Carolina Journal Radio No. 871: Kansas decision boosts pressure for N.C. Medicaid expansion

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 of public policy events and issues welcome to Carolina Journal radio I Michiko got during the next hour, Donna Martinez and I will explore some major issues affecting our state communist China presents long-term challenges for the United States during a recent visit to Raleigh, a national expert with the heritage foundation warned about the importance of addressing those challenges, but you must break from Raleigh did nothing to make state lawmakers resolve their impasse over the state budget, you'll hear Republican and Democratic assessments of the stalemate, as lawmakers prepare for another legislative session and the 2020 elections. New rankings are designed to show how well those lawmakers support business and free market interest and will take a closer look at the way North Carolina pays for transportation projects. Those topics are just ahead. First, Donna Martinez joins us with the Carolina Journal headline the state of Kansas is set to become the next state that will expand Medicaid under the affordable care act. That news has some in North Carolina wondering if or when our state will follow suit. But our next guest says that expanding Medicaid is a poor decision whether you the first state to do it for the 50th. Jordan Roberts is the healthcare policy analyst for the John Locke foundation.

He writes frequently about Medicaid and healthcare issues@johnlocke.org Jordan, welcome back to the program is so interesting story that was published in the Winston-Salem Journal in which a Wake Forest University professor named Mark Hall told the reporter that North Carolina EA is part of a small group of states in the southeastern part of the country that is a stubborn outlier essentially in not expanding Medicaid your reaction to that.

Well I think about policies about policy and it doesn't matter how many states are doing so you are trying to resist that here in North Carolina do not have some of these negative effects, and so you know we did remember that the affordable care act made Medicaid expansion optional to states insisted still have some autonomy to say no, and just because other states are doing.

It doesn't mean North Carolina should follow suit and implement bad policy here.

Jordan remind us of what the Medicaid program is supposed to do and who was supposed to serve you so you know this is program was started in the 60s for the lowest income individuals. No pregnant pregnant women and children are disabled elderly, the most at risk, and most portable people in our population, so Medicaid expansion does is it expands the eligibility threshold up to 138% of the federal poverty line to include able-bodied childless adults into this program for most at risk individuals and so we see that you know is a problem that the scope of this program was for the most at risk individuals into expanded up to these individuals that don't meet the criteria largest expansion of government welfare and that's not the direction we should be going to fix some of these complex healthcare problems is such an important point that you brought up because there may be some folks who think that well there are all these people half a million of them who qualify because they're poor or they are widows or they are the elderly. They will qualify for the original intent of Medicaid social safety net. But what you're saying is that the proposal here in North Carolina by Gov. Cooper and his allies is to expand what the program is meant to do, and adding all sorts of other people who have other options.

You absolutely Medicaid program Artie serves over 2 million people over 1/5 of our state so there's all kind of problems currently in the Medicaid program and so you know it doesn't make sense to put a new priority on these this expansion population. The able-bodied childless adults. We have 2 million people that currently qualify for our very generous Medicaid program and is one of our biggest budget line items and it seems like a financially reckless move to just blow it up and say I will take the federal money and will expand out another half a million people, such as projections of how many people would actually sign up. We see another states is that the projected and actual enrollment are very different numbers and so states are kinda stuck with dealing with that after-the-fact trying to make up budget deficits and to do that with new taxes or to take away funding from other parts of the budget so you need to think about what this would do to the state of North Carolina and we arty have a very no full Medicaid program and so thinking of those people should be our priority and we can work to make the private insurance market better to provide for these folks who would be eligible for an optional Medicaid expansion, North Carolina Jordan, if North Carolina went forward and expanded Medicaid to this whole new group of half a million people or more that you just defined for us what kind of impact would we have on the current legitimately enrolled recipients of Medicaid. Well, you know, we have a very rural population here in North Carolina and we have what we call medical deserts where there is not a lot of physicians in the area and even the physicians in the area may accept Medicaid so we have these structural systemic problems with people accessing healthcare and just giving people an insurance card paid for by the government doesn't get any of the problems why we have people that can afford insurance and why there can't access and medical attention where they live so you know we don't think that's the right way to approach this by just extending people insurance car. We have deeply rooted problems and we need to solve before we expand the welfare program to this new population and wait lists for current recipients or services that they need that they can get yeah absolutely there is population that would like to be treated for their chronic conditions at home is the actually disabled group and so to make their care more accommodating to provide them at home care.

There is a wait list for that and so these are these the people of the Medicaid program was supposed to be caring for the most disabled in the most needy folks in our state and so is the people that we should be prioritizing with a state-funded health insurance program. Jordan I know that you have done a lot of research into the private insurance market and options that those half a million people or more have other than Medicaid and being moved onto the Medicaid rolls. What about that, do they have affordable private insurance options. Yeah a lot of folks that are currently up for Medicaid expansion. If North Carolina were to experiment be eligible there already currently eligible for a zero dollar monthly premium Obama care plan and so they do have options. There are no association health plans hopefully become sooner short term duration insurance is a ton of other options here and so we don't want is to expand Medicaid and crowd out the private individual market and that's what we see in the states, Idaho, who just recently expanded Medicaid next year Obama care enrollment was down 14,000 individuals.

That's what we call crowd out and that has negative impacts for those that are currently buying their insurance on the private market and projections in Kansas shave that 55,000 individuals currently on private insurance would switch over Medicaid so were doing is just shifting who's paying for the cost of the health insurance from private payers to public payers, taxpayers so that's one of impacts that we would probably likely see in North Carolina a massive decrease in the individual market now being paid for under Medicaid. Every time we talk about this Jordan. I walk away from our interviews thinking.

Medicaid expansion really not the best option for the people were talking about who have legitimate needs for affordable housing and healthcare. My goodness. We all want that, of course, but there's other options for them and it leads me to this question.

What is the appeal then to lawmakers and policymakers around the country and expanding Medicaid when there are other ways to help people who need help and I think it's it's it's an easy option just to take the federal from the Army and the federal government is paying for 90% of this, but keep in mind that were running almost $1 trillion deficit a year. So all this new federal spending for Medicaid expansion would come from you.so that's that's big issue that we see.

We want to not contribute to anymore here in North Carolina because that's how this law is paid for by new borrowing so you know it's negative impacts across the board and we are all the federal taxpayers as if we are not paying the federal portion. We are just taking out of our paychecks and we don't see it exactly borrowing more money increasing the federal debt that has brought negative economic consequences. We been talking with Jordan Roberts. He is the healthcare policy analyst for the John Locke foundation. With this much more Carolina journal radio to come in just a moment tired of fake names tired of reporters with political axes to grind. What you need to be reading Carolina journal, honest, uncompromising, old-school journalism, you expect and you need even better, the monthly Carolina journal is free to subscribers sign up Carolina journal.com you'll receive Carolina journal newspaper in your mailbox each month. Investigations into government spending revelations about boondoggles. The powerful leaders are and what they're doing in your name and with your money. We shine a light on it all with the stories and angles. Outlets barely cover but there's a bonus print newspapers published monthly daily news site gives you the latest news each and every day lot on the Carolina journal.com once, twice, even three times a day won't be disappointed. It's fresh news if you'd like a heads up on the daily news sign up for daily email Carolina journal.com Carolina journal rigorous unrelenting old-school journalism. We hold government accountable for you. Welcome back to Carolina journal radio amateur coca China generates lots of headlines these days, many of them negative, which we know about America's complicated relationship with China.

It's a topic Walter Loman addressed recently in Raleigh for the Jesse Helms center. Loman directs the Asian studies Center for the heritage foundation joins us now just how different are the United States and China looking at it just right at this moment where each side is a we just see the world from different perspectives opposite perspectives in many ways the relationship between the state and citizen for most the idea of natural rights of the states has and has really internalized. You'll have to read John Locke to understand that as an American because as an American you have internalized part of the way you look at the world and we take it for granted that governments around the world the same way is universal so you do have Chinese people that understand it and see it that way you'll have institutions in China supported the Chinese have one party one state system that doesn't believe in the rights of man or natural rights or anything like that. So we look at things from very very different perspective versus local differences, there's differences in the way we think the world should be managed different interests that we have in parts of that conflict directly. Some people are talking about coupling the American and Chinese economies. I think the biggest problem with this essay is basic human inability to deal with scale. You know you got a look at the scale of what's going on half a million foreign companies are invested in China. The $1.6 trillion we have in trade with the region as a whole and the fact that you thousands of suppliers going back and forth across borders and everything else is just is just way too big to decouple.

I think what will happen if we try to decouple so we can take action intended intended to do that decouple will do his will will we will separate the United States from a lot of these networks and the Europeans will be a part of the Japanese would be part of the Taiwanese Australians all be a part of it.

We will set up barriers for our own engagement in all of these always networks so the bottom line is we have some fundamental problems. Chinese just like we just talked about whether it's values or whether it's art are really concrete interest, but we can live with them at the same time, especially on the side of things so that no easy answers is to be able to slog through it.

That's the voice of Walter Loman, director of the Asian studies Center at the heritage foundation in your speech. You mentioned a riddle link to American relations with China.

Little is that we have to look at Asia Pacific as being more than just about China were not dealing with these countries just to deal with China on the other hand, were going to effectively deal with China. We got a deal with all those other countries so so that's the riddle is that it is more about more than about China but in order to address the China problem we have to be there with all these other countries telling them it's not just about China that we care about the way that they're being inundated by refugees or the way that they are dealing with drug trafficking issues or things like that because attorneys are there to Chinese or their way diplomatically, politically, they go to all these offense that they have in the region on the different conferences and they are now becoming donors to the region so so we have to be there to being actually a part of the life of the region you know I always point this out this difference, that the Middle East no conflict is such a part of politics in the Middle East right people waking up every day in their first thought is how I can get my land back. Or, you know, getting kill that guy killed my sister you know a lot about conflicts, not like that in Asia the most part it's about making money people wake up every day from the guy in the street selling trinkets to CER tycoon in Hong Kong. Think about ways to make money US, isn't there helping people make the best of their lives were missing half of the equation. We can have 15 US aircraft carriers in the region is not to make a difference in the Chinese are the ones there helping people make money and help people better their lives. They're going to get the advantage were not there going to benefit their own vision for the region.

We will benefit hours. You also called the American Chinese relationship along complex struggle.

How so you can see it playing out now with this technology issue. How do you separate out security threats come with Chinese investment for Chinese trading relationships like with microchips in bona fide technology and that sort of thing how you separate those things out from the water economic relationship. How do we attack trying China on cyber theft and IPR violations without your price entire economic relationship. How do we speak up about what they're doing in Western China with weaker Muslims, but basically concentration camps but at the same time not jeopardize or exacerbate other problems that we have so that that's the that's where the complexity comes in and I think you I think natural American recourse is to try to simplify it and come up with something that's more. Let's say elegant door course, that's that that's the most charitable way to put his elegant approach that can come to reconcile this and we can take the attorneys on the head could be that easy.

You have to slog through these issues we have to prioritize over long time without any clear outcome. You said during the speech, there's no boardgame solution. One of the solutions out there that we have just stumbled on. That is, the people who are debating this. Maybe some people in government. I don't think many actually but a lot of academics and people are looking at this they're looking at it is this great power struggle with the Chinese almost a new Cold War, the Chinese and it's just not going to be that simple way to approach it. Just look at look at the other countries on the board. Okay. During the Cold War, we find it on our own. We had the world allies Western Europe allies in Japan and Australia in Southeast Asia.

We had allies so what happens in the school work are all those guys still on our side this time. I don't think so. Maybe, but I think they're going to have to choose if you're in Germany.

Even if you're in the UK here in Japan pans on the front lines you choose, especially Southeast Asia's most risky or even a choose sort of geostrategic struggle that America leads sort of theoretical construct about how to confront China or you can choose economic benefit. A lot of people you choose economic benefit of the central coalition that we required to win the Cold War that that's why that's why it's important to look at it in some of its complexity. That's Walter Loman of the heritage foundation. He spoke recently in Raleigh delivering the Adm. James W.

Nance lecture Jesse Helms center will return with more Carolina radio in a moment. If you have freedom we got great news to share with you now. You can find the latest news, views, and research from conservative groups across North Carolina all in one place North Carolina conservative.com it's one stop shopping. North Carolina's freedom movement and North Carolina conservative.com. You'll find links to John Locke foundation blocks on the days news Carolina journal.com reporting and quick takes Carolina journal radio interviews TV interviews featuring CJ reporters and want foundation analysts, opinion pieces and reports on higher education. James Dean Martin, Center for academic renewal, commentary and polling data from the scimitar's Institute and news and views from the North Carolina family policy Council.

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If you believe in the importance of free enterprise, it's likely that you will support lawmakers who also support free enterprise will how can you tell whether they do or don't.

Our next guest will help us address that question Anna Bevan gravelly is Executive Director of the North Carolina free enterprise foundation or in C free welcome to the program.

Thanks Ronnie.

So tell us a little bit about this tool that you have that's available to people who are interested in politics interested in business and an interested freighter prize that helps them determine whether there lawmakers support free enterprise right so we at the end of every year or long session for the Gen. assembly produce a legislative business rating and this rating really gauges and rights members based on their understanding of free enterprise as a philosophy.

This is something that you could compile a number of different ways. Tell us how you how you do your rate so we have two parts that we have a subjective and objective subjective is we involve lobbyists on government affairs professionals on key business leaders in the state to provide a rating, one, 200 and commits of 10 how they feel like members of the Gen. assembly are and their disposition toward free enterprise and the second part is objective and not their votes straight up. There's no opinion and not it's how they vote on particular pieces of legislation so you could buy, as you said, the objective and subjective and a number of different votes not just one or two here and there. Actually have 12 and the Senate and 13 and the house that we select and we have a research committee that gets together at the toward the end of session and they go through and look at why did the session hold in terms of free enterprise each year is different because that opportunity to have votes that lend itself toward going in the free enterprise direction are supporting pro-business efforts are different every session and so this this session we it worked out we had 12 in the Senate, and 13 in the house and some votes were. We looked at multiple bills, but some bills were repeated in this year where we looked at particular house resolutions to the appointment of two members to the industrial commission and then asked Superior Court Judge. The reason why we looked at those that expanded the way we view what's impacting the business community in North Carolina briefly. Can you tell some of the other things that you countered about the support for incentives or things that there are no there's no incentive legislation and votes in this particular one in the past we've had Senate votes. We had the map back to add on some business healthcare at the farm act simply popular names the session and made it it's made their way entire rating on his heart to really look past that as we look at the importance of business and on the involvement that those have on this and state that gives people a sense of the types of things.

So we're chatting with Anna Bevan gravelly who is Executive Director of NC free now, we kinda know how you put it together. Let's talk a little bit about how healthy out so in general are lawmakers as a whole supportive of free enterprise, or is there some work to do the whole. We've been using a steady uptake in the ratings.

On average, moving toward hundred hundred is that most the highest free enterprise rating in zero is the lowest there's been a steady incline over the last decade. That's one thing that we show in our report we did some infographics that really summarize the information to show the comparative nature of the report. It's cool to see what ratings are, but it's also really important to put that in context. No. In C. Free is a nonpartisan group, but some people will be interested in looking at are the Republicans more free enterprise are Democrats more free enterprise. Is there any difference what are your radio show.

There is a difference. Republicans do have a higher free enterprise rating, but interestingly the Democrats in the Senate have a higher rating than the Democrats in the house and the Republicans in the house of a higher rating than the Democrats in the house and usually there's conversation about which chamber is more fiscally conservative and we do a chart in interesting analysis that shows the timbers of gone back and forth between which one is more fiscally conservative in its approach to free enterprise, which I think is is is encouraging because of continuing to see some challenge and that what's interesting I might also be because the variation of what types of the help from year to year. So beyond Republicans versus Democrats now let's talk about some of the individual performers when you looked at the list may let's start with Senate some of the top performers on top for as we have Sen. Paul Newton. He was top and president pro tem Phil Berger was sex on the last in all of these members only talk about the number that when they rank is .25 difference and their and their rating scores that were still dealing with a good number of people who rating above 90 someone for store six.

Probably not a huge Jeffrey may be a big difference between someone who's five and 45 correct yeah yeah looking on the house side was of the top folks John Bell was the first on the house side and speaker more was rated 17 kn. I think that speaks to the strength of his caucus. Actually, that that so many of them are rated above him and top-performing Democrats in the house were representative Don Davis and sees a representative can get meant and representative Michael Ray and that on the Senate side, I'm guessing that one of the top performers is Don Don Davis and also Sen. Pelayo was at our events at the leadership luncheon in the first week in December you put these ratings out. How do you hope people will use them either. The lawmakers themselves who are looking at there lawmakers. Yeah, that the value that we have is that we free enterprise foundation don't have a lunch that of agenda so we evaluate that legislation as a whole for the session instead of saying like these are particular pieces of legislation that we wanted to get past and think that makes the ratings stronger in the sense that we are we are nonpartisan were not just looking to advance free enterprise and so when people whether you're an interest group or lobbyist group or pack or members, we we are a gauge that just provides that particular outlook and can be used as a foundation for future discussions you hope people will look at these ratings and if they see someone who writes highly say okay that's very good and that they write a little bit lower. Talk to about, you know, like to see you more interested in free enterprise yeah absolutely that the impact of this legislation. This particular report that we do is I think it's pretty limitless because it does approach from such a clear perspective on meeting with members talking to them about the way they approach whether it's through the subjective rating or or their's are straight up votes in the objective. It's certainly a conversation starter. If people want to learn more, including the ratings for all 170 members of the assembly.

What's the best way for them to get this information visit our website and see furry.org and we have that legislative business rating from this year, as well as on the last decade of of LDR's that is the voice of Anna Bevan gravelly she is Executive Director of the North Carolina free enterprise foundation or as we've been calling them and see furry thinks about you joining us. Thanks much more on Carolina Journal radio real influence. You either have it or you don't and at the John Locke foundation we have it, you'll find our guiding principles in many of the freedom forward reforms of the past decade here in North Carolina. So while others talk or complain or name call. We provide research solutions and hope 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 over your life. Our goal is to transform North Carolina into a growing, thriving economic powerhouse, the envy of every other state research is how policymakers make decisions that ensure you keep more of what you are. Expand your choice of schools for your kids. Widen your job opportunities improve your access to doctors. The recipe for stability and a bright future for truth for freedom for the future of North Carolina.

We are the John Locke foundation. Welcome back to Carolina Journal radio Donna Martinez the bass night bridge on the Outer Banks, which replaced the Bonner bridge is well known to most North Carolina dance but it turns out president Donald Trump also knows about this bridge. In fact, the president use the bridge as an example of oppressive federal rules that make building infrastructure like bridges costly and very slow Joe Colletti is senior fellow with the John Locke foundation.

He follows transportation issues and policy here in North Carolina and he joins us now. Joe will come back okay so what you think when you hear president Trump talking about North Carolina and the bass night bridge. It's always weird to hear something positive from a Republican about Mark last night from, but the presidents commentary about it that it took 25 years to build, to replace the Bonner bridge and a large part of that was due to environmental concerns and lawsuits in regulations and barriers to being able to to replace that bridge that all made sense. And so it's a very good thing for the president to be looking at how do we ease the regulatory barricades to to building infrastructure needed infrastructure like the Bonner bridge were the best I bridge for or like new runway at are you well replacement runway are you that's being held up by regulations reaching out without 540 and with other projects across the state. So how do we go about that because on the one hand there might legitimately be hurdles that project needs to get over. But what's appropriate and what's inappropriate how we decide that the existing laws been litigated for 50 years. As folks pointed out that the from the time that it was created until the current until today it's 50 years worth lawsuits from environmental groups trying to stop trying to stop construction projects and infrastructure projects in the name of the wall and so the presidents ideas to change some of the regulatory some of the regular framework around that to ease that it still has to go through public comments and all insurgent. It'll be a while before takes place, but once that's in. Once that happens will be most of them have another round of lawsuits to figure out the answer to your question. So while all that goes on at the federal level here in North Carolina. Joe, you know transportation issues them just up one side down, down the other here. Let's talk about some of the key factors that determine how we build roads and bridges and how we pay for them.

First of all there is huge court ruling and it was in relation to a law called the map back in North Carolina and this was determined to be unconstitutional and it's important for this discussion because it was a key factor in how North Carolina planners really made their plans for building roads and they were negatively impacting property owners around the state. He was kind of the Reader's Digest version of what the map back was doing to property owners and whites ruled unconstitutional. 1985, the legislature passed the map act, which said that the Department of Transportation could put out a map and everything along there would then be, but it wouldn't have to buy anything in the proposed route and until they were ready to actually build which got a decade could be a yes could be decades, in part because of the environmental and what that did those that froze the value of a person's house or diminished. It because if you know that the house that you're looking to build or the property that you're looking to buy for commercial purposes. The to is going to at some point be replaced be torn down and replaced by road. There's not a lot of value there. And so the court said that that's a taking by the state and that was part of the reason why the past law was so that the department transportation could pay less to to condemn property and take it for their roads and so it was the intent.

The courts recognize that and said that that's unconstitutional you can't do that you have to pay just fair compensation so the department transportation now has probably about billion dollars worth of of liabilities to property owners.

They paid somewhere close to $300 million of that already, but still have another large trunk that still left. Unfortunately, the Gen. assembly.

This past December and bailing out the department transportation over a number of other things also limited the amount that the department could pay in and compensation to owners under the map act $250 million a year. So to be a member of a number of years more before all of these owners are Chuck RRR compensated for their taking unfortunate.

If you are one of the victim.

Some of the map back okay so the map back to can't be used, unconstitutional. What then are North Carolina planners using as the criteria for determining how we build roads or or what is needed. There is a state transportation infrastructure plan is largely about data-driven at the state level for for large projects and that is that that's based on the traffic that's going to go through their and the value that's created from the road and that's add food at the state level. The largest projects are that and for as you get closer to local level there is more local input and less reliance on data down to about half and half half just this makes sense and half the data says this this is what it should be and so that's how most things are are being planned.

Now there's no question about how much land the department transportation is taking for for their projects and if there over overbuilding what it compared to what they could do and should do to be able to maintain the commercial and residential character of the places where there were there building. We pay for all of us. Most of the money comes from gas taxes 40% will 40% of the money comes from gas taxes and most of the rest of it comes from other user fees from drivers sales tax on cars that you buy drivers license title tags all of those things Come into the cost that we pay for roads and for most of the rest of the transportation system in the state. That means that when we pull up to the gas station and I would fill up the tank. Most of us just look at them how much a gallon gas cost.

We don't realize that there's a nice little chunk of that. That actually is a federal gas tax, and also state gas taxes. Part of of the price of a gallon gas.

Here's the thing Joe and you written a lot about this. Were going to more fuel-efficient cars.

Now we have electric cars, does that mean that our revenue is diminishing. It has been diminishing has been diminishing for a long time. Actually it was, it went down further further faster. In the 70s than been recently because that's where the biggest fuel efficiency gain efficiency has continued for to improve one of the things with electric vehicles and with hybrids is that those are high-end vehicles and so the gas that is actually becoming regressive because electric if you have electric vehicle.

If you test like you're not paying the gas tax so there's there's a there's increasing concern across that in the department transportation has a commission that's looking at that and will have its recommendations early next year.

In early 2021 on what should the what should the revenue structure look like an we've talked in the past about one of the ideas could be to do mileage based tax so you take a look at the weight of the vehicle you take a look at how many miles is driven and you say that that's us that substitutes for the gas tax. That's why we rely on Joe Colletti Senior fellow at the John Mott foundation.

He does all of that analysis don't think that's all the time we have for the show this week. Thank you for listening on behalf of my cohost Mitch. Okay I'm Donna Martinez. Hope you join us again next week for more Carolina general radio. Radio is a program of the John Locke to learn more about the John Locke foundation donations support programs like Carolina send email to development, job.or call 1866166553636 Carolina radio is the John line foundation airline is maintaining Carolina broadcasting system, Inc. all opinions expressed on this program are so nearly station nation about the show. Other programs and services of the foundation will free at 866 JL would like to thank our wonderful radio affiliates across airline and our sponsors. Carolina general radio. Thank you for listening. Please join us again next week