The Mercatus Center at George Mason University recently released a new research project ranking states across the nation based on their access and openness to health care. Dr. Darcy N. Bryan, an associate clinical professor at the University of California-Riverside School of Medicine and an author of the study, describes the Healthcare Openness and Access Project (HOAP) as a “set of tools providing state-by-state measures of the flexibility and discretion that patients and providers have in managing health and health care. In other words, how open are each state’s laws and regulations to institutional variation in the delivery of care, and how much access to varying modes of care does this confer on the state’s patients and providers?”
The top-ranked states for openness and access in the study are Idaho, Montana, Missouri, Mississippi, and Utah. The lowest-ranked states are Georgia, New Jersey, New York, Connecticut, and Rhode Island.
After the passage of the Affordable Care Act (ACA), citizens, health care professionals, and elected officials lost much of the power they previously had to make health-care-related choices, and until now, many of the parties did not have a way to quantify what had been taken away by the implementation of the ACA. Mercatus created this study and its state-by-state rankings to fill that void.
Robert Graboyes, a senior research fellow at Mercatus and one of the authors of the HOAP report, noted, “[S]tates control many important aspects of health care, which they can alter without seeking approval from the federal government. … Who may practice medicine? Which services can nurses provide? Who can own a medical practice? What constitutes malpractice? Can doctors and patients interact via remote video technology? Can new hospitals freely challenge existing institutions? The way states answer these questions has an enormous effect on the cost and quality of health care,” Graboyes wrote.
In a recent In The Tank podcast, Heartland Graphic Designer Donny Kendal and Government Relations Director John Nothdurft discussed the Mercatus Center study, arguing it successfully brings a degree of transparency to the complex system of health care laws and regulations now in operation throughout the country using dozens of reliable indicators, including direct primary care rules and health-care-related taxes.
What We’re Working On
Budget and Tax
President-elect Donald Trump’s Tax Plan
Dan Pilla – the author of 14 books and one of the nation’s leading experts on taxpayers’ rights and the Internal Revenue Service – unpacks the tax reform plan unveiled on the campaign trail by President-elect Donald Trump. “It is easy to talk about tax reform on the campaign trail but quite another thing to get your policies enacted once you’re in office,” wrote Pilla, who also asserted if Trump holds true to his campaign promises – and if the plan survives what Pilla refered to as “the congressional mix-master” – there are many powerful, positive elements packed into the plan. Among other things, Pilla says we can expect as a result of these reforms “taxpayers in all brackets [to] see a reduction in their federal tax burden. Said another way, everyone would have more money in their pockets.” Read more
Education
Competency-Based Education Would Have Higher-Ed Costs, Study Finds
In this article published in School Reform News, reporter Jane S. Shaw writes about a new study prepared by the rpkGROUP consulting firm and funded by the Lumina Foundation that says colleges and universities could cut the cost of some of their degrees by as much as 50 percent by using competency-based education (CBE). The report examined CBE programs at four institutions: the University of Wisconsin-Extension and Kentucky Community and Technical System (both public universities), Brandman University (a private nonprofit university), and Walden University (a private for-profit college). “All four institutions … made efforts to ‘deconstruct’ the credit hour in some respect, moving toward new methods of student engagement and assessment of student learning,” the study said. After six years, the report estimates, operating costs for these schools will be half the cost of traditional academic programs, but it may take longer to recoup their investment costs. Much depends on “aggressive growth” in enrollment and the implementation of additional efficiencies, say the researchers. Read more
Energy and Environment
Nevada Voters Choose Electric Power Competition
In this article published in Environment & Climate News, Managing Editor H. Sterling Burnett discusses Nevada voters’ decision to overwhelmingly vote in favor of a state constitutional amendment that, if approved a second time, will open the state’s electric power market to retail competition. Burnett says currently in Nevada, utility companies operate as monopolies within their respective geographic service areas, with the Nevada Public Utilities Commission regulating utility prices and other terms of service. In Nevada, this monopolistic structure has resulted in one company, NV Energy, controlling 90 percent of the state’s electric power market. Question 3 on the ballot, referred to as the “Energy Choice Initiative,” would open Nevada’s electric power market to retail competition from other providers, ending the near-total-monopoly held by NV Energy. Because of features unique to Nevada’s constitutional amendment process, Questions 3 will have to be passed by voters a second time in the 2018 general election to become law. Read more
Health Care
Research & Commentary: Maine Should Open Doors to Direct Primary Care
One of the lesser-known factors contributing to the rapid increase in the cost of health care in Maine is the shrinking number of primary care physicians (PCPs) available relative to the size of the population. The Robert Graham Center estimates to maintain current rates of primary care utilization, Maine will need “an additional 120 primary care physicians by 2030, a 9% increase of the state’s current (as of 2010) 1,243 practicing PCPs.” In this Research & Commentary, Senior Policy Analyst Matthew Glans discusses direct primary care and how it could help patients and physicians in Maine. “Direct primary care empowers patients and doctors, giving them more freedom to establish and participate in health-care-provider models that work best for all patients. Maine should remove unnecessary regulatory barriers to direct primary care to help revitalize the state’s primary health care system,” Glans wrote. Read more
From Our Free-Market Friends
Economic Freedom of North America 2016
Economic Freedom of North America 2016 is the twelfth edition of the Fraser Institute’s annual report measuring the extent to which the policies of individual provinces and states were supportive of economic freedom and the ability of individuals to act in the economic sphere free of unnecessary government restrictions. There are two components to the Fraser Institute’s study, one that examines provincial/state and municipal/local governments only and another that includes federal governments as well. The report finds New Hampshire has the highest level of economic freedom among all U.S. states for the second year in a row. Florida finished second, and Texas tied for third with South Dakota. For the second year in a row, New York was the least-free state in the country at 50th. California ranked 49th. Read more
Nathan Makla is a former state government relations manager for the Government Relations Department at The Heartland Institute.
