REFORM AND REVITALIZATION in Raleigh

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1 REFORM AND REVITALIZATION in Raleigh NORTH CAROLINA MEDICAL GROUP MANAGERS Charleston, South Carolina May 17, 2013

2 2

3 HOW IT ALL BEGAN... 3

4 January 7, 2013 Swearing In Ceremony Judge Paul Newby 4

5 January 10, 2013 Granddaughter Katelyn Inauguration Day at the General Assembly 5

6 Governor Pat McCrory State of the State Address 6

7 Halifax Mall 7

8 HOW THE CHAMBER HAS CHANGED SENATE 2010 SENATE 2012 = Democrat = Republican 8

9 HOW THE CHAMBER HAS CHANGED HOUSE 2010 HOUSE 2012 = Democrat = Republican 9

10 YEARS OF EXPERIENCE Term in both Chambers = 2 years SENATE 2012 HOUSE 2012 Average Term 3.94 Average Term = 3.5 = new = 2 terms = 3 to 6 terms = 7 to 10 terms = > 10 terms 10

11 North Carolina General Assembly Session LEGISLATIVE PRIORITIES Improving the State s Economy (Jobs) Transforming Public Education Making Government More Efficient Tax Reform Voter Integrity 11

12 North Carolina General Assembly Session ADDITIONAL FOCUS Health Care Reform (Medicaid, CON, State Employees Expand State s Defense Industry Promote Export Growth 12

13 North Carolina General Assembly Session How a Bill Becomes a Law It must be read three times in each chamber It must be approved by both chambers If the bill is subject to consideration by the Governor, it must be signed (or not vetoed) by the Governor. If the Governor does not sign or veto a bill within ten days after it has been presented to him/her, the bill automatically becomes law. The ten day period is extended to 30 days if the bill is presented to the Governor after the General Assembly has adjourned. 13

14 North Carolina General Assembly Session How a Bill Becomes a Law Each Representative allowed to file up to ten Bills May co-sponsor as many as they desire to support Resolutions do not count toward quota 14

15 North Carolina General Assembly Session Current Status 951 Bills filed in the House 724 Bills filed in the Senate 21 Bills made into law (9 House, 12 Senate) 15

16 BILLS I HAVE FILED HB196 WS/FC School Board Vacancies HB197 Local Flexibility School Calendar HB235 Parent Consent to Quit School HB287 Increase Dropout Age from 16 to 17 HB477 Allison s Law/Use of GPS Tracking Device/Domestic Violence Protection Order 16

17 BILLS I HAVE FILED HB634 Standardize Emergency Hospital Codes HB635 Involuntary Commitment Custody Orders HB748 DOT/Oversight Standards for Greenways HB749 Local School Flexibility HB750 Charter School Flexibility/Pilot * Primary/Sponsor of 160 Bills 17

18 RESOLUTIONS I HAVE FILED HR193 Honoring Representative Larry Brown HR198 Honoring March of Dimes 75 th Anniversary HR342 Honoring City of Winston-Salem 100 th Anniversary 18

19 HOW DO WE RANK? * Data as of January of the Year Reported INDICATORS Population Percent Change in Population Median Household Incomes Unemployment Rate Percent Living in Poverty

20 HOW DO WE RANK? INDICATORS Per Capita State & Local Taxes State & Local Taxes as Percent of Income Per Capita State Taxes Per Capita State Expenditures Per Capita State General Fund Expenditures

21 HOW DO WE RANK? INDICATORS General Fund Expenditures as a Percentage of Income Per Capita Federal Expenditures Per Capita State & Local Debt Per Capita Federal Grants Bond Ratings

22 HOW DO WE RANK? INDICATORS Infant Mortality Percentage of Adults Overweight or Obese Percentage Without Health Insurance Per Capita Medicaid Expenditures

23 HOW DO WE RANK? INDICATORS State Funding Per Pupil, K Percent with a High School Education or Less Average Annual In-State Tuition

24 HOW DO WE RANK? INDICATORS Percentage of Computer or Math Occupations State Government FTE Employment Percentage of Roads Maintained by the State

25 NC Employment as a Share of US Employment

26 Poverty Rate: NC Compared to US and Neighbors

27 HEALTH STRENGTHS Low Prevalence of Binge Drinking Low Incidence of Infectious Disease Few Poor Mental & Physical Health Days Per Month CON Regulations Top Hospitals/Physicians Bond Ratings (Financial Strength) 27

28 HEALTH CHALLENGES Low Per Capita Public Health Funding High Prevalence of Diabetes High Infant Mortality Rate High Prevalence of Low Birth Weight High Poverty Aging Population 28

29 HIGHLIGHTS Diabetes remains high at 10.9% of the adult population More than 800,000 NC adults have diabetes 29

30 HIGHLIGHTS In the past five years, air pollution decreased from 13.0 to 10/0 micrograms of fine particulate per cubic meter In the past five years, the rate of preventable hospitalizations decreased from 75.1 to 62.6 discharges per 1,000 Medicare enrollees. 30

31 HIGHLIGHTS Rate of uninsured population increased from 13.4% to 16.7% in the past 10 years Immunization coverage dropped below 90.0% of children ages 19 to 35 months for the first time in eight years. 31

32 HIGHLIGHTS North Carolina s drop-out rate of 6.43% in 2006 has decreased to 3.01%% in 2012 North Carolina s graduation rate has increased to 80.2% in 2012 from 68.3% in

33 NORTH CAROLINA S FINANCIAL HEALTH UNFUNDED LIABILITIES Unemployment $ 2,500,000,000 Retiree Health 30,000,000,000 Medicaid 250,000,000 TOTAL $32,750,000,000 Percent of Annual Budget 160% 33

34 NORTH CAROLINA S FINANCIAL HEALTH UNEMPLOYMENT RATE North Carolina ranks 45 th with a rate of 10.5% North Dakota has the lowest rate of unemployment at 3.5% South Carolina ranks 43 rd with a rate of 10.3%; Georgia ranks 41 st at 9.8% while Tennessee ranks 35 th with a rate of 9.2% 34

35 NORTH CAROLINA FY General Fund Revenue by Source $ 20.6 Billion Individual income tax comprises more than half of all General Fund revenues Sales and use tax comprises more than one quarter of total General Fund revenues All other taxes combined comprise 15% of total General Fund revenues Non-tax revenue sources comprise remaining 4% 35

36 General Fund Revenue by Source Corporate Income 5% Individual Income $11.2 billion 55% Sales and Use $5.5 billion 27% Franchise 3% Non-Tax 4% Other Tax 1% Insurance 2% Beverage & Tobacco 3% 36

37 NORTH CAROLINA FY General Fund Appropriations Proposed $20.6 Billion Education $ 11.4 Billion 56.0% Health & Human Services $ 4.8 Billion 23.0% Justice & Public Safety $ 2.4 Billion 11.0% Debt Service & Reserves $ 1.2 Billion 6.0% 37

38 NORTH CAROLINA FY General Fund Appropriations Proposed $ 20.6 Billion General Government $ 412 Million 2.0% Natural & Economic Resources $ 412 Million 2.0% 38

39 General Fund Appropriations by Subcommittee Proposed Health & Human Services $4.8 billion 23% Natural & Economic Resources 2% Justice & Public Safety $2.4 billion 11% General Government 2% Debt Service & Reserves 6% Education $11.4 billion 56% 39

40 NORTH CAROLINA FY DHHS State Funding Proposed $ 4.8 Billion Medical Assistance and Mental Health account for 84% of DHHS General Fund appropriations in the recommended budget: Medical Assistance $ 3.2 Billion 69.0% Mental Health $ 700 Million 15.0% All Other Programs $ 800 Million 16.0% 40

41 DHHS State Funding Medical Assistance and Mental Health account for 84% of DHHS General Fund appropriations in the recommended budget $700M (15%) $800M (16%) Medical Assistance Mental Health All Other Programs $3.2B (69%) Recommended State General Fund Appropriation 41

42 Projected Increases/Demographic Changes Population of North Carolina Segment of Population 2011 Number and Percent 2031 Number and Percent Percent Increase Total 9,669, % 11,729, % 21% Age >60 1,851, % 2,988, % 61% Age >65 1,289, % 2,296, % 78% Age >85 155, % 265, % 71% Baby Boomers (Born ) 2,377,235 24% 1,811, % 42

43 NC GENERAL ASSEMBLY Health Care Opt for Federal Exchange No Medicaid Expansion Medicaid Appropriations State Health Plan CON Plans 43

44 NC GENERAL ASSEMBLY Health Care Related Bills Introduced HB18 HB105 HB177 HB181 HB183 Youth Skin Cancer Prevention Require Pulse Oximetry Newborn Screening CON - ASC Physician Supervision Required/ Nurse Anesthetist Allow Hospitals to Test Blood for DWI 44

45 NC GENERAL ASSEMBLY Health Care Related Bills Introduced HB247 HB285 HB351 HB498 HB580 HB609 Freedom to Negotiate Health Care Rates Amend Respiratory Care Practice Act Study Prescription Drug Abuse by Students Mandate Autism Health Insurance Coverage Establish Statewide Telepsychiatry Program NC Cancer Treatment Fairness 45

46 NC GENERAL ASSEMBLY Health Care Related Bills Introduced HB631 HB634 HB674 HB676 HB693 HB704 Urge ALS Awareness & Research Standardize Emergency Hospital Codes Study Medicaid Provider Hearings Eliminate Dietetics/Nutrition Board Eliminate Exceptions/Med Treatment/Minors Study & Encourage Use of Telemedicine 46

47 NC GENERAL ASSEMBLY Health Care Related Bills Introduced HB730 HB742 HB771 HB798 Health Care Conscience Protection Act NC Competency, Accuracy, Responsibility and Excellence in Radiologic Imaging Inform Patient/Drug Cost Less Than Insurance Co-pay Release of Medical Records 47

48 NC GENERAL ASSEMBLY Health Care Related Bills Introduced HB827 HB828 HB832 HB862 HB866 Designate Primary Stroke Centers Update Physical Therapy Practice Act Expand Pharmacists Immunizing Authority Health Insurance Market Reforms Preterm Premature Rupture of Membrane Awareness 48

49 NC GENERAL ASSEMBLY Health Care Related Bills Introduced HB867 HB877 HB878 HB881 Medicaid County of Residence Licensing of Health Insurance Navigators Certified Registered Nurse Anesthetists in Counties with Central Access Hospital Greater Financial Oversight of Local Management Entities/Managed Care Organizations 49

50 NC GENERAL ASSEMBLY Health Care Related Bills Introduced HB886 HB888 HB900 HB941 Repeal Portions of Federal Health Insurance Tax Amend Drug Laws/Ellison versus Treadway Exempt Continuing Care Facilities from Certificate of Need Legislative Research Commission Study/ Medical Use of Cannabis 50

51 FRESHMAN EXPERIENCES 51

52 QUESTIONS 52

53 THANK YOU! 53

54 REFERENCES 1. Slides 8 10 Civitas Review, Volume IX, Issue 1, Winter Slides North Carolina Rankings By Indicator, How North Carolina Compares ( 3. Slides More Jobs, Bigger Paychecks: A Pro-Growth Tax Reform for North Carolina. 4. Slides America s Health Rankings, ( ). 5. Slide 32 North Carolina Department of Public Instruction ( 6. Slide Appropriations Committee: NC State Budget Actuarial Report. 7. Slides The Governor s Recommended Budget. ( 8. Slides 42 North Carolina Medical Journal, Volume 74, Supplement, March

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