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Carolina Journal Radio No. 808: Expert analyzes Cooper’s N.C. emissions order

Carolina Journal Radio / Donna Martinez and Mitch Kokai
The Truth Network Radio
November 12, 2018 8:00 am

Carolina Journal Radio No. 808: Expert analyzes Cooper’s N.C. emissions order

Carolina Journal Radio / Donna Martinez and Mitch Kokai

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November 12, 2018 8:00 am

Gov. Roy Cooper has signed an executive order calling on state agencies to reduce greenhouse gas emissions. The goal is to have North Carolina follow through on dictates of the Paris climate agreement, even though the Trump administration has pulled the United States out of that agreement. Donald van der Vaart, John Locke Foundation senior fellow and former N.C. environmental secretary, dissects Cooper’s order and analyzes its implications. Many American cities appear to face a state of decline. The group Strong Towns endorses action that would help reverse that decline. Development director Bo Wright discusses Strong Towns’ recommendations. That includes the roles public and private actors should take. After less than three years on the job, UNC System President Margaret Spellings has announced plans to resign in March. Despite the surprise announcement, Spellings told reporters she is proud of the system’s accomplishments during her tenure. She outlined some of those accomplishments during a recent news conference. Today’s college students have embraced activism to a degree last seen in the 1970s. But former Yale professor William Deresiewicz recently cautioned a Duke audience against treating college as a way to promote that activism. Deresiewicz made a plea for a traditional liberal-arts education that forces people to think, reason, and question their beliefs. The federal government has granted North Carolina a waiver to make major changes in its Medicaid program. Among the changes is a shift from a fee-for-service system to one in which the state allots a set amount of funding to address care for each Medicaid patient. Statewide and regional groups will contract with state government to manage its Medicaid services. Dan Way, Carolina Journal associate editor, discusses waiver details and assesses the significance for Medicaid’s future.

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From Cherokee to current attack from the largest city to the smallest and from the statehouse into the schoolhouse Carolina Journal radio your weekly news magazine discussing North Carolina's most public policy events and issues welcome to Carolina Journal radio why Michiko got during the next hour, Donna Martinez and I will explore some major issues affecting our state.

This week's edition of Carolina Journal radio was brought to you by Blue Cross and Blue Shield of North Carolina working every day to transform the health system for North Carolinians. More information available at today. We.com a number of North Carolina and American communities seem to be in a state of decline will hear from a group called strong counts is working to reverse that decline, University of North Carolina Pres. Margaret spellings made a surprise announcement she's leaving her job after less than three years to hear her discuss the UNC system's accomplishments.

Duke University audience recently heard a warning from the left of center speaker. Don't let your activism get in the way of a good tough liberal arts education and will learn about the federal government's recent decision granting North Carolina a significant waiver. It will permit major changes in the state Medicaid program.

Those topics are just a headfirst Donna Martinez joins us with the Carolina Journal headline, Gov. Roy Cooper says that he wants to cut greenhouse gas emissions by 40% in North Carolina and he wants to do it in just several years. By 2025 and his executive order describes his plan is a commitment to address climate change and transition to a clean energy economy.

The question, of course, now is, is the governor on the right track for the wrong track with his plan.

Don Vandermark is the former Sec. of the Department of environmental quality for the state of North Carolina. He is now a senior fellow with the John Locke foundation Don welcome back to the show extra give us your general sense.

Having read the executive order that the governor signed and which lists his goals and how he would go about your general sense of this whole well let's looks looks a little bit farther back and understand what he's talking about is roughly the same level of reductions that were sought by the Obama administration's clean power and modeling.

Roughly 40% 38%. There's a 2012 205. Nevertheless, that level of reduction was shown in the EPA at that time the Obama and EPA did not disputed to make no difference in terms of global warming out all over hundred years and so the question is really even if you even if this Executive Order were actually followed up to the letter of what would actually accomplish. But then if you stuff a little bit closer, you realize that the baselines that the Executive Order refers to were some 15 to 18 years ago. So a lot of these reductions actually have occurred for various reasons, hydraulic fracturing, making natural gas cheaper, more energy efficiency technology having been implemented through some of our buildings so it's not it's it's not an unreasonable Executive Order from that standpoint practicality, because you're saying that the state essentially met a good portion of the school already. Sure we've already had a 25% reduction in CO2 since the 2005 we had massive increases in energy efficiency in our buildings since baseline the main nerve 2002, 18 years ago 6 to 60 such a long time but if you stop a little closer.

Again, you ask will houses have a cousin Executive Order cannot authorize anything that isn't already authorized by law is simply a policy or guide for the agencies governor overseas and so there if you read the Executive Order there a lot of meetings that are going to occur. There a lot of plans that are going to be developed. But at the end of the day, it's not clear how direction going to affect their goals. Let's talk about a couple of the components that are in the executive order, there's the general goal the reduction of 40% which we talked about, but the second item is this increase the number of registered zero emission vehicles individually to at least 80,000 are we talking about electric cars here is that the deal primarily I think they're talking about a pipe dream first falls zero emission goals all electric are not zero emission vehicles wired well that electricity comes from somewhere that electricity is generated using coal in North Carolina: natural gas and some nuclear so you course, there are missions that there's no tailpipe so you might feel better about trust me, emissions are occurring elsewhere. Also there not more efficient than gasoline engines. Despite the the fictitious numbers that the EPA is used in the past is been shown to be phony, but that's what they're talking about how he's going to increase the number of registered as AEDs to 80,000. I have no idea.

I'm not sure we do any good thought on the issue of these vehicles is they run on batteries. Okay. Well, as you said, there's there's emissions at any different point. But what happens when the battery lack of a better phrase, since I'm not a a scientist like you are goes to put okay when it's it's over and done what happens the back and ordinarily you would landfill if you could recycle some components of the cost. The actual mining goes into the production is also impactful on the garment. So yeah, you're right. You have to take a look at a cradle-to-grave type of analysis for those batteries and the batteries are significant right is a significant component of a zero mission vehicle to be lugging these batteries around and a very expensive and they include a lot of heavy metals and items that you do have to be careful about when you do disposed of. I think this point this is an important one. Whenever were talking about this type of program is really to look at time cost versus benefits and what it sounds to me like you're saying is that this plan is is put together in being reviewed or presented essentially in a vacuum outside of the other things that will occur over time. I think it's fair to say that all of us want to make sure that were preserving our environment and the difference comes when when we look at the ways to do that so how do we save the planet, so to speak, but do it in a way that that recognizes that no matter what you do, there's can be a cost somewhere for the good news here is that the free market strain but free market is already taking care of this for us as we said was already a 25% reduction folks are continuing to strive for more energy efficiency vehicles in their homes, you're going to see these reductions occur. In fact part of this I think is simply trying to take credit for things that are going to occur anyway and in your course exactly correct.

You don't want these kinds of possibly regulations that come from this actually support those efforts or make them more costly than they already are now the weather goals here in the Executive Order says we want to transition to a clean energy economy. Isn't that what natural gas is Artie been doing based on the free market. Certainly my opinion is that natural gas is a far less polluting fuel than coal, nuclear power is not even mentioned so great the great alternative. The fact of the matter is that environmentalists now believe methane is a super pollutant because it is, for whatever reason it's being used a lot more because it's cheaper for them, for whatever reason, there are now attacking. I'm not sure that doesn't have something to do with the fact that the Russians according to Hillary Clinton funded some of these environmental specialist groups and it's not in their interest to see natural gas being produced, but but but yes, we ought to be happy about where our environment is we are to be thankful that because of hydraulic fracturing we are able to clean up our power sector and is going to continue.

Lastly, donning our remaining moments. Here the chance to just talk with Gov. Cooper because you know a lot about this and you have worked in state government is a senior official. You also have a scientific background. What would you tell them is the correct path forward, well frankly, my question is are these resources being used, to the best bandage. As I said were making reductions are sector in CO2 power sectors is getting cleaned up. Perhaps there some other issues in the environment that deserve these kind of attention. Talking with Don Vandermark. He is a senior fellow with the John Locke foundation.

He is the former secretary of the North Carolina Department of environmental quality donning this much more Carolina journal radio to come just this week's edition of Carolina journal radio was brought to you by Blue Cross and Blue Shield of North Carolina working every day to transform the health system from North Carolinians. More information available at today.

We.com voters have spoken in North Carolina. How can you make sense of what they said about the legislature Congress, the courts, the Constitution, Carolina journal has you covered in print each month. Online every day. Carolina journal is your source for up-to-the-minute information about North Carolina state government policies and their impact on you Carolina journal offers in-depth analysis of the election's aftermath, then looks ahead to 2019.

How will elections affect your family, your wallet, your schools, your business find out in the free Carolina journal newspaper online@carolinajournal.com Carolina journal your number one source for government news that affects you visit Carolina journal.com today. Welcome back Carolina journal radio I Mitch coca you get the sense that American cities are on the decline. If so, which we do about our next guest offered some ideas during a recent presentation for the John Locke foundation. It was dubbed a curbside chat. Oh, right, is development director for the group strong talents welcome to the program.

Thank you, Mitch. Thanks so much for having me here before we talk about the decline or not of American cities. First of all, tell us what is strong talents yet so strong towns is now in its 10th year. We already media organization that's looking into simply the development pattern of America. The connection between the ways that our cities develop that the physical layout of them. The roads, the sewers, what they look like the streets in the municipal finances of our cities and so I might be jumping ahead with your question about the client in American cities.

What we see is a lot of us cities and when we say cities.

We basically mean municipalities so that looks like counties. It's not just don't think just the urban can enter core. We see a lot of municipalities really struggling with her finances and a lot of that has to do with the way that we built our cities, basically post-World War II. We spread our cities out and that has financial ramifications. And so our organization is dedicated to kind of exploring that connection and then providing resources to city leaders in engage citizens across the country to make their towns and cities stronger so you mentioned that this really has a lot to do with the way the cities developed what one of the ways that they develop that have ended up causing some perhaps unintended consequences or problems. The people didn't foresee yet. So what we see is a lot of pre-World War II development but of urban thinkers will divide stuff into pre-World War II and post-World War II, basically pre-World War II tip to make it really simple. We built our cities around the basically walking. We built it around. Walking from your home to local shop, what, where is post-World War II.

We built our cities around the automobile and strong towns is pretty agnostic about know where you live and stuff like that.

But what we do is look at the math and when we look at the math we see that when you build a city or community around the automobile wound up spreading all of your infrastructure out and it's very very costly for municipalities. So, for example, one of the examples I should share in the presentation is Lafayette, Louisiana.

So we have a lot of data on Lafayette, Louisiana as well as other cities across the country Lafayette in 1949 had something like 3 feet of pipe per person, whereas in 2015 they had 50 feet of pipe per person. Meanwhile their population only grew basically three times what if your city what you should see when you look at that is your you know your income in your population growth for three times but your liabilities grew. Basically 50 times and you.

You simply can't do that as a said you can't spread out in that way and remain solvents. We see a lot of cities that have developed in this way, and today the really struggling because of Canada. The obligations that they have with road maintenance liabilities and maintaining sewers and in all of that kind of stuff that is the voice of Bo right.

He is development director for the group strong towns both some people are going to hear us and they're going to say wait a minute. These cities develop this way because this is the way people wanted to live. They wanted to have big houses and big yards and not be all crammed into one central location. Is it a problem with that.

That is based on the way people have chosen to live or reserve some other factor.

Totally I and and this is why mentioned before, the trunk ounces lease begins from the perspective of being semi-agnostic about the development pattern we didn't start as urban advocates or anything like that. I was point out and I don't know if that's helpful or not, but Chuck Marrone, who founded strong towns, since kind of in the voice in the face of our organization. When he started strong towns.

He was living on 5 acres outside the town and basically was a planner and engineer and realize that the way that were building our towns and cities is making us poorer as communities in and I myself grew up, then suburban and rural area and so I totally get the need for space. I'm someone who might always live in a single-family home. That's just comfortable for me but there's there's a guy here in North Carolina named Joe minute cozy out of Asheville, North Carolina, who we work with a lot in his response to this question is is is an Italian guy and he's bald and he sees a short guy and he said yeah I want to be 62 and have a full head of hair. But you know you can't. No one wants to pay for that for me and so that's kind of the responses.

Yes, I totally get that in. We are not know trying to bang people over the head and say you need to move within city limits you. You can't have this for trying to say there's a cost to this and as a society we need to pay for that because basically the cost to live so spread out okay so we have the situation of the cities that have been developed in these different ways in ways that the from the vantage points of strong towns are very costly. What we can do about it. We can't go back and say all right were to knock everything down and rebuild it. So how do we approach the issue yeah so there's if there's a few things to say one is what can we learn from the past. What can we learn about the ways that we did builder towns and cities of the first things will notice when we do that is that prior to World War II.

We built incrementally. We made small investments over a broad area over long period of time allotted to the development pattern we see today. In addition to being spread out its it's gonna developed all at once.

We think of kind of a suburban neighborhood today.

It's developed all at once to finish date and when it's finished.

It's at its peak value it's peak prosperity and then it simply declines. From there we see a lot of places struggling with that so one of things we can do is learn from the past and learn to build incrementally and bring some of those kind of insights into the way we builder towns and cities today. The other thing that Joe minute cozy and in our organization. Strong towns always points to the city simply need to do the math. So they need to account for their expenses to give just a very, very rough number we've looked at in Lafayette Louisiana they decided that they needed $20 of private wealth created for every one dollar of public investment. So if the city goes out and puts in a row that cost $100,000 for the asphalt the sewers. The pipes all of that stuff you need about $2 million of private wealth generated as a result of that public investment that goes to pay for the police and firefighters you know maintenance on on all the stuff that it takes to make a city run so cities need to do the math. What we see what we saw in Lafayette is two and three dollars of public investment. For every one dollar private investment in a lot of the rural areas we see three and four dollars of public investment for every one dollar private investment city simply need municipalities simply need to do the math and account for their finances in the same way that like a business might do the same way that we treat our, personal finances.

Another question people might have. After listening to us is okay.

This all sounds kind of interesting. What's this could mean in terms of you to see higher taxes do we need more development restrictions are there policy recommendations that you all are making that would have that kind of basic impact on taxes or development rules.

That's worth.yet the reality is we couldn't raise our taxes enough to pay for our backlog of maintenance liabilities and a lot of cities that simply not an option in places where we've done that math it would look like a 46% increase on taxes today with 3% increases over inflation that's not going to happen were certainly not advocating for that to happen, but we do. We are not necessarily policy advocates.

That's not our role. We want to can build a broad movement of people who are pushing for change, but we have had a number of elected officials both at the mayor that governor level and I recently some folks in Congress took notes and we have made a few policy recommendations that have to do with infrastructure where that money should be spent. What kind of infrastructure actually has return on investment guest is been bow right development director protects what you're doing think you will have more on Carolina journal radio in just a moment. Did you know you can now advance freedom and free markets just by shopping with Amazon it's true online shopping is now a great way to support the John Locke foundation just shot using the Amazon smile program and designate the work foundation to receive a portion of your purchase amount that's right you shop and Amazon donates money to last the John Locke foundation is how it works long time to smile.amazon.com Amazon smile. It's the same Amazon you know same products same prices is much better. Amazon donates .5% of the price of your eligible purchases to the John Locke foundation to try and be sure to designate the Locke foundation is a nonprofit, you want to support. It's that easy. So now not only will you enjoy what you buy will also support freedom.

Don't forget log on to smile.amazon.com today by something nice and help defend freedom. Support the John Locke foundation voters have spoken in North Carolina. How can you make sense of what they said about the legislature Congress, the courts, the Constitution, Carolina journal has you covered in print each month.

Online every day. Carolina journal is your source for up-to-the-minute information about North Carolina state government policies and their impact on you Carolina journal offers in-depth analysis of the election's aftermath, then looks ahead to 2019. How will elections affect your family, your wallet, your schools, your business find out in the free Carolina journal newspaper online@carolinajournal.com Carolina journal your number one source for government news that affects you visit Carolina journal.com today. If you have freedom we got great news to share with you now.

You can find the latest news, views, and research from conservative groups across North Carolina all in one place North Carolina conservative.com. It's one-stop shopping. North Carolina's freedom movement and North Carolina conservative.com. You'll find links to John Locke foundation blogs on the days news Carolina journal.com reporting and quick takes Carolina journal radio interviews TV interviews featuring CJ reporters and Locke foundation analysts, opinion pieces and reports on higher education from the James Dean Martin Center for academic renewal, commentary and polling data from the scimitar's Institute and news and views from the North Carolina family policy Council. That's right, all in one place North Carolina conservative.com that's North Carolina spelled out conservative.com North Carolina conservative.com. Try it today. This week's edition of Carolina radio was brought to you by Blue Cross and Blue Shield of North Carolina working every day to transform the health system from North Carolinians. More information available at today.

We.com welcome back Carolina journal radio I Michiko kind after less than three years on the job UNC system Pres. Margaret spellings is leaving. Despite the unexpected early departure spellings told reporters. She's proud of the University and her colleagues upon the work we have done all that we have accomplished. Together we have defined national trends on affordability and accountability together, we developed a muscular and measurable strategic plan with institution specific performance agreements and publicly available dashboards that is created accountability and transparency and laid the foundation for years to come. Together we put a lid on tuition implementing empty promise.

Implementing fixed tuition for students who are continuously enrolled and passing two years of no tuition hikes for resident students. Together we strengthened each of our institutions raising enrollments raising graduation rates increasing completions for underserved groups including low income and rural students. We are graduating more students in critical workforce areas and increasing external research funding. Our state's confidence in this world-class system is clear, the general assembly invested in us with the strongest budget in a decade and taxpayers have invested in us through the connect and see bond.

The first buildings of which have now opened for students.

All of this has happened over the past three years.

In the midst of a changing landscape buffeted by the urgent issues of the day as a system we have adapted and evolved to meet the times we validated the system platform and rebranded as the unified statewide system that we are and we've used our platform to better tell the story of our University.

We brought together thought leaders from across the state to connect the education continuum like never before. Initiatives like the my future and see commission. Our teacher preparation efforts in the financial aid study group are examples of the statewide coalition. We have created.

I came into the position intent on creating a culture of higher expectations and that shift is underway, but times change and those changes demand new leaders and new approaches. I will leave proud of the contributions made during my tenure and forever honored to have served I've been blessed with the opportunity to travel the state and meet its best and brightest. This university is the state's most important asset, its mightiest engine that's UNC system Pres. Margaret spellings shall be leaving the job March 1 three years after moving to North Carolina the early departure comes with a separation package of more than $500,000 will return with more Carolina journal radio commitment to truth and transparency in government. That is the mission of Carolina journal and we are proud to deliver and now proud to tell you the North Carolina press Association has honored to members of our team with awards reporting and writing, that's right, we really do deliver award-winning journalism we shine the light on government spending, reveal the truth about boondoggles and dig deep into programs paid for with your tax money. We keep you in the know in a way other media outlets don't in our reach and influence are growing all of our outlets.

We reach more than 1 million N. Carolinians each month so make sure you're one of them.

Our monthly print edition arrives in your mailbox every month. Our online daily news site Carolina journal.com has fresh stories, opinion pieces, and more. The award-winning Carolina journal team I reporters make government accountable to you.

Call 1866 JL FINF0 for your free subscription, welcome back. Carolina journal radio I Michiko kind. Today's college students have embraced activism to an extent not seen since the 1970s, but William Teressa which says there's something missing the public intellectual, and former Yale professor recently addressed the topic during his speech at Duke.

He started by focusing on students interested in doing good, it's easy to know if there is a lot harder, about which one place with that is a coherent vision of the social good, rather than about slow like overthrowing the picture or just medically higher power. Or maybe it's not that easy to know what you're against your people declare opposition to capitalism, but there waiting the way these in turn suggests that they don't really know what capitalism is, they appear to equated greed or equality or markets or money or having to work, all of which predate the emergence of capitalism by thousands of years and features of most if not all human society for the article nor do I hear any clear ideas or for that matter any ideas at all about what we should put in place. Capitalism. If you wish. Let's define it briefly is the private ownership of production free-market distribution in the cycle of investment and profit.

Capitalism is you don't like what he will take control of the economy. Centralized planning for small-scale collectivism questions are nothing any of those things are bad real questions are questions that need to be addressed. If you really work to bring about the what comes afterwards.

The debate about capitalism is just an example for duress which larger point is that when you commit yourself to the good to making the world a better place. You need to commit yourself first of all to action at all but to something else, something that must proceed action something called reflection of inflation or analysis study. In a word, you must commit yourself thought yet that is precisely what I find to be lacking today in circles no less than anywhere else. Not just in campuses but everywhere nobody was certainly nobody wants to think about their own beliefs, values, assumptions. Now this is always a problem everywhere. Nobody ever wants to think about their beliefs, values, and assumptions. It's too much trouble, much to try asking people to think about their beliefs value for the subject is what Plato's teacher Socrates went around Athens doing until Palestinian citizens decided they were sick of hearing him and they said here drink this, the problem is especially acute today, particularly for young people more particularly for progressive college students, most particularly for progressive students at elite colleges people exactly like you. That's because the limited time something approaching religious there's a right way to think and write with top right and the right things to think and talk. Secularism is taken for granted. Environmentalism is a sacred cause issues of identity, particularly holy Trinity of race, gender and sexuality occupied the center of the discourse. The assumption on the left is that we are ready. You are already in full possession of the moral effect may also be the assumption on the right there is what's happening on the left on my side only as we really know we supposedly already know what's good bad what's right what's wrong.

There's really nothing to discuss. We just need to talk about the best way to put our belief and practice.

That's the voice of public intellectual, William Teressa which speaking recently at Duke University. He explained how a college campus can reinforce conformity to a single viewpoint. They are illusions that sociologist call total soon to tell the other members lives like prisons, monasteries, mental hospitals or the military for interest to get out. This is said to be higher aggressively is cursed by tire and I'm sure I don't need to explain that either decision about this in class this morning concerning giving everything on college campuses and a lot of students so disagree with one another anymore in class. So I've been told that school after school and the reasons it was talk to liberal arts college in Northwest issuing class. It's not, let's talk about issue X but let's talk about what position is the correct one to have that issue X is selected will form you told me that the first things you do if you got college was to keep quiet Christian faith and her non-marriage, which were informed for me that is careful when requesting consensus beliefs. The phrases opinion in terms of explain to me why I'm wrong, so he chose the rating will get you branded as a racist.

Don't talk that raises the antidote dress which says students need to learn how to think the classes should force them to engage with topics that have no easy answers. Now if that sounds really hard. It's because it is really hard and it's supposed to be really hard to get a class for example that is in our food be like if the football coach only maybe practice twice a week would be a lot easier, but you would be very good and you lose all your games if it happens in a good course is directly connected to learning how to make our like that's what's right writing papers before you write a paper that makes a teacher goes to report .5 point identify errors in logic falls structure problems the way you handled evidence opportunities you missed places where objections dissipated. She also raises further questions suggest additional lines of inquiry and commands the ways in which he did things run by the way that teaching thing is very very labor-intensive not to trust myself to the games and the this is why the whole priority with the whole set of which we hire, promote and reward faculty is deeply screwed because in research universities, teaching you actively incentivize wears good teaching even if you're already a good teacher is extremely labor-intensive duress which says it takes more than just one tough class to help homeless students thinking skills again and again and again in classic classic class. You write a three page essay your first week of freshman year, then maybe write a 15 page seminar Junior hopefully you paper senior SA 5080 pages or fewer sides made you go through now lab lab reports or computer program that proves your and even four years is barely enough to make a decent start. That's why college marks just one step in the pursuit of wisdom that's according to William Teressa Witt's recent speaker at Duke University, will return with more Carolina journal radio this week's edition of Carolina journal radio is brought to you by Blue Cross and Blue Shield of North Carolina working every day to transform the health system from North Carolinians. More information available at today. We.com voters have spoken in North Carolina. How can you make sense of what they said about the legislature Congress, the courts, the Constitution, Carolina journal has you covered in print each month. Online every day.

Carolina journal is your source for up-to-the-minute information about North Carolina state government policies and their impact on you Carolina journal offers in-depth analysis of the election's aftermath, then looks ahead to 2019. How will elections affect your family, your wallet, your schools, your business find out in the free Carolina journal newspaper online@carolinajournal.com Carolina journal your number one source for government news that affects you visit Carolina journal.com today. Welcome back to Carolina journal radio Donna Martinez North Carolina has received federal approval to transition to a cost saving health Medicaid managed care system to system that will take the state out of the day-to-day management of the government insurance program, which helps the elderly, disabled, and the poor. Danwei covers healthcare for Carolina journal. He joins us now to talk about the import of this green light from the feds and welcome back to the show when you done to please the beer help us understand the program in general and how many people are covered and how does it work funding lies. There are of 2 million people, roughly in North Atlantic current Medicaid and see health choice is a joint program with the federal government. The federal government pays the bulk of the money but the state does allocate substantial resources. That's 1/5 people. That's a huge government program to provide healthcare, medical care to people most enormous outlay and that's why I get so much attention among the lawmakers and the policymakers the state of North Carolina applied for a waiver and since the federal government helps fund this program you have to get permission from them in order to make any substantive changes to how this operates correct right is called a demonstration waiver, and that was filed last year. What was there. The requested North Carolina submitted and that is now been approved will completely revamp the program they're calling it the just change in Medicaid and North on in 40 years. So they're going to be moving from a state day-to-day management of the program to contracting it out to all four statewide entities and 12 regional entities will be commercial plans big insurance companies will probably get a lot of the statewide contract tension and then Dr. let hospital led local regional providers can also apply for more regional plans help us understand a little bit more about that. So you're saying the state would get out of the day-to-day operation. What is it that the state is doing now that it won't be doing well. All of the services that are provided will be managed and looked at by these entities, rather than the state having to have their people doing that so they'll be contracting with the state to under what's called capitated program rather than paying a fee for service for every treatment every service. The patient gets these providers. These networks will get a flat fee per patient and will have to manage that care case management program for that allotment. Some of our listeners might be single. Hey, wait a second. That sounds like they're going to be given a certain amount of money but but what about the quality of of care as it is right now if someone is covered by Medicaid and they go see a doctor whatever service that Dr. provides that Dr. bills Medicaid for in the reimbursed but you're saying that instead of that that the doctors are the groups of doctors would be given a flat amount of money for each patient and then they need to manage that person's care. With that money right so they're completely redirecting how the program works out to make change. It's a huge change in what's going to happen is that these providers will be contracting will have contracts that have metrics and so they will look at quality of care and health outcomes rather than volume of service so that you could go to Dr. many times but not actually have good health outcomes. Now they want to be accountable more accountable coats of the state will say to his partner contract. We need to see these kinds of advances. These kinds of outcomes. This level of quality and if you don't meet that we are contract could be changed or even rescinded. It sounds like a really common sense reform that really focuses in on making sure that people are getting the care that they need versus just test after test or visit after visit, but I would suspect and that some people will be saying, but what is the accountability measure there for someone if you're seeing a doctor. What if you feel like you're not getting the care that you need. There must be some sort of mechanism in place to make sure that the quality of care at the very least doesn't decrease, but hopefully would would increase right and a lot of these metrics are still being worked on. Nurse still hundreds of pieces to this puzzle are being put together the state open the bids from the vendors. Just this month will be awarding contracts in February and between now and then they'll be looking at some of these items at your mentioning trying to get the best kind of plan that they can in place. How does the EM cost savings come into effect here will. If you recall, in 2013 blistering state audit that showed the Medicaid program was in complete chaos. They had run up $2 billion worth of cost overruns and four years. This is happening. Year after year it was. You are writing about this for a number of years that it just kept going over budget and over budget right so when McCrory administration come in. They said hey this has to stop and they put forth the first plan the first iteration of this reform and as it progressed into thousand 15 they sold on the current plan start working towards what now has been approved by the federal government so low state savings Medicaid program is shown surpluses last couple years so they completely overhauled the program to great success and that's helped not have these pressures on other state agencies to give up money at the end of the year when I find out. Medicaid is blessed their budget. Interesting that damn as you look back at the previous years, the McCrory administration was working on this set that was a Republican governor. We now have a Democrat governor in Roy Cooper so does that mean that there is a bipartisan view that something had to change it.

Medicaid kind of on different sides of the fence in many ways. If you recall, the Cooper administration tried to expand Medicaid without authorization from the legislature soon as the governor took office. There push has been to expand Medicaid. The Gen. assembly's view the Republicans more or more on a page where they want to make sure everything Medicaid is running smoothly.

Before I consider an expansion just by the size of the populations of program has been expanding. Anyhow, it's not like it's a static number because more people are moving to North Carolina and population growing what is been the reaction by doctors and hospitals to this sort of change in in the news that the offense have indeed approved the waiver to go forward with this would've been a lot of wariness on the medical profession. Up to this point that I think now some of them are looking at this tomorrow will see how it works mostly what networks we can get into. So I think there's more of a willingness to take part. Now it's just these entities will have to start assuming some of these doctors into their networks to provide what the patients need is this essentially a one and done reform or is this considered a first step toward some other reforms that could potentially take place. Will this particular program. Now, will be phased in over three years. So the first allotment is $96 billion procurement for some of the services is the largest in state history. So even with this first demonstration model there will be some phases and no depending how everything works.

There could be more changes down the road talking with Dan way he covers healthcare for Carolina journal where he is an associate editor, you can read Dan's work on this@carolinajournal.com.

Thank you very much that's all the time we have for the program this week. Thank you for listening on behalf of my cohost Mitch.

Okay I'm Donna Martinez. Join us again next week for more Carolina journal radio this week's edition of the Carolina Journal ready brought to you by Blue Cross Blue Shield working everyday transform the health system. More information available today.

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