REFORM AND REVITALIZATION in Raleigh NORTH CAROLINA MEDICAL GROUP MANAGERS Charleston, South Carolina May 17, 2013
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HOW IT ALL BEGAN... 3
January 7, 2013 Swearing In Ceremony Judge Paul Newby 4
January 10, 2013 Granddaughter Katelyn Inauguration Day at the General Assembly 5
Governor Pat McCrory State of the State Address 6
Halifax Mall 7
HOW THE CHAMBER HAS CHANGED SENATE 2010 SENATE 2012 = Democrat = Republican 8
HOW THE CHAMBER HAS CHANGED HOUSE 2010 HOUSE 2012 = Democrat = Republican 9
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
North Carolina General Assembly 2013 2014 Session LEGISLATIVE PRIORITIES Improving the State s Economy (Jobs) Transforming Public Education Making Government More Efficient Tax Reform Voter Integrity 11
North Carolina General Assembly 2013 2014 Session ADDITIONAL FOCUS Health Care Reform (Medicaid, CON, State Employees Expand State s Defense Industry Promote Export Growth 12
North Carolina General Assembly 2013 2014 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
North Carolina General Assembly 2013 2014 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
North Carolina General Assembly 2013 2014 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
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
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
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
HOW DO WE RANK? * Data as of January of the Year Reported INDICATORS 2009 2011 2013 Population 10 10 10 Percent Change in Population 9 6 6 Median Household Incomes 37 39 39 Unemployment Rate 38 44 45 Percent Living in Poverty 38 38 38 19
HOW DO WE RANK? INDICATORS 2009 2011 2013 Per Capita State & Local Taxes 18 18 17 State & Local Taxes as Percent of Income 21 17 23 Per Capita State Taxes 25 18 24 Per Capita State Expenditures 18 15 12 Per Capita State General Fund Expenditures 28 29 26 20
HOW DO WE RANK? INDICATORS 2009 2011 2013 General Fund Expenditures as a Percentage of Income 33 33 32 Per Capita Federal Expenditures 39 43 34 Per Capita State & Local Debt 11 9 8 Per Capita Federal Grants 27 30 30 Bond Ratings 1 1 1 21
HOW DO WE RANK? INDICATORS 2009 2011 2013 Infant Mortality 44 44 45 Percentage of Adults Overweight or Obese 31 31 37 Percentage Without Health Insurance 37 40 35 Per Capita Medicaid Expenditures 32 30 25 22
HOW DO WE RANK? INDICATORS 2009 2011 2013 State Funding Per Pupil, K-12 23 26 31 Percent with a High School Education or Less 27 25 27 Average Annual In-State Tuition 6 7 10 23
HOW DO WE RANK? INDICATORS 2009 2011 2013 Percentage of Computer or Math Occupations 20 16 18 State Government FTE Employment 21 21 24 Percentage of Roads Maintained by the State 4 4 4 24
NC Employment as a Share of US Employment 1981 2012 25
Poverty Rate: NC Compared to US and Neighbors 2011 26
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
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
HIGHLIGHTS Diabetes remains high at 10.9% of the adult population More than 800,000 NC adults have diabetes 29
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
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
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 2006. 32
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
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
NORTH CAROLINA FY 2013 2014 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
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
NORTH CAROLINA FY 2013 2014 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
NORTH CAROLINA FY 2013 2014 General Fund Appropriations Proposed $ 20.6 Billion General Government $ 412 Million 2.0% Natural & Economic Resources $ 412 Million 2.0% 38
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
NORTH CAROLINA FY 2013 2014 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
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%) 2013-14 Recommended State General Fund Appropriation 41
Projected Increases/Demographic Changes Population of North Carolina 2011 2031 Segment of Population 2011 Number and Percent 2031 Number and Percent Percent Increase 2011 -- 2031 Total 9,669,244 100% 11,729,907 100% 21% Age >60 1,851,124 19.1% 2,988,476 25.5% 61% Age >65 1,289,618 13.3% 2,296,795 19.6% 78% Age >85 155,718 1.6% 265,686 2.3% 71% Baby Boomers (Born 1946 1964) 2,377,235 24% 1,811,120 15.4% 42
NC GENERAL ASSEMBLY 2013 2014 Health Care Opt for Federal Exchange No Medicaid Expansion Medicaid Appropriations State Health Plan CON Plans 43
NC GENERAL ASSEMBLY 2013 2014 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
NC GENERAL ASSEMBLY 2013 2014 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
NC GENERAL ASSEMBLY 2013 2014 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
NC GENERAL ASSEMBLY 2013 2014 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
NC GENERAL ASSEMBLY 2013 2014 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
NC GENERAL ASSEMBLY 2013 2014 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
NC GENERAL ASSEMBLY 2013 2014 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
FRESHMAN EXPERIENCES 51
QUESTIONS 52
THANK YOU! 53
REFERENCES 1. Slides 8 10 Civitas Review, Volume IX, Issue 1, Winter 2013. 2. Slides 19 24 North Carolina Rankings By Indicator, How North Carolina Compares (http://www.ncleg.net/ped). 3. Slides 25 26 More Jobs, Bigger Paychecks: A Pro-Growth Tax Reform for North Carolina. 4. Slides 27 -- 31 America s Health Rankings, (http://www.americashealthrankings.org/nc ). 5. Slide 32 North Carolina Department of Public Instruction (http://www.dpi.state.nc.us/) 6. Slide 33 -- 34 Appropriations Committee: NC State Budget Actuarial Report. 7. Slides 35 41 The Governor s Recommended 2013-2015 Budget. (http://www.osbm.state.nc.us/index.shtm). 8. Slides 42 North Carolina Medical Journal, Volume 74, Supplement, March 2013 54