My colleague Elias Tsapelas has produced a lot of excellent research on Medicaid over the last few months. And this important work will continue: Medicaid spending already constitutes a third of Missouri's budget and is growing rapidly, which will put mounting pressure on other state priorities. Missouri will eventually have to decide whether it's a government that sometimes provide health care benefits or a health care provider that sometimes governs.

The existential risks of an unreformed Medicaid program are not, however, the only health care issues that Missouri should grapple with next year.

• Earlier in 2019, I published a paper on the state's Certificate of Need law, which can dictate where hospitals and other care centers open, and how readily Missourians can access important health care services. Missouri's CON law should be repealed.
• I have talked about short-term medical insurance reforms for a long time as yet another option to provide consumer choice and economic value. Policymakers should reduce the mandated coverage requirements on Missouri health insurance products generally, but they should be especially careful about harmonizing Missouri's short-term medical insurance market with the new rules instituted at the federal level early in 2018.
• Elias and I have also talked about other reform options, including reassessing the state's scope of practice regulations, taking a fresh look at our medical licensing laws and pursuing innovative health care shopping incentive programs, both in public and private.

There will be many important items on policymakers' legislative agendas in 2020. Medicaid reforms should be a high priority—not only as a health care priority, but as an issue that will affect the state's financial health well into the future. But legislators should also not forget that great progress can be made for Missouri patients through other legislative changes, and I hope these largely modest reforms make their way onto the agenda.