicine options. Meanwhile, Mississippi is making it more difficult for patients to access the doctor of their choice via telemedicine. 

Follow: Spotify / Apple

The Department of Revenue announced today that they are allowing patrons in a Leisure and Recreation District (LRD) to leave with a mixed drink from their to go order.

This means if you live in one of the 19 LRDs in the state, you can order a mixed drink with your curbside order and take it home.

"Due to the emergency situation all Mississippians are facing, ABC is now allowing drinks in the "to go" orders made by patrons for curbside pick-up if the restaurant is located in an LRD," the order reads.  

The following cities are designated LRDs: Bay St. Louis, Tupelo, Ridgeland, Jackson, Gulfport, Biloxi, Ocean Springs, Brandon, Clinton, Diamondhead, D’Iberville, Hattiesburg, Laurel, Long Beach, Moss Point, Natchez, Pascagoula, Pass Christian, and Vicksburg.

Restaurants will still be prohibited from selling you a mixed drink if they are located outside one of the allowable cities because it it prohibited by state law.

Over the past few weeks, DOR has made updated multiple regulations to make it easier to purchase alcohol. Along with the most recent change, liquor stores can now take orders online or over the phone, while providing curbside delivery rather than having to enter the retail establishment. You are also allowed to purchase a sealed bottle of wine with their to-go order.

These actions were previously illegal.

On Friday evening, businesses deemed non-essential closed their doors in Mississippi as they have been doing over the past couple weeks to combat the coronavirus pandemic that has spread across the country. 

Was this the right call? Was it too much or too little and too late? Regardless of what the blue checkmarks say, I will defer to the experts who are making those decisions and guiding the governor through these unthinkable times.

My family is doing the best we can to stay safe, and that’s really all we can control. Just like your family is all you can control.

But as we went for a ride on Saturday around lunchtime, we got a weird feeling going through the empty parking lots of the normally bustling Dogwood Festival Market off of Lakeland Drive in Flowood. Of course, as you drive near the Target, Kroger, or Lowe's you probably see more traffic than normal. 

But across the street near Belk, Old Navy, HomeGoods, Bath and Body Works, etc., you see a sprawling empty parking lot. For those who are fans of dead malls, it was as if that is what you entered. Except the signage was intact and the landscaping was freshly manicured. 

Yet tucked in between large national chains are numerous small businesses, such as Time 4 Toys, a rare independent toy store that competes every day with the likes of Walmart and Amazon. That was already enough of a challenge. Not being able to open their doors is just the latest obstacle.

But they, like many others, are getting creative. They’re offering free delivery within a 10 miles radius of the Flowood store. They are also offering curbside pickup from 11-2 during the week for those who place orders online. If you’re struggling to find something, send them a Facebook or Instagram message or call the store. They will be there to help you. 

And that’s just one of the many, many retailers who are trying to survive financially. Because as has been said, this is not just a health crisis. It’s also a financial crisis. The 30,000 Mississippians who filed for unemployment last week can attest to that. 

We don’t know when the health issues will pass or when we will all be safe to go about our daily lives. The stay at home order is in effect until April 20, but it could certainly be extended. Beyond not knowing when we’ll return to normal, we don’t even know what normal will look like. 

Will we be ready to go into restaurants or will we stick with the convenience of food delivery apps? Will we maintain our virtual approach to business with more people working from home or attending conferences in another state without having to leave town? Will you feel safe being within five feet of another person?

Maybe. Like most everything going on right now, we don’t know is the only answer we can be sure of. 

But for those who have kids who enjoy going into a toy store – and those whose livelihood depends on it – we can just hope that our small businesses make it. 

While Mississippi’s Board of Medical Licensure largely walked back a previous decision to allow patients to use services provided by out-of-state physicians via telemedicine, other states such as Michigan and West Virginia are removing regulatory restrictions in the wake of the coronavirus pandemic.

Michigan’s Gov. Gretchen Whitmer, a Democrat, has issued two executive orders. The first suspended the state’s certificate of need program and removed some restrictions on medical licenses and nursing assistants. The second order issued on March 29 was more thorough, with several components:

On a similar note, West Virginia’s Republican Gov. Jim Justice issued an executive order on March 19 that suspended the state’s regulations in several areas:

Mississippi has been a mixed bag. The state’s Board of Nursing issued a proclamation that allowed out-of-state nurse practitioners to use telemedicine to treat Mississippi patients without having a state license. The practitioner only needs a license in another state. The proclamation also allows practitioners licensed outside the state to complete a waiver form to practice in Mississippi.

The Mississippi Board of Medical Licensure issued an amended proclamation last week that limited telemedicine for out-of-state physicians not licensed to practice in Mississippi to only those who have an existing doctor-patient relationship rather than any licensed physician. 

On March 15, the board issued a proclamation that said it would not enforce regulations governing out-of-state physicians using telemedicine to treat patients in the state in response to an emergency declaration by Gov. Tate Reeves that urged a reduction of regulations due to the spread of the coronavirus.  

The proclamation would also have the board not enforcing its rules requiring physicians to examine patients prior to prescribing medication, including controlled substances, to encourage the use of telemedicine. That part of the proclamation is still in effect.

Under existing regulations, a physician using telemedicine to treat patients must be licensed to practice in Mississippi.

All three states are part of the Interstate Medical Licensure Compact, which has 26 states that have joined together to streamline their normal licensing process for licensed physicians. This provides physicians moving from one compact-participating state to another the ability to get a license in their new state within days rather than weeks or even months.

There are two policies that could increase the supply of hospital beds and the supply of healthcare providers in Mississippi. The first policy is certificate of need (CON). The second is telemedicine.

In part 1 of this series, we focused on what the goals of healthcare policy should be during the coronavirus outbreak and reviewed recent federal and state actions aimed at increasing supply and access. In this second part, we recommend five reforms Mississippi policymakers should make to CON laws to immediately increase bed capacity and five reforms they should make to telemed laws to increase access to qualified healthcare professionals.

Certificate of Need

A certificate of need (CON) compels would-be medical providers to demonstrate a community need for a new facility or service. In Mississippi, the Department of Health is the arbiter of this process. The problem with CON laws is that they circumvent the natural interaction between supply and demand, by which providers and consumers determine where new medical services should be offered. In place of the free market, we end up with Soviet-style, bureaucratic planning. This planning tends to be biased toward current providers and is sometimes used to block out-of-state providers from offering their services in Mississippi. The results are well documented: reduced access, lower-quality, and higher mortality rates.

In the context of the coronavirus, certificate of need laws make it more difficult for hospitals to quickly respond to patient needs. States are thus creating pathways for providers to submit emergency CON applications. Mississippi already has an emergency CON application process in place, but the current application could be customized and streamlined so that providers aren’t hindered by red tape during the current pandemic.

As things stand, Mississippi is projected to run out of ICU hospital beds as of May 3. In this respect, we are better off than most states, and for both better and worse, are at the high end of existing hospital beds per capita: 4.0 beds per 1,000 vs. a nationwide average of 2.4. This surplus could serve us well during the current outbreak. But in a nonemergency situation it suggests we are not using healthcare resources efficiently. It is also safe to assume that not every area of the state has equal access to hospital beds. Some hospitals, in an emergency, may need to ramp up supply.

A review of Mississippi’s numerous CON laws raises multiple red flags. These laws need to be suspended, not only to deal with the current coronavirus outbreak, but to create capacity for other emergency services, such as open heart surgery, ambulatory surgical services and diagnostic imaging.  

In particular, Mississippi should suspend the following five CON requirements:

This latter requirement is particularly onerous, insofar as the state is currently enforcing a moratorium on the approval of new CONs for the construction or expansion of skilled nursing facilities and intermediate care facilities.

There are likely other policies that hinder hospitals from increasing bed capacity in an emergency. Instead of forcing hospital administrators to operate in a gray area during this and future pandemics, state policymakers should act now to clarify the process by which providers can increase bed supply, especially in critical care situations. 

Telemedicine

Telemedicine has emerged as an important tool for sustaining and supporting healthcare services in the current “shelter-at-home” environment. Telemed allows patients to consult with a doctor over the phone and/or via video. 

In response to the coronavirus, Mississippi’s key licensing boards have taken divergent stands. The Board of Medical Licensure initially (see proclamation dated March 15) encouraged “all physicians to utilize telemedicine so as to avoid unnecessary patient travel, both in-state and out of state.” In order to facilitate this stated goal, the Board waived the requirement for an initial in-person examination and, also, clarified that physicians licensed in another state could treat patients in Mississippi. A few days later, however, the Board walked back from this proclamation, claiming that only out-of-state doctors with a previous patient relationship could practice telemed in Mississippi.  

By contrast, the Board of Nursing is allowing nurses who hold an out-of-state license to practice in Mississippi. The Nursing Board is also allowing recent graduates and retired nurses to practice in appropriate settings.

Mississippi took an early lead in using telemedicine to treat various conditions like diabetes, and the University of Mississippi Medical Center is using telemed in a number of innovative ways. The state is also part of various interstate compacts that make it easier for out-of-state healthcare professionals to see Mississippi patients in a telemed setting. These include the Interstate Medical Licensure Compact, the Nurse Licensure Compact, and the Physical Therapy Compact.

That said, the overall legal and regulatory environment for telemed in Mississippi is mixed. As other states are opening the door wide to telemedicine and many patients are using it for the first time, we are going to see an expansion of telemedicine services across the country both during and after the current health emergency.

Here are five things Mississippi should do to avoid falling behind:

The coronavirus has demonstrated the U.S. healthcare system is far more fragile than any of us imagined. In spite of spending more per capita than any other country, our healthcare system is suffering from personnel and supply shortages. To meet the current need, some states are cutting red tape to increase supply. Monopolistic practices – embodied by archaic policies like certificate of need requirements and telemedicine restrictions – are not only increasing prices and limiting access during normal times, they are literally crippling our ability to respond to both individual and systemic healthcare emergencies. Mississippi would do well to follow other states in lifting these restrictions during the current outbreak and in repealing them after the crisis passes.

Gov. Tate Reeves issued a statewide 'shelter-in-place' order today to help slow the spread of coronavirus in Mississippi. The order begins on Friday at 5 p.m.

The statewide order came a day after a local order in Lauderdale county.

Individuals will only be allowed to leave their house for health-related reasons, to obtain food and common household supplies, to engage in individual outdoor activity, and to work in an essential business. Those essential businesses include, but are not limited to, hospitals, healthcare facilities, grocery stores, pharmacies, child-care centers, as well as a variety of functions from sectors such as utilities, transportation, agriculture, manufacturing, and finance and banking.

The guidelines for the order include:

Mississippi’s first positive case of coronavirus was confirmed on March 11. As of April 1, that number had escalated to 1,073 as the number of people being tested continues to climb. These numbers now count tests from the state, as well as private providers. Twenty-two deaths have been reported. Using the available data, the current mortality rate is 2 percent.

All local, county, and state law enforcement officers will be able to enforce the order. The order is in effect until April 20.

As the coronavirus pandemic began to sweep across the nation, it became clear that we were critically short on certain medical necessities including hand sanitizer, masks, and ventilators. Many feared for what would be a soon to come shortfall on these items that are medically critical to prevent further spread of the virus and effectively treat those who have it. 

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 that the country needs. In Mississippi, we have seen local business leaders bravely take risks in order to fill critical medical needs. 

A few days ago I had the chance to speak with Josh West, owner and founder of Blue Delta Jeans, a high-end clothing company based out of Oxford that creates custom order jeans, tailored to each individual.

In 2012, Josh launched Blue Delta Jeans after working in economic development. Through his previous role, he had the opportunity to work with a range of factories, and it was clear to him that while some manufacturing was moving abroad, there was a strong supply of skilled workers in North Mississippi and a demand for American-made products.

And that business has only grown in the past eight years.

Today, Blue Delta Jeans is doing things a little differently. They have fully transitioned its factory to make much-needed masks. After only two weeks of production their team is now able to construct 10,000 masks a week and are aiming even higher. While not medical-grade, these high-quality masks are designed to be used in non-acute situations, especially those in waiting rooms, grocery stores, and elsewhere, thus allowing for the medical-grade masks to be entirely used by those who need them. Once the masks are constructed, they are then shipped to government entities for statewide distribution.

If he had been told in February that Blue Delta would be making masks, Josh said to me that he never would have believed it. Yet, as the virus got worse, he heard more about the need for supplies, especially masks. So, he started looking further into it and then began contacting his local suppliers. His focus was on making the product safe, so he worked with Mississippi State University to conduct initial tests before construction of the product. Then, in just a 48-hour period, they changed the entire factory over from jeans to masks.

Blue Delta is now not only providing masks, but also continued employment, a critically important need for people as we undergo a continued economic slump due to the virus. Josh told me that each employee was given the opportunity to leave, and that when times returned to normal, he assured each that they would have a job waiting for them, and yet every single employee chose to stay and transition to working on masks. They are ensuring a safe work environment by placing temporary walls up and allowing each individual to practice social distancing while sewing the masks.

Blue Delta has been able to keep people employed and has even sought to hire more workers in order to expand their capacity for mask construction. The power of a steady paycheck is critically important for those seeking to provide for their families during this time of need. And so, in this way, Blue Delta Jeans has fulfilled a dual need both through their support of their workers and supports of thousands of people through the construction of their masks.

This local clothing company, that started in 2012 with just one seamstress, is now making 10,000 masks a week to support the community. Josh West and his company highlight what’s great about Mississippi and this country.

As we closed the conversation, Josh noted that, “[h]opefully we’ll be making jeans again one day.” Neither Josh nor I are certain when this crisis will end, but even once the Blue Delta Jeans factory is back to its normal line of work, I don’t think anyone will soon forget what they did for the state.

These businesses that are stepping up deserve to be highlighted, and so the Mississippi Center for Public Policy is launching a series dedicated to doing just that. Over the coming weeks, we aim to showcase the stories of these local businesses who have willingly given up their normal operating procedures to help as many people as they possibly can.

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.

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