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Carolina Journal Radio No. 766: Parity law unnecessary to boost N.C. telemedicine

Carolina Journal Radio / Donna Martinez and Mitch Kokai
The Cross Radio
January 22, 2018 12:00 am

Carolina Journal Radio No. 766: Parity law unnecessary to boost N.C. telemedicine

Carolina Journal Radio / Donna Martinez and Mitch Kokai

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January 22, 2018 12:00 am

Telemedicine can play an important role in the future of North Carolina health care. But that doesn’t mean the state needs a law forcing insurers to pay health care providers the same amount of money for services provided through technology as they would for in-person visits. Katherine Restrepo, the John Locke Foundation’s director of health care policy, explains why North Carolina should not follow the lead of other states that have adopted so-called “telemedicine parity” laws. Speaking of government restrictions on health care, North Carolina’s certificate-of-need law continues to stifle innovation and reduce options for patients. Dr. Jay Singleton, a New Bern ophthalmologist, offers a firsthand account of the CON law’s negative impact on his ability to provide the best services for his patients. Driverless cars are heading to North Carolina’s roads. A state legislative committee recently asked experts in the field what the state should do to prepare for these new vehicles. You’ll hear their responses. Charlotte is one of two American communities attracting increased attention from the U.S. Justice Department. Attorney General Jeff Sessions recently visited the Queen City to announce the creation of a new federal violent crime task force targeting Charlotte. Sessions explained how that group –  and another focusing on western Pennsylvania –  will work to target violent criminals. The General Assembly recently returned to Raleigh for a day, but lawmakers didn’t end up doing much business. A session that was originally designed to address state constitutional amendments, judicial reform, and other matters ended up producing only a handful of appointments to state boards and commissions. Rick Henderson, Carolina Journal editor-in-chief, recaps the latest legislative action.

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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 Muskoka during the next hour, Donna Martinez and I will explore some major issues affecting our state North Carolina's certificate of the rules continue to stifle healthcare renovation to hear first-hand account from a New Bern ophthalmologist. He explains how certificate of need rules of hurt his ability to serve patients. Driverless cars are heading to the states roads what should government do about them. You'll hear from some experts in the field. Charlotte is one of two communities in the eastern United States targeted for a new violent crime task force.

US Atty. Gen. Jeff sessions recently visiting the Queen city explains why have state lawmakers recently returned to Raleigh for a single day.

What did they do. What did they leave on the table will offer the details. Those topics are just ahead. First, Donna Martinez joins us with the Carolina Journal headline there called telemedicine parity laws.

While many states have them.

North Carolina does not in our next guest says that is a good thing.

Catherine Restrepo is the director of healthcare policy for the John Locke foundation. She explains in a new report that telemedicine is thriving in states that don't have these parity laws. She also writes in the states that do well there can be some consequences that are detrimental to patients. Catherine joins us now to talk about the new report Catherine welcome back telemedicine.

First of all, give us a brief explanation of what that is and how that's different from sitting in a traditional just office with your doctor yesterday telemedicine. Put simply, it's delivering healthcare at a distance so you can have patient sitting in the comfort of their home and they can use their phone or computer to have an online consult with a physician sitting in his or her office in a different completely different location. So this is super helpful, especially for patients living in rural areas and it so timely I were talking about this now because on Mina North Carolina. There's over 100 healthcare primary care professional shortage areas across the state and overall the state is generally rural. Let's talk about that a little bit more in a few minutes, and how this can really improve access to healthcare and health services. We talked about telemedicine parity laws, which is the subject of your new report were now talking about insurance reimbursement for these telemedicine services and help us understand little bit more about these laws what they actually require the insurance company to do well. Telemedicine parity laws that similar to another any type of health benefit mandate really in the benefit mandate what that is that the government is forcing insurance companies to cover particular services works and extend certain benefits to certain types of patients. So in this case 32 states have passed telemedicine parity laws which state legislatures are forcing insurance companies, private insurance companies to pay for telemedicine services and these services are otherwise already covered for a patient when they're seeing a doctor in the office so they're trying to make it equal. In other words, if and if a doctor is paid for service that is conducted in the office.

He should be paid for that service that's done through telemedicine. That's the debate at hand.

So people might be listening to this and they're saying will wait a second that that kinda sounds like a good thing you know yeah just make this an equal payment. So yeah, I mean like it's an incentive for more providers to adopt telemedicine because with current evidence. I mean, it is a can be cost-effective and it's very is convenient for patients, especially those living in rural areas, which we will talk about in a little bit but in reality it can lead to a slippery slope, because when you look at telemedicine there's three types of there's three types of telemedicine have virtual services where you can have an online live consultation with Dr. through your phone or computer and there's asynchronous. There's store-and-forward, where a patient can take a picture of a rash on their phone or computer Senate to a doctor to review later. Or there is also a remote patient monitoring which is where hospitals can look at patient vital signs who are located another hospital if there's a shortage of providers in that area. Though it leads to a slippery slope, because if you make health insurance companies cover one type of telemedicine he could leave them. He could have them ending up being forced to print to providing cover other types of telemedicine so it limits the freedom for insurance companies to provide telemedicine services or include those benefits in different health plans how they want to. So Catherine if North Carolina continues to not have not adopt a telemedicine parity law does that somehow mean that those of us who live in North Carolina and need a doctor or need some sort of some service or care.

They were getting shortchanged now because, to the extent that telemedicine is already working to the extent that the market was that are working with telemedicine and minutes multibillion dollar industry globally there so many startups in North Carolina that are homegrown in North Carolina. I mean real IMD is one telemedicine app that was created by a large emergency group emergency physician group in North Carolina and they offer online consultations for $50 out of pocket so I think that embedding this embedding this service in your health insurance package were provided where health insurance companies are forced to. It also could have it sort of undermines the point that basic primary care when delivered through telemedicine is also affordable when paid for out-of-pocket on and so that also shield consumers from the actual pricing and cost of healthcare, which really is just adding to the problem of healthcare price transparency. We talked about that problem. Any times on this program again, really, that disconnects between consuming the service and actually understanding the cost and Ryan, who pays for it. Catherine I know you that you wrote this report because you're always following healthcare innovations in government intervention into healthcare, but here in North Carolina. Our state legislators are actually starting a look at this question tells about yes right now well last session there was a bill that was put forth to have parity law passed for telemedicine and it's not just the coverage where insurers will be required to cover telemedicine services but what parity is it will be these doctors will get paid at the same rates for the treatment that there delivering in person. So again, this sort of undercuts the notion that with the advancement of technology is supposed to lower the cost of healthcare and me. When you compare and out-of-pocket.

It's $50 out of pocket to Hatton on average to see a doctor. Through virtual console versus a can be up to hundred $80 out of pocket if someone doesn't have insurance to go in into the brick-and-mortar building of the primary care physician's office. So were there looking at that on those of the unintended consequences of it. But since then that Bill has failed, but has turned into print a proposed committee substitute where right now they are on was a study done just assessing the overall landscape of telemedicine North Carolina and is bringing more stakeholders to the table like the Department of Insurance, and other other stakeholders that could weigh in on the impact of what how best to expand telemedicine in the state will Catherine if policymakers read their read your report.

You make a compelling case for not adopting a parity law in North Carolina keeping things the way they are, but you say that there actually are a couple things that policymakers could do to help improve things. What about yes and and lawmakers that mean it's it's great the things that they've done already. Right here North Carolina Gov. Roy Cooper just signed off on a multistate licensure agreement amongst nurses in north Carolina nurses have signed on to the nursing licensure compact so you can get a multistate license where you can deliver telemedicine to other states that are a part of that compact so it's actually expanding telemedicine by removing licensure barriers are making licensure, making licensure more streamlined so it's less I guess there is less variance across states when it comes to different telemedicine rules and regulations, and lastly Catherine, this issue of location and geography. It just seems like telemedicine is is really the answer to people living in any corner of North Carolina. They can access the care they need. And as you said, we got all sorts of areas where there is a provider shortage yes on and there is a committee right now, the legislature, the committee on access to healthcare in rural North Carolina, and they're talking about how telemedicine expanding telemedicine can really help mitigate these issues, especially not not only because there's healthcare provider shortages, but because certain providers may not take Medicaid patients, so there's a whole economic issue of access not just the shortage of providers, and I think telemedicine is definitely one way to fill in those voids we been talking with Catherine Restrepo. She is the John Mark foundation's director of healthcare policy. Her report is called the case against telemedicine parity laws. You can find it@johnlocke.org Catherine thank you very much.

Thank you stay with us much more Carolina radio to come in just a moment government plays a key role in your life affecting your paycheck the way you educate your kids the way you do business. How can you tell if government is doing a good job making the right choices. Spending tax dollars wisely.

Carolina journal.com tackles those questions every day. The John Locke foundation publishes Carolina journal in print each month and on the web each day@carolinajournal.com you'll find exclusive investigative reports on topics. No one else is covering what else a rundown of the best new stories, editorials and opinion columns in North Carolina. John Hood's daily Journal news stories and important public event set Carolina journal.tv and the voices of the newsmakers themselves at Carolina journal radio and print on the air and on the web. You can find the information you need@carolinajournal.com welcome back Carolina journal radio on which coca this program is highlighted North Carolina restriction on healthcare called the certificate of need. Our next guest offer some first-hand perspective on the certificate of the process. He is Dr. J Singleton in ophthalmologist and owner of Singleton vision center in New Britain. Thanks for joining us. You will soak up certificate of need.

First of all remind us if the healthcare provider like you wants to expand the facility sometimes adds a major medical equipment or do some other things you might need to get a certificate of need. How's that work well it doesn't work for FFF video is very difficult. I first started this will be in 2009 I decided I'd like to add some more capability my practitioner the ability to my services. They're pretty easy for me to do right there in the office is that of the service.

And where there are multiple different types of surgery going on. According to children Tom so I started the process and you learn things as you start the process first to see kind of a guarantee of a certificate possible or or pathway to the writ you realize quickly that is, the offer. Certainly there is a possibility of your certificate of need, but it's nearly impossible in the state with the third most restrictive state in the Congo US because we distributed lost control so many aspects of healthcare, so I tried my best. If you need consultant I was getting a certificate of Sunni lawyer which is massively expensive and we, the first roadblock we came up against was that I didn't have any need. Despite the meeting 2000 servers a year in my in my region. There is no need for quotation marks for regular people in my region that was hard because that's shut off the back there's no need. We were going to petition for need and want to the entire process will begin to realize that our hospital in the ACO in the area was going to oppose us after we created the need and the estimates were somewhere around $400,000 in lawyer fees. If I were to do that with no guarantee of success. So we decided to go to Ralph's and went to legislature before we get more into the details.

Let's back up and explain to people. If someone wants to get the surgery from you.

Now you were talking about expanding the facilities that you control. But if the if you're doing it now before the certificate of need process started. How would you do what you couldn't do it yourself in your own office. He had to go somewhere else exactly Maurice, we have changed a few things. I'll talk about those are probably later my lecture, but historically male in most cases, if a person comes in with most insurances, especially Medicare, which is 90% of multiple mulches practice on the average, the you're not allowed to do the surgery in your office and to make his convict is as short as possible there for every surgery versus urgency. The surgeon gets for his work or her work and then there is a facility fee that the facility gets to try to pay the overhead of the surgery. Every surgery has a different overhead. Depending on what products you use on the throne of the reusable turtle stomach surgery for for five minutes, surgery is pretty expensive. What average it costs about seven or $800 to do surgery so if it without without the mulch making on average $580 per cataract surgery. You can see how you lose you over hundred dollars every single case.

If you didn't also get the facility fee so in North Carolina facility fee is linked to a certificate of need. If you don't have it you can collect, thereby indirectly. Indirectly making it such that you can't perform the surgery and be financially viable in your office we are chatting with Dr. J. Singleton was ophthalmologist and owner of Singleton vision center so going back to the beginning of your store. You saw that there was a need from your perspective to expand your think about doing that in your room facility and right off the bat, rather than just saying okay I'm gonna make this business decision and see how it works. You decided to hire a certificate of need consultant and assert the certificate of need, lawyer, and you learn that you would probably face of opposition for this and that there wasn't some government determined meets what happens next, will not much in this state. Most physicians or physician groups whenever they look at that that huge amount of exposure with this open-ended possibility of nothing decide to back down and when she backed down effectively to your all your tips have been stifled before you even start yet, but you said that to you rather than just a stepping way to go get him to give up, went to the Gen. assembly you I did. I decided there the pigs will not lawyer fees and actually playing the game just not worth it. And it wasn't really long-term Bible either. I also didn't want to be one of the guys who climbed to the top and then kicked the letter down. You know for other people you wanted to make sure that that was at least something that ophthalmologist or surgeon could do if they wanted to. When orthopedic surgeons do. They wanted to you doesn't mean that you have to. This means if you have the volume of the skill in the business acumen that you should be able to open your facility.

So began talking to legislature. First I talked with the lobbyists with you with Peter logging grid because they are the largest in our state and give money to different folks who were so supportive of me and my cause and I came up and talked to many many different representatives in the House and Senate mostly just to educate them because you know at the beginning of the session they have 5060 items that are on their list is as things they need to look into and anyone of those that could be a specialist and maybe not. And so not to be condescending, but maybe they didn't know enough about certificate of the vessel seems a black and white to me that I thought that could be the only reason why you wouldn't vote for this monopolistic abolishment of this monopolistic all you must not understand. So I talked to them over and over and over again spent a lot of time appear culminating with me actually harm my own blog is myself at the behest of the longest fit with group who said you really would help us. We had at least another longest considering we have probably 1/10 the amount of lobbyists that the hospital association has in the hospital association has been fighting any changes in certificate of need laws consistently anything you I don't even think that they really care that much about letting noble from all judicious that the slippery slope argument that than ever, but everything else could fall and you have to realize this is not just wishful thinking, or, or any assumptions are part of 15 states have already left the COM also behind in their doing fine so it there. There is that data out there which the Makeda's studies have shown light on that actually show that the certificate of need is actually hurting is not helping us in every single state that is in the brief amount of time that we have remaining.

Basically what you're asking. The Gen. assembly to do is love you other ophthalmologist of other doctors just practice your trade make these expansions as you decide and not put barriers in place that would stop you from doing yet what were asking the legislature not to pick the winners and losers.

You know and not to create a system it may be too late for us some large hospital systems which are so large that they have their own most ecosystems around them but not least, not to prolong this and make these too big to fail. You know, we need to restore the balance in healthcare where physicians make these decisions. Administrators do their best to make them happen and make sure the hospitals are safe and get back to really what will we consider a nonprofit organization help the communities help the people around them and not look for these huge paychecks that is the voice of Dr. J Singleton ophthalmologist and owner of Singleton vision center thanks to you tomorrow. Carolina journal radio. If you love freedom we got great news to share with you now.

You can find the latest news, views, and research from conservative groups all across the state. All in one place North Carolina conservative.com one-stop shopping for North Carolina St. movement had 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 radio interviews TV interviews featuring CJ reporters and Locke foundation analyst plus opinion pieces and reports on higher education.

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Support the John Locke foundation will Qubec Carolina journal radio I Mitch coca driverless cars are heading to North Carolina wrote some state lawmakers want to prepare state representative John Torbert recently asked an expert panel for advice. What should we do as a general assembly to to further ease or further assist in implementation of what is coming. As far as automation and transportation. What you see us as legislators wondered what would be the most important thing we need to look at and 28 Chris Cunningham is director of highway systems at NC State University's Institute of transportation research and education. The private industries working hard on the personal vehicle. This can be really hard to keep up with them.

We just did provide the tools to be able to help research and come up with answers but on the right side and on the transit side.

Those are the two that get the most exposure something that's real important for you guys, it's important for us. Also on the side just to get exposure from an automation standpoint. Thomas Chase works with cunning evidence.

He states transportation research Institute.

We've heard a lot about the technology side, but there's still the human side that's that's here so people are still new to ride these vehicles I feel is one big question we talk about how it would develop the state develop the different cities with suburban eyes always different things spun off of having personal vehicles and as we switch to a different type of transportation. There is a big wrench and what we think a citizen look like in the future. Terry Lightsey is Executive Director of emerging technologies policy for GM. What we need as we go forward from here is flexibility.

This technology is all in its infancy, there is much more that we don't know what we do know at this point, and frankly I think what would like to do was to be able to work with the Department of Transportation them with you as we learn more. Going forward, and find out you know what the issues may be and and then we can work on solutions for those when were much more educated and and know a lot more.

Ed Bradley is program manager for safety regulation at Toyota. I often get this question else, not from lawmakers but from traffic engineers of the people are responsible for the roads, bridges, intersections, traffic signals and our response to them is to continue doing your best practices for the human driver. Whatever you do, that is better for the human driver is going to be helpful in the near term for automated and connected vehicles.

Paul Steinman of infrastructure firm H in TB hopes to see changes in the University curriculum.

This is a completely different mode whole sector of the economy that we really don't train people for our universities and community colleges. Everything from automotive technologies to all wireless technologies. There is a real good up in the workforce out there right now to have people can help us continue to move this forward. You been listening to experts answer legislative leaders recent question. What should North Carolina's general assembly do to prepare the state for driverless cars will return with more Carolina journal radio really influence you either have it or you don't and at the John Locke foundation. We do, and that's not bluster in a private survey of more than 250 North Carolina political insiders 87% said we influence them either a great deal or a good amount.

So while others talk and complain. We get to work providing research solutions and help our team analyzes the pressing issues of the day jobs, healthcare, education, and more. We look for effective ways to give you more freedom, more options, more control. Our goal is to transform North Carolina into a growing, thriving economic powerhouse that is the envy of every other state. Our research is actually help policymakers make decisions that ensure you keep more of what you earn. Expand your choice of schools for your kids. Widen your job opportunities and improve your access to doctors. The recipe for stability and a bright future. The John lock foundation were dedicated to making North Carolina first and freedom were dedicated to you will Qubec to Carolina journal radio I Mitch coca US Atty. Gen. Jeff sessions made a recent stop in Charlotte wasn't a social call sessions wanted to focus attention on recent trends involving violent crime over the last two years, but national trends have reversed the velodrome rate is up by nearly 7% in two years.

Not reversing the downward trends we've been seeing motor is a nationally by more than 20% in 15 and 16 months. Remarkable reversal so I strongly believe in fear that these trends are not a blip or normally I know everyone in this room works day and night to combat crime, but I figure that if we do not act now and act smartly the search bar resources moving the resources to the areas that need them most. This nation could see decades of crime progress, reverse more focus on high crime areas focus on the worst criminals.L4 criminals as a Commissioner and in New York city told me all works on improved techniques in policing on even more than we've seen in the past or critical. That's the national picture. Why did Jeff sessions share this information in Charlotte. I'm here to announce two new violent crime task forces in the country that will focus on the areas most in the we think at this time the Charlotte area in western Pennsylvania violent crime rate in Charlotte is high in Pittsburgh is even higher that to but we will not be complacent and accept the status quo of the leaders in this community will rise to meet this challenge, we will be with you from the federal side all the way. The fact is, some people just have to be prosecuted. I wish it were so. I wish we had better solution for the problem in jail. We don't do my experience tells me so appreciate your work. What will Charlotte's new violent crime task force do will bring together the federal agents and local law enforcement officers and it will be assigned to the FBI Charlotte division headquarters and related crime is already being addressed by the FBI's Charlotte division safe streets task force. So this new violent crime task force will concentrate on other violent activities like bank robbers, carjackings, kidnappings, extortion, new task force will help the FBI and local police communicate, coordinate, and ensure we are not duplicating efforts. That's US Atty. Gen. Jeff sessions speaking recently at Charlotte. He's announcing a new violent crime task force targeting the Queen city, one of two new task forces announced across the country. Crime has been increasing here and in America and that is deeply troubling. So the communities are suffering. So to the communities that are suffering we are marshaling our resources and with you, we will be relentless in our pursuit about criminals that are victimizing your neighborhoods.

These taskforces are the kind of efforts that are part of our newly reconstituted project safe neighborhoods crime from our agenda of the Department of Justice read that agenda put forward by experts. We have all lot of studies on it because it was with the present blue shed that is the cornerstone of his agenda did go down. It is successful rehab objective data that shows it so we'd like to enhance that bring that back with intensity of effort and you can be sure it's this local friends and requires all US attorneys to be leaders and cause them though to work with our partners at state and local develop and craft a plan for effective law enforcement based on your priorities in your communities, but following certain principles that we know have been proven to work sessions since violent crime is climbed in many parts of the country, including Charlotte.

Sadly, this beautiful city has not been immune to the problems either over just the last two years.

The violent crime rate is up by nearly 1/4 here after a marketable robbery is up by 1/3 assault is up by 29% motors are up staggering 36%. Charlotte's numbers fit with the overall change in crime patterns that bothers sessions loosening some trends that are not acceptable, but limited show how much progress was made here 20 years ago, violent crime rate was 1600 vest per hundred thousand in the late 90s all it hit through three years ago 589, 1600 589 in their last year was popped up.

Those 732 and looks like this year will be even higher again so we're looking at three consecutive years of increases here and as we all know these are not just numbers of their moms and dads and daughters and spouses, friends and neighbors empty places at Christmas dinner holes in the hearts and souls of victims of that will never close this doesn't mention the 64,000 people last year of drug overdose sessions, explained his support for a new Charlotte violent crime task force I'm not going to accept the rise in crime. I know you are not plain and simple unit will not allow the progress made men and women in blue over the past two decades to simply slip through our fingers. We will not see that community a block or streetcorner dogs are drug dealers as Atty. Gen. I am committed to combating the surge of violent crime and supporting the work of our police.

I have made it one of the top priorities in word and deed.

The day I was sworn in as Atty. Gen. present Trump sent me an executive order to be pretty direct and sex-linked all the laws reduce crime in America not to preside over ever increasing crime in America, so that the Department of Justice we embrace the go and know you do and I know from experience, and you know from experience we can do this. We've done it before and we need to do it again.

Why will sessions have is federal law enforcement officers work closely with police, sheriffs and state law enforcement groups, 85% of law enforcement officers in America are state and local 85%. These are the officers that have the critical street-level intelligence regarding the criminal element in our communities who should target first where the moment we are most effective when experience, state and local investigators are paired with the resources and expertise of federal law enforcement. What's the message for those who believe the current spike in crime can't be stopped is not hopeless.

We believe we can see crime in America trend down again. That's US Atty. Gen. Jeff sessions speaking recently in Charlotte announce the creation of a new violent crime task force targeting the city will return with more Carolina journal radio in a moment. Full color throughout every issue more visual storytelling. We've revamped Carolina journal to make it easier to read a new look and a new feel.

But one thing hasn't changed and it never will. That is our commitment to truth and transparency in government, you can still count on Carolina journal for investigations into government spending revelations about boondoggles and vetting of corruption. No permission to shine the light on what North Carolina government and the bureaucrats who run it are doing in your name and with your money will never wane and because of that our reach and influence are growing through all of our distribution outlets we reach more than 1 million N. Carolinians every month so make sure you stay informed. Read the monthly print edition of Carolina journal.

Then check in several times a day, Carolina journal.com that's where you'll find fresh stories, opinion pieces and updates on government politics and your money. Carolina journal. We hold government accountable to you.

Welcome back to Carolina to radio and Donna Martinez by a vote of 116 to 0, the North Carolina House of Representatives has taken action to address concerns over the discharge of the Gen X compound into the lower Cape fear River region, but this issue is far from resolved. Carolina has been on top of the debate debate that took center stage just days ago as the Gen. assembly met in special session Rick Anderson is editor-in-chief. He joins us now. Rick welcome back.

Thank you. First of all remind Saul what Gen X actually is.

It's a chemical compound that uses its manufacturing processes and at certain low levels. It can be discharged into water supplies and there are the permitting process at the Department of environment quality allows for this discharge.

But it turns out that the War is one of the companies could use as Gen X has discharged amounts that well exceeded allowable limits in some areas where it wasn't supposed to.

So this is what this is all about the Cape fear region River basin folks are very concerned about that was your concern about contamination of drinking water and other things like that and we can certainly understand that.

I mean, that's a legitimate question the quality of the water in any contamination in all that public health issues.

So tell us about what occurred with House of Representatives.

How is it that they are trying to balance issues of public health and water quality with business interest as well what they've done is they have basically appropriated's several sums of money to try to both study Gen X to do more sampling to make sure that there's not contamination in other areas and then also to have ongoing data collection of this and that, to decide how to take further public policy decisions about this. So what they did was they voted to purchase very sophisticated equipment that can do sampling for this and for other compounds that may not will be identified yet but that may be toxic certain concentrations to add some new personnel to DEQ so that the environmental researchers there can figure out exactly what concentration levels are also to require some data reporting a regular basis. Miss problem dates back close to two decades and this is just a verse of general Sibley is dealt with it all. The vote was hundred and 16 to 0 so unanimous on how it turned out in the house but Rick there were some a number of amendments that failed. There were some legislators who wanted a much stricter regulatory regime right they wanted more people that wanted what money they wanted to change the standards able to do a lot of things to ratchet the situation upward.

What was very useful.

I think this particular process was that the Republican leaders on the environmental side brought a lot of Democrats in the process of negotiation they listen to a lot of feedback. They hold public hearings of the area and pricey Harrison of Guilford County use direct representative and will loose strongest environmentalists in the Gen. assembly complemented a representative of Ted Davis of New Hanover County who was leading this debate and basically said there were things that I would like to do that would be stronger than this, but I'm not going to do that affects you withdrew an amendment she was planning to introduce Chris that I will see this go forward. This is the forgiveness of the best actually taken years on this we should go ahead and move forward if we need to be more we can do more of it later, but we need to get started right now. This must also come up before the North Carolina Senate right and there are some questions there as to whether the leadership in the Senate may have a different point of view.

Actually, there are good questions about her strictly believers the Senate have a different point of view, Senate leader Phil Berger essentially dismissed the legislation. He said it didn't do anything he would do nothing to prevent future discharges. It was he was really dismissive of the entire process. So this is something to be taken up in the regular session of the Gen. assembly with a could be more deliberative about it and essentially said the Senate was going to do anything with it all until I come back for the regular session which will be sometime in the spring that's very interesting because my recollection is that House Speaker Tim more praise legislation. So do we now have the two legislative leaders at odds yet.

What we do on this issue, something of that. Basically I think to some extent. They were hoping not to do anything else in particular except for some other issues dealing with with legislative right are sufficient judicial district like they wanted this to be a very very light agenda and bringing in Gen X something that the Senate really wasn't interested in having a full-fledged debate on at this time. And so even though the houses pass legislation still life is not going to go anywhere until the end of the year and was the loss that it does nothing about it, but dosimeter burgers digested express something that he didn't like some aspects of the legislation and didn't really plan to do anything about it right now is anything else been covered in this special session there were things that that work work covered. One thing was called by Gov. Roy Cooper for the general Sibley to add some money to education spending to cover the cost of of adding teachers to allow class-size reduction in early grades.

This is a big point of contention between the Gen. assembly of the governor. The governor-based meta-members of the of the left.

Various Democrats are claiming that this is an unfunded mandate. The general Sibley order classes class-size to be smaller which requires the hiring of more teachers who did provide the money for the Gen. assembly said yes we did provide extra funding. We just didn't say you have to hire teachers with this money would you said, here's money and use it as you see fit, but you should certainly meet our interest to meet our standards and so this is an ongoing debate is that the Gen. assembly members who supported the class-size reduction and had appropriate additional money. By the way, said you school district use items for this rudder stuff is not our problem. If you can't spend your money right and what judicial reform there's been a lot of talk about that recently. Yes, there's a there are competing agendas in the two bodies of the Gen. assembly.

The house is extremely interested in doing judicial redistricting because the judicial districts in the state covering gossip District Court, Superior Court, that sort of thing, not the statewide offices like Court of Appeals and Supreme Court District Court in Superior Court have not been significantly altered in 50 years and a personal sky's population are very different road but is changed his composition quite a bit over that time from time to time to tweak things with the gun is a bad additional personnel and that sort of thing in different districts with a really haven't changed. Those districts dramatically in the house is very interested that it wants to do that. The Senate on the other hand, wants to change the way that we select judges. There are various plans that they are floating right now involving changes. The changes in the judicial terms of office changing whether or not there some sort of appointment based system rather than election based system. Some combination of the two and there. The house seems to have real interest in that and so you basically have again the two bodies going after different things and not really meeting in the middle there was a hearing that was held in early January about this and essentially at the end of the hearing. They decided to talk about it some more. That's that's where we stand right now it sounds like you may have for almost wanted to bite off more than they could to get that sounds like a a major type of reform package right. Sen. Berger called for the appointment of this joint committee back in the fall of the report for the end of the year actually to deal with this issue and they have been discussing this for some time, but still what it seems to me as it is just the two chambers have just different idea about what's the bigger priority and with the judicial redistricting. There's also a question of whether or not there potential voting rights act issues here because some of the prep redistricting comes under consideration would effectively fuel double bunk, African-American judges, and might have a situation in the some of the leaders of the Arctic communities are very concerned about this because they're afraid that African-American judges while we put together the same part of the statement won't have a judicial authority throughout the state.

And lastly, Rick had there had been some talk at one point at least, that they might do some discussion of amending the North Carolina Constitution any of that, no, not this time, and I doubt that it happened right now Rick Anderson is editor-in-chief. Thank you Rick thank you that's all the time we have for the program this week. Thank you for listening on behalf of Mitch. Okay I'm Donna Martinez.

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