While waiting for that announcement, I’ve been busy filing bills. So far, I’ve filed 12 bills and one resolution. The resolution rejects the proposed salary increases for elected officials. Those bills fall into three categories: ethics, health care, and criminal justice. I’ve written previously about the ethics proposals and the salary rejection resolution, so this week I’ll focus on the other two.
I have proposed three “small ball” Medicaid reform bills. These bills don’t move Medicaid into the optimal market-based space; but they make incremental improvements that will yield better outcomes and savings for taxpayers.
House Bill 319 expands the list of providers eligible to provide Medicaid services through telehealth, or the use of new electronic communications technologies. The most common, and probably oldest, example of telehealth, is radiology. A radiologist can review x-rays, MRI, and other records without being in the same room, or even the same country, as the patient. A technician takes the scan and forwards the necessary medical information to the doctor.
As technology has improved, telehealth services are available in other areas as well. For example, a dermatologist in Columbia could help diagnose an unusual rash or skin lesion using a high-resolution digital photograph taken by a family practice physician in Eldon. House Bill 319 would facilitate the expansion of telehealth services where medically appropriate.
House Bill 320 is similar to a bill I filed last year and would require the Department of Social Services to develop incentives programs to encourage health care providers to open health clinics in or near high poverty schools. In 2009, then Texas Gov. Rick Perry signed legislation creating a similar program in Texas and research has shown that these clinics both improve health outcomes for children in poverty and save taxpayer money by reducing unnecessary emergency room visits.
Because this bill’s opponents have engaged in deception, it’s important to point out that (1) consent of a child’s parent or guardian would be required before a student received any services, (2) no school-based clinic could perform or refer for abortion or contraceptives, (3) the student’s medical records would not become a part of their education records, (4) schools would not be turned into medical providers and no health care provider could collocate without permission of the school, and (5) there’s no new Medicaid eligibility in the bill.
The bill is simple. We have children currently on Medicaid who are emergency room frequent flyers and/or who don’t always receive timely medical care. We know where these kids are during the school day. HB 320 creates incentives to make health care more convenient for these children which, in turn, helps keep them out of the emergency room and saves taxpayer money.
House Bill 386 creates incentives for primary care physicians to serve Medicaid patients outside of normal business hours. Like House Bill 320, it would push Medicaid recipients to receiving health care services in a more appropriate and less expensive setting than the emergency room.
House Bill 332 would tighten the “Mack’s Creek Law” to limit local government to collecting ten percent (down from 30 percent their annual general operating revenues from fines and court costs for traffic violations. This bill is identical to a bill sponsored by Sen. Eric Schmitt (R – St. Louis County). I expect that a similar or identical may also be filed by Rep. Paul Curtman (R – Union). A municipality that subsists only by extracting heavy fines for traffic violations from its own citizens, or those unfortunate enough to pass through, should be forced to close its troll gates. St. Louis County is littered with such municipalities. (By comparison, Jefferson City collects less than 4 percent of its revenue from fines.)
Local governments will, of course, oppose this bill. Vigorously. Those facing those loss of power naturally oppose the change. One criticism I’ve already heard is that we’re limiting the power of government. To that I plead guilty as charged. (An aside: I thought about filing a bill like this last year but decided against it because I thought it would be too difficult to take on all of the local government lobbyists. Events over the summer obviously made success more likely.)
House Bill 334 would require prosecutors and law enforcement agencies to have a written policy directing investigations of officer-involved shootings to outside agencies and prosecutors. They could appoint a prosecutor in a neighboring jurisdiction or a person designated by the Missouri Office of Prosecution Services, an entity within state government which helps elected prosecutors throughout the state. This is already a common practice. A recent local example (though not involving a shooting) was the death of Brandon Ellingson at the Lake, where the local prosecutor appropriately recused himself and appointed a special prosecutor.
As I wrote previously, prosecutors should not bring charges because of political pressure, public spectacle or general calls for justice disconnected from the actual facts. I respect and, indeed, agree with the grand jury’s decision, and I depart from those who impugn St. Louis County Prosecutor Bob McCulloch. This bill is about general confidence in the criminal justice system. It would not increase the power of the Attorney General or Governor because I have less confidence in the ability of persons in those positions (past, present, and future) to make judgments free from political pressure and bias than other local elected prosecutors or an attorney designated by MoOPS. And it would not re-open the Michael Brown file. It states that it would only apply to situations occurring after August 28, 2015. It would, however, increase confidence in our criminal justice system.
Prosecutors are biased in favor of law enforcement. That’s their role in our adversarial system. Remember the last campaign ad you noticed for a prosecutor who promisednot to side with law enforcement? Of course not. We don’t want prosecutors to be “impartial” regarding law enforcement officers within their own jurisdiction. We want them to work closely with law enforcement officers to put bad people in jail. While the prosecutor’s position requires sufficient independence and fairness to exercise prosecutorial discretion, they still play for the same team. In the rare example where the situation is flipped – where a law enforcement officer may have broken the law, House Bill 334 would take the common and best practice and make it law.