The best part of serving in the legislature is having the ability to positively affect the outcomes on a broad range of policy issues. The worst part, aside from dealing with sometimes petty politics, is that one rarely gets to catch one’s breath — at least if one is fully engaged. Returning to Raleigh on Sunday night, I was excited by the range of issues I would consider during the coming week, and I was despondent over how little time I’d have to consider them.
Last week was mostly about one issue: Medicaid reform. However, I also participated in a vetting of a major regulatory and environmental bill, House Bill 765 [Regulatory Reform Act of 2015], and upon returning to Henderson County continued meetings with local health care providers about Medicaid reform, while joining a well-attended session organized by Duke Energy on proposed electric transmission lines.
Medicaid Reform & Health Care
When asked by the Asheville Citizen-Times about negotiations on the budget and what the Senate’s priority is, Senator Tom Apodaca (R-Hendersonville) stated what I already knew: “We’ve drawn a line in the sand in the Senate, saying we’re not touching anything else going forward until we know about Medicaid. It is the top priority.”
I get that, as does House leadership. Thus, as a freshman House appropriator, most of my discretionary time has been learning Medicaid by meeting with local health care providers and lobbyists representing hospitals, doctors professional groups, and large health care organizations and insurers.
Naively, I initially figured I’d spend a week or two studying and I’d understand health care issues, but like a newly-minted lawyer learning about the law, it seems the more I learn the more I recognize I don’t know.
Last week, in an effort to paint a picture for my colleagues of health care in Henderson County, I invited Park Ridge CEO Jimm Bunch, Blue Ridge Health Center CEO Jennifer Henderson, Four Seasons CEO Chris Comeaux, and Thrive Executive Director Kristen Martin to meet with my fellow appropriators, Rep. Nelson Dollar (R-Wake), Rep. Linda Johnson (R-Cabarrus) and Rep. Donny Lambeth (R-Forsyth). Dollar and Lambeth are the lead appropriators dealing with Medicaid reform, and Johnson is a long-serving appropriator. In other words, they all know a lot more about Medicaid reform and health care issues than I do.
The discussion was wide-ranging, covering not just Medicaid reform but also the Certificate of Public Advantage (or “COPA,” the law put in place when Mission and St. Joseph’s merged, Certificate of Need (or “CON,” a restraint on certain expansions of health care facilities or purchase of equipment until approved by state government), and how care is provided to low-income people or people needing mental health services. In the end, when we get into negotiations with the Senate on Medicaid reform and these other issues, I’m hoping that my colleagues can help me protect Henderson County’s high performing health care system from the unintended effects of any changes we might make while reforming Medicaid or changing COPA or CON.
Henderson County is also served by two hospitals besides Park Ridge: Pardee and Mission. Two weeks ago, I met with Mission CEO, Dr. Ron Paulus to talk about health care issues, and last week, I spent the better part of the morning with Pardee CEO Jay Kirby. Pardee is affiliated with UNC Health Care, and Kirby brought a UNC Health physician to talk with me about Medicaid reform.
While there are many facets to the differences between the House and the Senate on Medicaid, the most fundamental difference relates to the type of organizations that would receive payments to run the Medicaid system. The House budget proposes a likely non-profit, provider-led solution (provider-led entities or PLEs) while the Senate prefers for-profit insurance entities, usually referred to as managed care organizations (MCOs) or health management organizations (HMOs).
So going back to what Sen. Apodaca said, if nothing gets done “until we know about Medicaid,” then nothing gets done before we choose between the two types of organizations that might run this system. Conventional wisdom is that one needs to choose between one model or the other, but increasingly colleagues ask whether, if we’re going to provide for competition under the MCO model, why shouldn’t we just let MCOs compete with PLEs? That’s a good question to which I don’t yet have an answer.
When House Bill 765 was debated by the Senate, Sen. Apodaca offered six amendments relating to the environmental portions of that bill. They were all good amendments, and they passed with broad bipartisan support. However, as my comments in the Hendersonville Times-News made clear, the House still has problems with the bill, and my concerns led to my appointment to the conference committee that will resolve differences between the House’s one-page bill and the Senate’s fifty-eight page bill.
Originally, I didn’t sign on as a cosponsor to the noncontroversial, one-page bill, since I suspected that it might turn into something else. My instincts were right. It is now a hugely different bill than the bill the House passed. A two-hour hearing on the Senate bill before the House Environment Committee attracted dozens of people and organizations opposed to the bill or with concerns about the bill. Subsequent to that hearing, the House voted unanimously to “not concur” in the changes made to the bill. Thus, the conference committee was appointed.
While HB765 gives me as much heartburn as any bill that is moving this session, I was relieved to see that Sen. Apodaca and I weren’t again put in the position of representing our respective chambers in these negotiations. We debated coal ash legislation and education funding in the last session and are already named conferees on House Bill 44 [Local Government Regulatory Reform of 2015] and on the budget. I’m sure mutual friends back in Henderson County will be glad to learn that we’re not also going to be negotiating environmental policy in HB765.
Proposed Electric Transmission Lines
Over the last two weeks, Duke Energy completed three public information sessions on its proposed transmission lines through Henderson County. The first two sessions were held while the legislature was in session, but I made it back for the third session at Blue Ridge Community College (BRCC). And what a session it was.
Arriving at the college just before the scheduled start of the session, I found myself at a standstill in the road a good distance from the auditorium, waiting to park. The turnout was huge, and most people didn’t understand the event was a “public information session” not a “public hearing” on the proposed transmission lines. Duke Energy had dozens of people on hand to answer questions, but there was no good way to handle the crowd that turned up. One could feel the tension in the hall as people milled around trying to look at maps and ask questions.
The prospect of large transmission lines bordering one’s property or even the specter of having one’s property condemned by Duke Energy for the transmission lines made everyone uneasy. While many people completed forms about their property or about their concerns, my suspicion is that many left frustrated without getting the information they wanted.
Over the next few weeks, I’m going to try to help constituents to understand the process, specifically understand what is being proposed, what the process is for making a decision, and how one can contest whatever the recommended route for the transmission lines is.
Duke Energy has a website that provides a lot of the information that constituents may want: The Foothills Project and a separate online application for submitting comments. Anyone interested in the project should visit the website and provide input on any issue relating to the proposed project. However, it is not surprising that folks are skeptical that the company, that will determine the proposed route of the transmission line and could ultimately condemn land, will be completely transparent. In an effort to get constituents whatever information they might want, I’ll be putting out lots of information on the subject over the coming weeks through my newsletter, webpage, Facebook Page and Twitter feed.
One thing to remember: While there were hundreds of people who attended one of the information sessions, once Duke Energy selects its preferred route, the number of people actually interested in the transmission will drop dramatically. For example, there was a large contingent from the Cummings Cove community at the information session at BRCC because one of the proposed routes runs near or through that neighborhood. If the recommended route doesn’t come by Cummings Cove, one would expect most of those people will no longer be as interested in the process since it is likely they wouldn’t be directly affected. Conversely, when Duke Energy announces its preferred route, people with land near that route will be talking to their neighbors, and one should expect even more intense interest from the people who more likely will be directly affected.
My hope is to put all the issues on the table, but I’ve got one disclosure. Several of the options that run through the Green River area in south Henderson County (not in my legislative district) will impact my land or my family’s land. Thus, I’ll be looking at this not just as a dispassionate legislator representing his constituents but as a landowner who has the same potential concerns as many other landowners in and around the possible routes for the transmission lines. Thought folks should know about this in the interest of transparency.