As Mississippi battles the outbreak of coronavirus, a study that ranks states on their openness and access to healthcare places the state mid-pack nationally.
The Healthcare Openness and Access Project, authored by three scholars from the Mercatus Center at George Mason University, ranked Mississippi 24th. The study measures the extent of control a state exercises over healthcare and the authors used 41 different indicators grouped in five categories.
The authors — Jared Rhoads, Dr. Darcy Bryan M.D., and Robert Graboyes — scored each state in each indicator on a 1 to 5 scale, with 5 being the best score. Then the scores for each indicator were averaged in their categories. Each state’s total score is an average of the five categories. Mississippi scored a 3.29, slightly above the national average of 3.27.
Rhoads said the new edition has some differences over the first index released in 2018, including moving some indicators from one category to another and reducing the number of categories from 10 to five.
“The result is more easily digestible now and what we’re hearing from readers and reviewers, it is a more intuitive way of organizing the data,” Rhoads said. “We wanted to give a general feel on how restrictive a state is versus how much it can liberate people to do what they think is best.”
In the professional regulation category, Mississippi scored well (3.40, above the U.S. average of 3.14) for being part of the Interstate Medical Licensure Compact (29 states participate), fewer optician licensing requirements and broad scope of practice for behavioral health providers and midwives. It scored poorly on scope of practice for dental hygienists and overly restrictive licensing of certified registered nurse anesthetists.
In the institutional regulation category, Mississippi scored a 2.83, below the national average of 2.96. This category measures how much control state regulators impose over the business operations of healthcare institutions such as hospitals and pharmacies.
The state’s certificate of need program has more restrictions than most, receiving a score of 2. The state’s hospital taxes (up to $2 per patient bed per day) and raft of restrictions on compounding pharmacies also drew low marks from the study authors.
Mississippi law requires CON approval for all projects that increase the bed complement or a capital expenditure of at least $2 million. CON approval is also required for major medical equipment purchases of more than $1.5 million and is not a replacement for existing equipment. Mississippi is one of 35 states that requires a certificate of need.
Rhoads said that Mississippi’s CON laws were one area that policymakers could make a big change to the state’s rating. He also said that even just chipping away at some of the restrictions (such as a law that passed a few sessions ago that didn’t require CON approval for capital expenses related to natural disasters) would be a positive way to impact the state’s healthcare access.
There were three bills filed that would’ve eliminated the CON program in this year’s legislative session, but all three died in committee without making it to the floor for a vote.
Mississippi also scored lower (2.83) than the national average (3.10) on patient regulation, which is defined as easier access by patients to certain types of drugs and other patient-oriented protections.
The state was penalized for not allowing oral contraceptives unless prescribed by a physician and a lack of a free speech in medicine law. The state received top marks for protecting good Samaritans and lower taxes on e-cigarettes.
In the payment regulation category, Mississippi received high marks for not having an individual mandate to require individuals buy health insurance, has fewer health savings account taxes, doesn’t restrict short-term, renewable health insurance plans, and allows drug manufacturer copay coupons. Mississippi received low marks for not allowing insurers in other states to issue policies in the state and its ban on reimportation of prescription drugs.
Mississippi also received high marks for not having a lot of regulations on direct primary care plans. These plans enable doctors to bill patients directly for services. This bypasses traditional health plans, where a third party pays most of the cost while the insured pays a smaller amount. The state also received high marks for reimbursing Medicaid providers at parity for remote monitoring.
A bill that would’ve kept these plans from being regulated as an insurance product by the state Department of Insurance died in the Senate without a floor vote.
Healthcare Openness and Access Project 2020: State rankings
Mississippi scored better than its neighbors overall. Louisiana had the next best overall score, ranked 30th. Alabama was ranked 35th, while Tennessee was slightly higher at 33rd. Arkansas was 40th.
New Jersey, Massachusetts and New York were the least free states overall, while Colorado, Arizona and Utah were the freest.
The HOAP index has been released earlier than planned. The 2020 edition of the HOAP was supposed to come out in June, but the authors pushed up its release considering the coronavirus pandemic.
This version is an early, non-peer reviewed version that was released early to help policymakers with information to remove healthcare restrictions to help fight the COVID-19 pandemic. A full, peer-reviewed version will be released later this year.
Social distancing is the common term used for what we are told to do these days. Stay at least six feet away from other people in public, avoid crowds of 10 or more, and, better yet, don’t leave the house unless necessary.
Once upon a time that was referred to as isolation. Today, it is simply a matter of doing things a little differently. Thanks to technology.
With Zoom, Google Hangout, Facebook Live, and others, socially distant businesses can conduct virtual staff meetings that use to take place in a conference room. Teachers can provide lessons with students being able to ask questions in real time. Church services are streamed online. Families can continue to communicate face-to-face, even if it’s just through a screen. And social gatherings are still occurring through virtual happy hours.
If you would like culture to go with that drink – which can be delivered to your house in most states, just not Mississippi – you can check out virtual tours of museums and national parks. Since movies and concerts are a no-go right now, numerous artists have been holding virtual concerts on social media, while “watch parties” allow you to synchronize movies with friends across town or across the world.
Excluding alcohol, most other products that you would purchase can be delivered to your front door. Thanks to entrepreneurs and apps that we don’t think twice about, you can have a meal from your favorite restaurant delivered while it’s dining facility is closed. You can have your grocery order delivered. Or at the least have your order that you placed on an app brought to your car as you wait safely inside.
And telemedicine, which has long been available, is becoming more common, and necessary. And thanks to easing of regulations, more accessible for those want or need to visit with a medical professional, but don’t want to leave their house.
Indeed, the common theme is technology and the government stepping aside and letting innovation happen. Because of this, we are able to proceed with a little normality in our lives for these crazy times.
Gov. Tate Reeves said Sunday that isolated shelter in place orders in Mississippi are imminent for communities in the state that have been hardest hit by the outbreak of coronavirus.
During a social media address, State Health Officer Dr. Thomas Dobbs and Reeves both said a statewide lockdown was not sustainable, but isolating clusters is part of the state’s new offensive strategy against the spread of coronavirus. As of March 28, the state had 758 positive cases with Desoto and Hinds counties accounting for nearly 20 percent of the cases total.
“If we depend on shelter-in-place to be a solution ... you're going to be sorely disappointed,” Dobbs said.
Reeves has signed an executive order closing dine-in services at restaurants, unless they are following mandated social distancing guidelines and less than 10 people are present.
States across the country have issued varying degrees of lockdowns with a wide range of what is essential, and what you are allowed to leave your house for. The only neighboring state with such an order is Louisiana, which is one of the hardest hit states outside of the New York City metropolitan area and the west coast.
Texas Gov. Greg Abbott has followed a similar path to Reeves in leaving the decision up to local governments. And the largest counties in the state – including Dallas, Harris (Houston), Tarrant (Fort Worth), Bexar (San Antonio), and the city of Austin – have issued such lockdowns.
The cities of Tupelo and Holly Springs have issued stay at home orders.
Gov. Tate Reeves announced today that he is clarifying his executive order from earlier in the week after it caused confusion among some mayors.
Reeves’ order stopped dine-in service at restaurants, unless there are 10 or less people present, and mandated social distances practices were being followed.
Prior to that, many cities had fully stopped dine-in service in their towns, or in the case of a couple towns – issued stay-at-home orders.
This then caused confusion among some city leaders, but Reeves clarified today that his order is the baseline, not the ceiling. If the locality had a more stringent order in place, that order still is in place. Or if they wanted to create a more rigid order tomorrow, they could still do that.
But if a city did not have any restrictions on the books, restaurants would not have to comply with Reeves’ order.
Reeves also reiterated that he will continue to lean on the Department of Health for guidance on further ordinances. He left the door open for either a statewide lockdown, or even a city or regional lockdown if conditions are worse in certain areas.
In many countries, commercial drones play a key role in the delivery of medical supplies, along with other critical needs. Five years ago, the first drone in the United States delivered medications to the mountains of Southwestern Virginia. It was part of a FAA pilot program for unmanned aircraft.
As we deal with the outbreak of the coronavirus, and the subsequent quarantine along with the need for medical supplies, the technology and capability of drones looks even more promising.
Is Mississippi prepared for the drone industry? Not according to a new report from the nonprofit Mercatus Center at George Mason University. The Mercatus Center looked at various laws among the 50 states and placed Mississippi 47th, along with Iowa.
Here is what the report considered:
- Airspace lease law. Drone highways must be demarcated by regulators and safely separated from airports, homes, schools, and other sensitive locations.
- Law vesting air rights with landowners. These laws clarify that the state is exercising its police powers and defining property rights. They also inform drone operators and residents about the extent of homeowners’ property rights, which reduces litigation risk for operators and homeowners alike.
- Avigation easement law. These laws allow drone operators to fly so long as they are high enough not to bother landowners and passersby. Even if the state or municipality doesn’t own the aerial corridors above public roads, drones will generally be allowed to access the aerial easements that state officials demarcate above public roads.
- Aviation advisory committee. For state and local authorities, widespread commercial drone services will raise issues such as zoning rules, noise limits, time-of-day restrictions, job training and education, and insurance. Most of these issues will require extensive exploration—by regulators, residents, researchers, and operators. States that have a statewide committee, task force, or department of transportation team dedicated to drones merit a higher score in the report.
- Drone jobs estimate. The report card ranks states based on the number of drone jobs per 100,000 people. Drone jobs serve as a proxy for soft factors such as whether a state has a community college system with drone programs or has workers in the aerospace industry. These factors can position states for future jobs growth in the industry, much as the auto industry has centered around Detroit and the IT industry around Silicon Valley.
Essentially, Mississippi has no infrastructure in place at this time to support drones.
Mississippi law doesn’t allow public authorities to lease low-altitude airspace above public roads and public property. Such a law would allow state or local authorities to create drone highways above roadways. It also doesn’t expressly provide air rights to landowners, which raises litigation risk for drone operators because landowners don’t know the extent of their property rights and may sue to protect their interests. Nor does it create an avigation easement, which means drone operators may be subject to nuisance and trespass laws, even if their drones don’t disturb people on the ground.
Neighboring Arkansas was the highest rated Southern state, receiving positive marks for airspace lease laws, vesting rights with landowners, and avigation easement law.
The Mississippi Board of Medical Licensure has amended a telemedicine proclamation and is limiting access to out-of-state physicians for the service.
The Board issued an amended proclamation Tuesday 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.
Getting certified to practice in Mississippi is easier thanks to action by the Mississippi legislature, but the number of physicians going through the process to get certified to practice in Mississippi is likely nil with the COVID-19 pandemic.
Mississippi is part of the Interstate Medical Licensure Compact, which has 26 states that have signed up 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.
Those states include: Alabama, Arizona, Colorado, Guam, Idaho, Illinois, Iowa, Kansas, Maine, Maryland, Michigan, Minnesota, Mississippi, Montana, Nebraska, Nevada, New Hampshire, North Dakota, South Dakota, Oklahoma, Tennessee, Utah, Vermont, West Virginia, Wisconsin, Wyoming, and Washington.
Georgia, Kentucky, Pennsylvania, and the District of Columbia have passed legislature to participate in the compact but has yet to be implemented. Florida, Missouri and South Carolina have introduced legislation to become part of the compact.
A number of distilleries in Mississippi are producing a new item for sale as the coronavirus spreads and one very essential product is available in limited quantities: hand sanitizer.
This didn’t come from a government mandate on the private sector. It was actually the opposite. The federal government stood in the way, until they reversed a couple regulations. 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.”
It makes sense that distilleries would be a natural fit for a product that contains a high amount of alcohol. And numerous Mississippi distilleries, which have had to close their bars and stop providing tours, are taking advantage of the relaxed rules. And if anyone understands overzealous government regulations, it is alcohol producers.
“I'm covered up in it — trying to make as much of the stuff as we can,” said David Rich, owner of Rich Grain Distilling Co. in Canton. Lazy Magnolia Brewery in Kiln is also making hand sanitizer.
In times of crisis, we often look to the government for an initial response. That is understandable. Yet it is the private sector who has always, and will always, respond as they can in times of need. As a new column in the Wall Street Journal outlines, Honeywell and 3M are hiring workers and increasing output for N95 masks. Ford and General Motors are using their global supply chain to make face shields, ventilators, and respirators. It is the private sector that created the technology that streamlined curbside pickup and delivery for grocery stores and restaurants.
And, of course, distilleries are now making hand sanitizer. Since government is no longer in the way.
Gov. Tate Reeves announced today that he will be signing an executive order later today to close restaurant dining facilities in an effort to combat the spread of the coronavirus and to instruct Mississippians not to gather in groups of 10 or more.
Saying he was relying on the advice of health experts in the state, Reeves made the announcement during a news conference at the Governor’s mansion this morning.
The state Department of Health has recommended restaurants close their dining facilities and move to take-out and delivery only. Many local governments have enacted similar bans. This includes: Lafayette county, Oxford, Jackson, Tupelo, Moss Point, Biloxi, Gulfport, Ocean Springs, Forrest county, Hattiesburg, Columbus, Starkville, Hancock county, Bay St. Louis, Diamondhead, Waveland, Vicksburg, Southaven, Olive Branch, Holly Springs, Pontotoc, and New Albany.
Reeves, who yesterday said he wasn’t issuing a stay at home order as a number of other states have done, said he will continue to rely on the advice of experts for the appropriate direction and that he believed most in the state are heeding the call to only leave their house if it is necessary.
Reeves was asked about that today.
“I’m not going to rule anything out at this time,” Reeves said. “We’re going to take every step experts ask us to take. I have not been advised by anyone to enter into a statewide lockdown. There are currently 18 states that have varying degrees of lockdown and what I believe is the majority of Mississippians are heeding the call to take care of themselves. We have some pockets where that has not been the case. But we are telling all Mississippians avoid groups of 10 or more.
“My commitment is to listen to the experts but at this time we don’t see this as the best course of action… The best information I have does not call for a statewide lockdown.”
Mississippi has 320 confirmed cases of coronavirus.
The purpose of healthcare policy during a health crisis, such as the current coronavirus outbreak, is to maximize existing resources to provide high-quality healthcare to as many people as possible.
What does this mean? It means we must be guided by two priorities during the current emergency:
- Increasing the Supply of Healthcare
- Increasing Access to Healthcare
These two priorities, however, should be achieved in a manner that honors our heritage of constitutional government. The question for policymakers thus becomes how to attain these goals while also:
- Respecting Individual Freedom and Responsibility
- Limiting Damage to the Free Market and the Economy
No doubt, various methods can be employed to increase healthcare supply and access. The healthcare economy, for instance, could be nationalized, with the federal and state governments commandeering factories and forcing them to make face masks and respirators. Doctors and nurses could also be conscripted and made to work in localities with the most need.
Such draconian measures should only be employed as a last resort. It is our task to determine whether supply-side, market reforms can meet the current need in a way that maximizes freedom and strengthens the free market. In fact, we are already experiencing the benefits of such an approach. Consider the following:
- Millions more N95 face masks will soon be available after Congress passed a law overriding Food & Drug Administration (FDA) red tape that has been hampering supply.
- Following South Korea’s own experience, the FDA has lifted regulations holding back the supply of testing kits and accessibility.
- Congress has passed legislation waiving restrictions on telemed for Medicare insurance beneficiaries.
Closer to home, Gov. Tate Reeves is pursuing a similar path by encouraging health care providers to consider how regulatory requirements are limiting healthcare access.
- Accordingly, the State Board of Medical Licensure recently suspended a rule that has been suppressing access to telemedicine. Of particular note is allowing physicians licensed in another state to use telemed to treat Mississippi patients.
- Likewise, the State Board of Nursing is allowing APRNs – Advanced Practice Registered Nurses, which include nurse practitioners, clinical nurse specialists and others – to prescribe medications without a prior face-to-face examination. In addition, APRNs that do not hold a Mississippi license may treat Mississippi residents via telemed. Nurses (RNs or LPNs) licensed in another state may also obtain a waiver to practice in Mississippi during the current emergency. It does not appear, however, that the State Board of Medical Licensure has formalized an identical waiver, beyond what is already permissible under temporary licensure guidelines.
- As with Medicare, the state Division of Medicaid is also employing additional telemed options for patients with Medicaid and CHIP insurance.
Clearly, much more needs to be done to cut red tape so that we may more effectively respond to the coronavirus.
Part II of this report will look at additional healthcare reforms that would save lives and increase access during the current emergency.