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Carolina Journal Radio No. 714: Familiar faces lead new N.C. General Assembly

Carolina Journal Radio / Donna Martinez and Mitch Kokai
The Truth Network Radio
January 23, 2017 12:00 am

Carolina Journal Radio No. 714: Familiar faces lead new N.C. General Assembly

Carolina Journal Radio / Donna Martinez and Mitch Kokai

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January 23, 2017 12:00 am

North Carolinians will see some familiar faces leading both chambers of the General Assembly over the next two years. Republican Phil Berger starts his fourth two-year term as Senate leader, while Republican Tim Moore begins his second term as N.C. House speaker. Rick Henderson, Carolina Journal editor-in-chief, discusses Berger’s and Moore’s priorities. He also assesses the role of the leaders of the Democratic opposition in both chambers. As a 2013 state law forces North Carolina to sift through thousands of government rules, reviewers have designated roughly 12 percent of those rules to disappear. Another 26 percent will face a more thorough re-examination. Now the chairman of the Rules Review Commission wants to go even further. Garth Dunklin recently recommended that lawmakers scrap a third alternative that has allowed state agencies to keep current rules on the books, without a more thorough review, if they are deemed to be necessary and not controversial. Dunklin and his colleagues believe every rule should undergo a thorough review at least once every 10 years. Some state lawmakers want to take a closer look at the way North Carolina government plans for emergencies. Sen. Ronald Rabin, R-Harnett, recently reminded colleagues that a legislative oversight committee can help the state cope with natural disasters, riots, campus unrest, and large-scale protests. Before Gov. Roy Cooper designated him as the next secretary of the N.C. Department of Transportation, Jim Trogdon briefed state lawmakers on the state’s long-term transportation needs. Trogdon is a DOT veteran and has worked most recently as national transportation director at the SAS Institute. In that role, he assessed the current state of North Carolina’s transportation system and highlighted ongoing funding challenges. A dispute over a proposed operating room in Leland is shining light on the continuing debate over certificate-of-need restrictions in North Carolina. Katherine Restrepo, John Locke Foundation director of health care policy, explains how the state’s CON law blocks innovation in the health care industry.

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From Cherokee to Currituck 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 of public policy events and issues welcome to Carolina Journal radio I'm Ashoka during the next hour, Donna Martinez and I will explore some major issues affecting our state.

The head of the state's rules review commission thinks more North Carolina regulation should face extensive scrutiny or why he's asking state lawmakers for help.

Some legislators are taking a closer look at North Carolina's plans for natural and man-made emergencies in the wake of hurricane Matthew and the Charlotte riots. They say now is as good a time as any for review before he was nominated to run the state Transportation Department Jim Trogdon briefed lawmakers on North Carolina's long-term transportation needs you hear what he had to say and you learn about the latest dispute involving North Carolina's controversial certificate of need law involves an operating room in Brunswick County not far from Wilmington. Those topics are just ahead. First, Donna Martinez joins us with the Carolina Journal headline this week, the newly elected Gen. assembly will get down to the business of budgeting and policymaking for 2017. Teaching these debates over ideas and legislation will be the four leaders that the members have chosen to lead them. Rick Henderson is editor-in-chief of Carolina Journal. He's been following the story about the leadership Rick welcome back to the program. I saw the first of what is the split now in the Senate and the house we know their super majorities again. You got more than 60% of each house and set it is a bit of Republicans, 74 to 46 is the split in the house 35 to 15 in the Senate. The Senate Republicans actually picked up a seat net in the most recent election and also Republican Bob Chambers Republicans running the show. Essentially that's right that's right so there because unlike go the US Congress were there's an opportunity for the minority in the Senate to place impediments legislation is really not very much that I that ice large minority could can do in their lessons large enough to be able to solicit estate of the Toth Gov. while you bring up the key new point in this whole discussion. That is the new governor we have a Democrat now in the governor's seat with Roy Cooper what role might he play in this set legislative discussion is one of his constitutional duty is to propose a budget so he will do that and that will be essentially an outline of his priorities because it really doesn't matter which party controls the governor's mansion budget is basically a wish list because the general assembly rewrites it so it basically is not that, but it does give an idea what priorities will be, but his role will be much more in the implementation of policy and he can emphasize things if you approves of the Gen. assembly does in a concert put on the back burner. Things like as much about the leadership then let's start first with the Republicans since they are in control. Sen. Phil Berger at Rockingham County will have a nether term, as the Senate leader is right. He will be back in charge of the Senate. He was someone who essentially has ruled the Senate with this Pretty tight ship. There normally speaking, if you have very contentious legislation. There's not a lot of debate on the floor about this. A lot of things are agree to privately. The Senate tends to be a very orderly body. We saw that during the special sessions in late December that not be the case, and so that was something that was very unusual that you had Sen. Ralph Heise for for Mitchell County challenge Sen. Berger about the house bill to repeal debate that was almost unheard of, but that's something that that will keep an eye on now because we do have some other new folks in senior positions and tell us about that is really powerful, other than Phil Berger will Senate they elect leaders, but the person who is really often, the second most powerful member of the majority in each chamber is the chairman's rules committee goes, the person is if you will, the enforcer or the speaker or from the Senate President pro tem because that person is chosen by the leaders of the membership the caucuses or the membership does not choose these people in the rules Committee Chairman determines the flow of legislation and determines what committees get the bills and what's gonna come to the floor or not. And so, in the case previously you had Tom at the doctor, who was from the Asheville area.

Someone who is not a doctrinaire conservative with someone who is certainly a very, very combative and very very forceful leader if people pay attention to Congress that the rules Germans a lot like the whip is the person who actually goes around, talks individually to members. Make sure that if something is come up the leadership wants that there are enough votes out there for something we should doesn't want that there are folks defeated so first needs to be really strong contact with the members and so now we have built Raven from Brunswick County.

Who's going to be the rules Committee Chairman and will see if he's able to maintain the same level of discipline the tongue at the dock.

Let's move over to the house and stick with the Republicans for a couple minutes here. Let's talk about the speaker of the house the number one.

Once again, add to more out of Cleveland County. Let's talk about the DS speaker pro tem in this case as well as the rules chairman Reiko this is Sarah Stevens from Sir Caleb Surrey County.

Who's going to be the new speaker pro tem and she's replacing Skip Stamm, who was long serving member of the Gen. assembly, someone who is a very passionate advocate for economic and social conservative issues and someone who was very very active and and certainly assertive policymaker who someone who is very adept at drafting policy and so Sarah Stevens is there will see how her her approach and personality much different to that of Skip Stamm said Skip was also someone who was very affable, who's really liked by people across the aisle.

Young indication of that a little bit yes.during the opening session on January 11 because Sarah Stevens was a co-nominated by Darren Jackson is in the democratically reverent house and so there was, there is this idea that there may be somewhat more collegial, at least interpersonal relationships in the house and the rules chairman in the house represented David Lewis at Arnett County and of course said the speaker himself to more as we mentioned another term that's right that's right into more succeeded Tom Tillis's U.S. Senate speaker Tillis was someone who much like Sen. Phil Berger in a very tight ship was things were.

The schedule ran very efficiently till Moore has allowed a lot of discussion among the members. He's also allowed legislation to be considered that may not have the strongest support of members of all of his caucus. And so it's gonna be interesting see how the two chambers differ again to the Democrats. Now when you mentioned one name already at Darren Jackson, a Democrat out of weight County will it turns out that the leadership for the Democrats. Both gentlemen are out of weight County I thought you have Darren Jackson of wake County and set aside. Yet Dan blew the long serving's general assembly member for both the House and Senate from White County will be a leading Democrats in the Senate.

Dan blue is someone again. This was of interest and that there was concern about how the Senate was going to handle confirmation process of gubernatorial appointees by Roy Cooper and Dan blew some of the civil yes we absolutely have the constitutional authority to do that and so there are some issues of constitutional law and procedures of the Senate, someone who's a veteran like Dan blue was going to be someone who will probably be Phil Berger's ally, a lot of procedural issues were making our policy but at least the two of them have an incredible institutional Ricky mentioned that Gov. Cooper will be presenting his budget now considering that the Democrats are in the minority in both houses of the Gen. assembly course Roy Cooper has the bully pulpit but in terms of the budget you mention, it would be his priorities. Is it really will it be a policy document or is this essentially the political document that the Democrats will turn to you and say this is what we believe in knowing full well that they don't have the power to pass these things.

There'll be a lot of politics in the budget. There will be some areas in which there will be agreement.

I would say transportation spending is one of public safety largely will be an area of agreement or you'll see some real differences in politics will be on things like teacher compensation money fruit potential for school choice and interesting aspect may be money for the UNC system because tomorrow's Chief of Staff was just hired by University of North Carolina for senior position and so that may be a way to a potentially help UNC out a little bit in these times, but there will be also issues with the Republicans are dedicated to getting state savings accounts as close to 12 to 15% of the general fund budget as possible and the Democrats have been critical of the so that may be a point in which Gov. Cooper asks for more spending. The generals and was willing to give to be an interesting debate is that budget gets put together and again will be hearing from the Democrats, and no doubt they'll be making their case and not only for the policy but looking forward to perhaps impeding up some seats in the next election live in talking with Rick Henderson, editor-in-chief and Carolina journal. I think you say when this much more journal writing, just North Carolina lawmakers head back to Raleigh. There's a new governor in town working together or working against each other will make big decisions decisions that affect you, your wallet, your home, your business, your kids education to keep up with those big decisions day by day. Even minute by minute look to Carolina journal, a full team of reporters and analysts there watching the action in the state capital. The reporting minute by minute developments for you Carolina journal. It's available each month as a free newspaper and every day with updated find us on Facebook to share items from Carolina journal share items from the John Locke foundation. Follow us on Twitter at Carolina journal at John Locke in the sea and at Becky Gray Carolina journal it your go to source for news about state government and how government affects your life. Visit Carolina today. Welcome back to Carolina journal radio why Michiko got one out of every 10 rules funneled through North Carolina state governments knew rules review process has been tossed out as unnecessary or outdated me while about 6/10 rules move forward without facing much scrutiny, but the leader of the state rules review commission would like to see that change commission chairman Garth Dunklin recently reminded state lawmakers about the rules review process. They put in place. That process requires agencies to take a look at their rules dump them into one of three buckets either unnecessary or necessary without public-interest or necessary with public-interest in the concept there was that the ones that were unnecessary would if that report was approved by the rules review commission be removed from the code. When that determination was made, rules that were necessary without public-interest would stay in the code as they were in the rules with public-interest would go through the re-adoption process and my understanding and memory is that a large part of the reason this bucket system was designed as there was some concern with 25,000 rules of administrative card that the process might prove a little bit overwhelming and so the opportunity to put things in pockets my pair of that process back now. The review process has been tested.

Dunklin says he and his colleagues have learned some lessons. Perhaps the process is not proven as overwhelming as we thought it might be. The other thing we have learned in doing an analysis of what has fallen into these various buckets is that depending upon when you look somewhere between 60 and 65% of the rules are falling and the necessary without public-interest bucket, which from a policy perspective to some of us feels like it frustrates the intent of the process in the sense that the rules need to see the day see the light of day.

They need to have an opportunity for the public to comment on them. They need to go through the process if just for no other reason than they need to be looked at. Periodically, which was one of the underpinning concept. Dunklin pointed out another quirk in the existing review process. Another thing that we have seen that has proven frustrating to me personally and I believe to some of the other commissioners is that there have been public comments made about some of the rules in the reporting bucket process to agencies that we have not been able to do anything about. So what we have seen is a number of instances where folks have made comments about a rule that was necessary classified as necessary without but because we were limited in our way of looking at it through our standard we had to say.

Well, you know, that's a pretty valid comment and that probably ought to be talked about, but it doesn't meet our standards so we can't move it into the house to be readopted. That's Garth Dunklin, chairman of North Carolina's rules review commission held what he and his colleagues go about addressing their concerns the idea that we came up with was a fairly simple one. Get rid of the middle bucket so that you then have to buckets rules classified by the agency is either unnecessary and removed from the card or it goes to the readoption process.

One of the things the recommended that concept to me is it really just sort of stepped back closer to the original recommendation in the first point, which was that everything should go through readoption and discussing it internally. One of the things that some people suggested is will why have the reporting process. Still, if you're just going to have these two buckets while make agencies put them in the two buckets and go through the reporting process.

One of the reasons I believe you want to keep. That is because, to the extent they declassify rules is unnecessary. That means when the report comes to and we evaluated. We determined that it's appropriate and we pass it on to you at that point in time. That rule was removed from the code so that allows that removal process to continue.

It has also been the case where we have had some circumstances where a rule was classified as unnecessary, and there was a public comment that said that rule actually is necessary. Sometimes the agency has responded to that and reclassify the rule. Sometimes the agency has not so in those limited circumstances where there might be a rule that an agency said was unnecessary. And there's comment around that, to the point that it looks like it probably ought to be talked about more fully then we could reclassify that into the readoption pile so it would have to go through that process, the outcome might still be that it gets repealed, but at least it got went through the discourse and the public comment process cited for those two reasons. I think it's a good idea, even if you get rid of the middle bucket to still keep the classification process because it allows those unnecessary rules to be peeled out of the card and it does allow us to have a chance to take a look at how they've been classified. What about the current process wouldn't change caused some problems. Things change. You learn from processes and legislative processes change over time, and I think we learned that we've got 60% of our code plus not being re-examined and it may be that none of it needs to be re-examined, but it can't hurt to go through that process.

From my perspective, there is an ability to strike along with people as to where they are in the process. I don't think we want to be disruptive until people who were already have classified things into buckets to redo that on but you can strike alone for the people who have not yet classified their rules and say going forward you're going to do to buckets instead of sort. Dunklin also likes the potential benefits for increased transparency and rulemaking, being Frank, we have a really good rulemaking process in North Carolina. As I've said before, but it is not as engaged as it probably should be.

This reporting process is even another step removed from the public so the likelihood that it's generating a lot of comments is reduced. That's another reason in my mind to push the process more into the main rulemaking process, we see an awful lot of reports with virtually no comment. Democratic state representative Ken Waddell liked Dunklin's ideas just don't want to make government so burdensome you know it takes a long time for the we have too many regulations. Yes, I said that and I think so.

My colleagues will agree with that totally. So I just want to make sure that we had process streamlined as much but probably wouldn't have built up to the comment and what times they were going to comment goes right. If you don't know is frustrating sometimes you don't know that you can comment on it but you go much faster.

Right now that what you're hitting on part of why this concept is being brought forward and that is been a lot of instances where we have seen people not realize that the train had left the station, we had the billboard rules a bunch of people showed up here or showed up at the rules review commission morning to talk about the substance of that in the train had already left the station here on we have that happen sets of rules say, the idea of affording the opportunity for con comment on in my mind is never a bad outcome. That's Garth Dunklin of the North Carolina rules review commission, any change in the rules review process will require support from the state House and Senate will return with North Carolina journal radio in a moment at the John Locke foundation where leading the effort to clean up the mess left behind by big government liberals for decades. The powerful left in our state had piled on rule after rule, regulation after regulation never really caring about the people whose lives are caught in the nightmare of complying. In other words, you their handiwork had made it tougher to get a job even increase the legal risk of operating a business. We say enough is enough. It's just not fair to you.

That's why reform minded lawmakers have turned to the Locke foundation for answers and acted to lighten your burden were proud that our intellectual firepower has improved lives. You can count on the John Locke foundation to watch out for your interest. The special interests.

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Welcome back Carolina journal radio language co-kind state lawmakers are taking a closer look at the way North Carolina copes with emergencies.

State Sen. Ronald Raburn of Harnett County recently reminded colleagues about the goal of their emergency management oversight committee emergency management in North Carolina to make recommendations to the Gen. assembly promote promote effective emergency preparedness management response and recovery. Raven says it's a timely topic kind of examples we have around the country right now we have the unrest in Charlotte. We had a hurricane Matthew week of fires are still burning out West campus incidents around the nation and more and more protesters are getting larger and larger and more violent. I think if we don't address these things head on and have some sort of a plan in place and make sure we're doing the best we can, that we will not be fulfilling the charter or executing the mission Raven says lawmakers need to play an active role. I think we have to be sure we are doing our best mustache the right questions. One pup in the mind just before yesterday as I was watching TV I got to wondering if UNC system has protocols in place and training and education for their students.

Like the protocol at Ohio State that says run high and fight. If we don't have such things in place and the students are receiving orientations, and some was not taken action by way of oversight to ensure these kind of things happen.

I think again that were falling short of what our mission is and I don't think we should do that. The next question would be, though you know if they do not have them, should they should is responsible for making that happen. Wants to know what has worked and what has not worked.

I think we have to make sure were taken advantage of all the lessons learned lessons learned aren't there to say that anything was done right, wrong, or indifferently is something to say we do this this happen. Maybe we can do this better the next time.

By doing this that's the lessons learned in the application thereof. Raven advocates a proactive approach by believing in the bottom line is what can the Gen. assembly to help with that and/or mitigate any kind of a disaster. The proposer state. I think go in my own personal opinion, we gotta be doing things you can't do anything preemptive or doing it advanced training to prevent a natural disaster, but I think maybe we can kinda look into are we doing enough to make sure that the man-made disaster which includes terrorism. By the way other were doing enough to preempt those kind of things this one thing the police up the mess. It's another thing to prevent the mess from happening. That's Republican State Sen. Ronald Raven describing his goal as cochairman of a legislative committee focusing on emergency management will return with more Carolina journal radio in a moment. If you love freedom we got great news to share with you now.

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Welcome back to Carolina journal radio Lepic coca before Gov. Roy Cooper designated him to be North Carolina's transportation secretary, Jim Trogdon already had delivered public remarks about the future of state transportation spending in his role as national transportation director at the sass Institute, Concord spoke to state lawmakers about North Carolina's transportation needs. We are the fourth fastest growing nation of state in the nation and will be by 2030 the fourth most populated state in the nation. The future will continue to stress our existing transportation systems and increase the level of our existing challenges in both scope and scale with a growth of 100,000 people in any given municipal area or County. We tend to see about a 5 to 10% increase in congestion and congested miles. We will continue to see these increased transportation demands in these high-growth areas specifically but even also in some of the moderate and slower growing areas. Trogdon pointed to specific projections for Asheville about 2035. It means a 10% increase in there and congested existing congestion level just in the Asheville municipal regional law, the Triad 20% in Charlotte and Raleigh regions 50% increase in congestion.

So some of the great discussion about modes and and the difficulty in getting around the regions and what other modes can bring will only be exacerbated as we move forward. Challenges extend beyond North Carolina's urban areas.

If that's the challenge. In these reason regions what would be the additional challenges in areas outside that may be seen because of slower growth or no growth and that is how do we support our economy and how do we connect to all of those regions so everyone has ability to participate, you'll see that nationally, and a lot of locations where you have significant mobility challenges. It's hard for the outlying regions to participate. Trogdon exam of the state long-term funding needs. Historically we've been using our state funds to maintain our highway system, and relied heavily 47% of our additional capacity in the TRP is from federal funds. The federal gas tax is at a flat rate and is been unadjusted since the 1990s and buying capacity has been reduced by 33% and currently must be supplemented nationally by general fund or national bit to maintain status quo Caf standards have increased from 25.0, 27.5 miles per gallon to 35.5 miles per gallon in 2015 and will go to 54.45 miles per gallon by 2025 as Caf standards go up.

Our revenues per mile declined from 1.2 cents per mile .6 cents per mile which means our per capita revenues annually will go from about $300 per capita for transportation revenues to hundred and $20 per capita for motor fuels estate investments per line mile will continue to be one of the lowest in the nation and usually regionally as compared to other states in our region. North Carolina is just slightly above South Carolina, and South Carolina is the 50th state in the nation in state investment per line mile. So North Carolina is currently 48 we are overly dependent on motor fuel taxes and we are spreading them very thin over a very large system. What about the states transportation spending moving forward.

As were looking at about half of our TRP coming from federal funds have from state funds. Is it sufficient. This is the cost of P4 .0 projects, which is estimated to be almost 60 million over the next 10 years that were submitted and then the amount that would be funded or the funding availability was a little less than 10 billion so you can see the next 10 years. The projects that were submitted for this tip over that tenure.

Far far greater than what the program was able to fund and I have heard comments of folks and will maybe that's because everyone has large wish lists out there. I can assure you that most of these embryos and operatives were limited to about 20 projects 20 to 25 that they can submit their list of needs over the next 10 to 15 years are much greater than what was submitted.

So these are their highest priority of needs that they submit for funding in the in the STI process. Trogdon highlighted the extent to which North Carolina relies on federal money for its transportation projects.

North Carolina's 47%, which is still better than the majority of the states out there those in blue are a higher percentage of the national average is 52. My observation is two of the states that tend to be better at delivering their needs on their statewide BMT programs Florida and Texas Florida is that 36% as compared are 41, 47% utilization of federal funds so they are less dependent on federal funds to deliver their projects in Florida and Texas.

Like likewise is 41%. So from a big picture level, the less you can be dependent on just the federal funds and a strong percentage of federal funds to deliver TRP projects the more flexibility in the better you can address the emerging needs across the state bonds consideration for further general obligation bonds in the future will be timely in North Carolina because the what we had authorized from 9019 96 have completely been utilized and are not any new available today, we view as revenue bonds build America Bonds private activity bonds.

All of those have been used in North Carolina on various turnpike projects and we have experience in each of those are there any other funding sources to consider. I would like to point out one that is emerging a little more rapidly in how it's been investigated nationally. As far as a long term use less vehicle miles traveled.

Oregon does have a pilot now California has entered into legislation that authorizes it as an option. Michigan and Minnesota are considering implementing pilots as well and and how to use vehicle miles traveled in lieu of and allowing option for that as compared to other sources will user fees and revenue. Trogdon examined recent changes in other states, a vast majority are responding by doing essentially what what we did in the last session. Here in North Carolina and that was change or modify our motor fuels tax to index it so that we don't see the sharps swings and declines. Other states have moved from a fixed cents per gallon to either an index or a percentage motor fuels sales tax type applied wholesale to a percentage fee instead of fixed fee policymakers face big decisions driving question that that you're faced with in all of us are faced with here in our state is once the right scale or magnitude of each of the sources and together. What makes the best blend for our state and our transportation needs. I think motor fuels revenue has the highest uncertainty in the long-term, primarily because of the of the impact long-term from the caf standards as well as which is not figured into those projections of the potential movement to all electric vehicles will met which may happen much faster than anyone realizes. Without reliable mobility economies can't really function very well and so it's up to you and in the rest of the partners across our state to determine what's the right objectives. We should be seeking and was the right level of resourcing that's Jim Trogdon, speaking before Gov. Roy Cooper nominated him to become North Carolina's Sec. of transportation merger with North Carolina journal rate at the John Locke foundation where leading the effort to clean up the mess left behind by big government liberals for decades. The powerful left in our state had piled on rule after rule, regulation after regulation never really caring about the people whose lives are caught in the nightmare of complying. In other words, you their handiwork had made it tougher to get a job even increase the legal risk of operating a business. We say enough is enough that it's just not fair to you. That's why reform minded lawmakers have turned to the Locke foundation for answers acted to lighten your burden where proud that our intellectual firepower has improved lives.

You can count on the John Locke foundation to watch out for your interest. The special interests. We would be honored to have your help in this fight. John and make a tax-deductible donation. Right now the John Locke foundation where fighting for you where fighting for freedom, welcome back to Carolina journal radio I'm Donna Martinez residence of a coastal North Carolina town find themselves at the middle of a dispute over the building of a new operating room for this town of about 18,000 people two groups actually want to do this, and the state of North Carolina will step in to decide the matter. Catherine Restrepo who is the John Locke foundation's director of healthcare policy is here to explain why the state of North Carolina cares about this at all and welcome back to the program.

Thanks. Okay, so we are talking about Brunswick County. Here, tell us what's going on stairwell and no nonhealth and on a marriage or so two different healthcare entities, they are they have applied for a certificate of need.

On because they're both building amatory surgery centers, and there is a need for an operating room. So there are certain right there certain services and healthcare facilities that are regulated under North Carolina certificate of need law so that both they both filed an application for a certificate of need to to establish his amatory surgery center and and build an operating room. Let's try to help our listeners understand a little bit more about this thing called certificate anything a little bit crazy complex. Why is it that the state of North Carolina even tries to decide who or where quote needs a medical facility. This crazy centralized planning process and the if you look at the history of AA. It was originally federal mandate in the 1970s and at the time the goal is to cut down on healthcare cost inflation so the federal government thought that will if you had the centralized state planning on regulatory agency that could sort of distribute healthcare facilities and services equitably across the state death would play no sort of slow the growth of healthcare spending.

If everyone has equal access or equitable access to services and hospitals across the state, but in reality I mean this this law has not been affected. It hasn't been effective for 40+ years now, and a while ago, the federal government that it's no longer mandatory is optional, but North Carolina actually has one of the strongest is heavily regulated CON laws in the nation. Now we have these two medical groups that have decided that there is a need in that area and they both build so I don't think both just build it just makes sense right if they would think hospitals in their community could take that risk themselves and the rest that money themselves to see if there's really a market demand for whatever they want to provide. Now they have to go through the ceiling process and so it all starts with this annual state medical facilities planned that the CON regulatory agency puts out every year and it's an inventory of another member of MRI scans the number of CT scans. All these different things that are regulated and number of hospitals amatory surgery centers across the state and so based on population growth in the volume of the services than they determine. Complicated formula. What is needed for the next year and that's when this whole process starts by the applicant come in on and and compete for for these applications. Essentially they have to get a permission slip and have to compete and win permission. The state in order to build this meantime, of course, the people in this town are waiting and waiting and waiting right yet. Yes, in the meantime, many patients don't even realize that they're being denied access to care and possibly a lower cost to mean if you just look at amatory surgery centers alone outpatient on any caring outpatient setting is much less expensive than a standalone facility when it's not affiliated with the hospital on compared to that same procedure being done in a full hospital setting is a huge cost differential. There so our listeners might be thinking G this sounds really inefficient. Sound like one of these things were governments involved in just you know there's paperwork. There's time, there's all sorts of things going on. That's not the end of the story. There's actually 1/3 group, a medical group that's involved in this tell us where in the process.

That really gets nasty couple parties, you know, competing for the same application mother in this case a non-operating room or an MRI machine but then 1/3 party can come and who hasn't even affiliated, who isn't even submitting an application for that MRI machine or that operating room and they can just think just petition against you know that this isn't needed on duplicate service days are over in you know it's going to be in overinvestment in and under underused type of facility or service so you know, this is why the state should not approve of death, even though there is a so-called need for will the state take them seriously and it sounds like maybe a fast food restaurant saying they don't want the competition from the guy who wants to move in across the street. Yes, I mean the state does look at this. There's a public comment. There is a review process on and if that's if I guess either of the two applicants are not pleased with the ultimate decision on then it can be taken not to the Court of Appeals or an office of administrative hearing which kind of looks at the whole application process again have to start from beginning again after this happens repeatedly throughout the year you and I talked about other incidents of this certificate process going forward in the legislature. There does seem to be a move afoot.

There are some legislators who started paying attention to this, in large part because the work that you been doing the last several years. What are you hearing from them about this on the ninth. I feel like it can be a Republican, Democrat, it seems I also think it's more of a rural urban issue at this point because a lot of people think that while there have it's and I mean even a lot of people who like the idea of less regulation and more.

The free market in healthcare really has a 10 on this whole CON regulation whether it should be fully repealed or reformed for certain services or our meeting, amatory surgery center not being regulated anymore because you know the thought behind that as well. If you have more of a competitive healthcare market on that you have an ASC that pops up in, and more of a rural area well back could put that local community hospital at risk because it it's under different rules and local community hospitals or hospitals, nonprofit hospitals and in that matter any nonprofit hospitals have to open their doors to everybody and they have to provide uncompensated care to maintain their nonprofit status. So if this physician led amatory surgery center comes along and siphons away lucrative services because outpatient surgery is generally very profitable. On that place those local community hospitals that risk. Now that's that's the argument that if there is more transparency in healthcare.

I think maybe it could be different story. But, regardless of whether you have certificate of need laws or not.

Burrell healthcare has been struggling for many many years and it is an issue. What's your recommendation when it comes to certificate.

I mean my recommendation.

I think that not to certificate of need should be repealed, but I think there's a lot of other ways that healthcare should be deregulated, or there is more of an equal level playing field amongst providers to be more price transparent and to provide more accessible, affordable care for patients.

Are there any success stories of deregulation in the healthcare area that we can point you to say see it really can work without all of these rules yes and I'm glad you brought that up because back in 2005, you know, despite North Carolina had a very having a very stringent CON law. Ahmed opened up the market to allow gastroenterologists or stomach doctors to be able to perform colonoscopies in their own endoscopy unit said it can be performed in an outpatient setting. And like I said before, something done in a standalone outpatient setting that's not affiliated with hospital is much less expensive for the insurance company and for the patient on so actually there is a 30% increase in colonoscopies on much of the good preventative health measure that people are taking advantage of because it's more cost-effective to buy it on. Even with that utilization increase on their Medicare still was able to save over $224 million within six years so it can be done point to things like that to calculate away as they start considering certificate of need in North Carolina would be talking with Catherine Restrepo. She is the John Locke foundation's director healthcare policy. That's all the time we have for the program this week you for listening on behalf of Mitch. I'm Donna Martinez come back again next week for another edition. Carolina Journal radio Carolina Journal radio is a program of the John learn more about John donations support programs like Carolina Journal radio sending email to development John Locke call 166166554636 airline is nearly done. Airline sponsored

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