Tag Archives: Certificate of Need

Save 3 Bills Favoring Free Enterprise & the 2nd Amendment?

Make 1 Phone Call and Save 3 Bills ?

As you probably know, the “Crossover” deadline is fast approaching in the North Carolina General Assembly. April 27 is the Crossover deadline for this session. Any bill (with a few exceptions basically having to do with budgeting) that has not been passed in one chamber and “crossed over” to the other chamber by the 27th will die in committee.

There are three bills stuck in House committees that involve subjects near and dear to our CCTA mission statement. One involves freeing up free enterprise. The other two involve pushing back infringements on our God given, 2nd Amendment supported rights. These two gun bills are being supported by Grass Roots North Carolina also.

Let’s take a brief overview of what’s in the bills.

HB-344, Exempt Ocular Surgery from CON Laws
This bill would allow ophthalmologists to perform ocular surgery in ambulatory surgical procedure rooms in their offices without obtaining a CON (Certificate of Need) so long as certain criteria are met.

As we’ve talked about before, this would bring down costs associated with such things as cataract removal while, at the same time, making them safer.

HB-588, Omnibus Gun Changes
This bill would simplify getting a pistol permit, allow a concealed carry permit holder to carry on property used as a school and church so long as school was not in session, and would also allow the holder of a concealed carry permit to carry on properties used for higher education (like community colleges, and universities). It would allow the governor and his immediate family to carry in the Executive Mansion and the Western Residence of the Governor. It would also allow legislators and legislative employees who hold concealed carry permits to carry in state legislative buildings. It changes the reason a person discharged from our U.S. Armed Forces can be denied a permit from “conditions other than honorable” to “dishonorable conditions.”

The Omnibus Gun Changes bill would also alter provisions relating to the confiscation and disposal of deadly weapons used to commit a crime. For instance, if the person convicted is not the owner of the weapon, it can be returned to the rightful owner. However, if the weapon does not have a unique ID # or is unsafe, it is to be destroyed. Other than that, it can be turned over to a law enforcement agency to use, sell, or trade.

The Omnibus Gun Changes bill would also change the concept of “going to the terror of the people” so that it would no longer apply to carrying a handgun concealed or openly, but it would apply to carrying “an unusual and dangerous weapon for the purpose of terrifying others.”

HB-746, NC Constitutional Carry Act
This bill would remove “firearm” from the list of concealed weapons one must not carry except while at home. It also provides that any citizen of the U.S. may carry a handgun openly or concealed without a permit in N.C. unless prohibited by N.C. or federal law.

The NC Constitutional Carry Act prohibits carrying on private property that is “posted” against it. It also prohibits consuming alcohol when carrying, and there are exceptions to who may carry such as people under indictment for or convicted of a felony, a fugitive from justice, an addict, etc.

The NC Constitutional Carry Act also provides that, when carrying a concealed firearm, one must also carry an ID, and, if approached or addressed by a police officer, must disclose that a concealed handgun is being carried and must be prepared to show ID if asked.

What can we do to help get these three good bills passed?

We can call or write Speaker of the NC House, Tim Moore. If he wants them to come out of committee and be voted on by the House, they will be.

Speaker Moore is a Republican. Republicans have a veto-proof majority in the General Assembly. The Republican Platform is favorable to free enterprise and the 2nd Amendment, so it is logical that they would favor these bills, and they are the sort of bills that the people who elected them would like to see.

Speaker Tim Moore’s phone number is 919-733-3451. Speaker Moore’s email address is tim.moore@ncleg.net.

Respectfully requested,


(Raynor James, Chairman CCTA’s State Legislative Action Committee)

Legislative Action Report on Education, Money, Jihadists in NC, and more

Dear CCTA Members and Friends,

If you don’t have much time, please go directly to the paragraph below with the words North Carolina Education Plan in bold type for a free solution to one of our most perplexing problems, and read that. Then, drop down to the paragraph with the words Syrian refugees in bold type, and read to the end.

I’ve talked to several legislators since the close of the General Assembly session. Most of them have expressed the same general idea about the budget. That is they take pleasure in the fact that the increase in spending is pretty much limited to the increase in North Carolina’s population plus the rise of costs caused by inflation.

Let that sink in a minute.

What’s wrong with it?

Well, it’s right and proper only if spending in the prior year was an appropriate amount. It seems to me that government was too big in the prior year, and it will be too big next year, too. And this is with a Republican majority who say they want smaller government. We need to communicate with our representatives at all levels of government that we are serious about wanting smaller government.

There are three more topics I’ve discussed with legislators recently.

We want Common Core academic standards gone from North Carolina. To a person, every legislator to whom I’ve expressed that desire has said that after they’ve received the report of the Academic Standards Review Commission in December, they expect a sub-committee of the Joint Legislative Oversight Committee to be set up to consider the report and how to follow up on it. They don’t want to lose the time over the winter before the next legislative session convenes.

That is a terrific idea, and I hope it happens. Please express that notion to every legislator whose ear you can get.

Also, in testimony before the Commission, Jerry Egolf, Linda Harper, and Kathy Young presented the North Carolina Education Plan as a proposed replacement for Common Core. Please ask the legislators with whom you discuss this issue to take a close look at it. Sandra Stotsky (one of the two professors on the Common Core Validation Committee who refused to sign off on Common Core) has praised the North Carolina Education Plan. The plan can be downloaded for free by going to http://nceducationcoalition.org/download-plan/.

I asked Senator Norman Sanderson about why we had failed to get rid of the requirement for a Certificate of Need in North Carolina, and when we might expect to get rid of it. He said he’s unsure about why it didn’t pass in the recently completed session, but he believes it has a good chance to pass in the upcoming session.

I had thought this issue was dead. Thank goodness I was wrong! Please tell every legislator you can that you want this to come before them in the short session, and tell them very plainly that you want the Certificate of Need (CON) requirement gone.

I also asked Norm about how we can get Syrian refugees (actually, potential Islamic Jihadists) out of North Carolina. He spoke of Governor Pat McCrory’s statement on the subject, and said he’d immediately sent the Governor a letter expressing appreciation for his action.

Both things are good, but we need to do more. We already have 59 Syrians relocated in North Carolina, and we are still threatened with the influx of many, many more. We are kind people, but we would be exceedingly foolish if we exposed our children, grandchildren, and ourselves to that Trojan horse. Please call, write, and pester our U.S. and N.C. representatives about removing this serious threat to our homeland.

If government can’t get protecting our citizens right, everything else will quickly become a moot point.

Very truly yours,


(Raynor James, Chairman, Coastal Carolina Taxpayers Association’s Legislative Action Committee)

CON Laws & Hospitals: their dirty little secret

By Jay Singleton, M.D.

Restoring the free market to our healthcare system in North Carolina is essential. This is currently being attempted in our General Assembly by repealing our outdated CON laws. Recently, opponents of repeal (hospitals) have suggested that this is not a free market as long as they still have to run emergency departments and see indigent patients. I agree with them on one point. Even without the CON, the market is not free. It will still favor the hospitals.

Our hospital systems were built to see patients. Not just the wealthy and insured, but anyone who walked into their doors. This function keeps our society safe and healthy.   In the 1940’s the Hill Burton Act spurred the building of small community hospitals all over our country to serve our growing post-war population. Knowing that these hospitals could not keep their doors open without help, they were granted a sizable and rare gift. They were exempt from paying any taxes. That means all taxes; no property taxes, no income taxes, and no sales taxes on any purchases.

Since then, hospitals have been amassing massive capital from this free pass. In the early seventies, the federal government offered them even more subsidies if they would adopt the fledgling “certificate of need” (CON) program. This law protected hospitals from any and all competition like an iron curtain, but it did not contain costs, and for that reason the federal government abandoned it in 1987. Many states followed suit, but North Carolina kept their CON laws, and our hospitals have added to their considerable wealth which has allowed them to carve out fiercely guarded turfs across our state.

Hospitals then complained to Medicare (in a now familiar way) that they were losing money on indigent patients, and it worked. Over the past decade, the federal government has steadily decreased the reimbursement of physician owned [ambulatory surgery centers] ASCs while keeping hospital owned ASCs the same, and physician owned ASCs are currently paid only 55% of hospital fees.

All of this history brings me back to my initial point. Even without the CON law, the market still favors hospitals. Physicians who open ASCs still have to contend with property taxes, income taxes, and sales taxes while being paid just over half what the hospitals get paid. All of this while still seeing indigent patients as evidenced by similar indigent care numbers when comparing existing hospital and physician owned ASCs.

Physicians who open ASCs have considerable personal financial risk (including the risk of financial ruin) if they choose to enter into this unfair arms race. Hospitals will still have massive advantages even after NC abandons its archaic CON laws; the market will not be truly free, but it’ll be closer.

The Federal Trade Commission has recently weighed in on North Carolina’s CON laws. Officials there commented, “CON laws raise considerable competitive concerns, and generally do not appear to achieve their alleged benefits for health care consumers.” They further explain that CON laws can restrict entry and expansion into health care markets, limit consumer choice, and stifle innovation. So, I ask you, why do these laws still exist in our state?

The CON law does not make hospitals solvent; it makes them rich. This means that they can expand into other areas and smaller communities absorbing local hospitals or even closing them down if they do not fit their needs. This is already happening at an alarming rate across the U.S.

So the next time you hear our large hospitals complaining about the post-apocalyptic world after CON, remember all the advantages they still have built into our system. Hospitals are flourishing in states without CON laws, and our state will not be an exception. The sky is not falling.

Editor’s Note:

Jay Singleton is an ophthalmologist who lives and practices medicine in New Bern, North Carolina. He has made an extensive study of what is true, and not true, about CON laws.


Visiting our Raleigh Legislators

Visiting our Raleigh Legislators
CCTA Legislative Action Committee Report of 4-3-15

Yesterday’s visit to Raleigh was a little different. Instead of setting specific appointments with every person we wanted to see, we took “pot luck” and stopped in to see fourteen legislators from eastern North Carolina (after having sent them an email “heads up” about our coming). At first I was disappointed, but it ended up being a productive day.

First, of our Legislative Action Committee members, only Kim and Glenn Fink and Hal and I were able to go. (There was no one problem, just a variety of things. A wife’s birthday [excused!], an unexpected visit from grandchildren [excused!], an impromptu and quickly called work meeting [excused!], etc. You get the drift – the stars were improperly aligned.)

Second, the legislative schedule was changed so that instead of the House and Senate sessions beginning at 2 p.m., they started at 10 a.m. and 11 a.m. Bummer. Where have all the legislators gone? They’re in session, of course.

Fortunately, since this was an introduction of CCTA to many, I had written a letter to each person we hoped to see and had them with us for hand delivery. My reasoning was, if written “snail mail” letters are useful, wouldn’t hand delivered letters be even better?

The legislators whose offices we visited and the counties they represent (all or part of the county) follow.

Senator Harry Brown, Jones and Onslow
Senator Norman Sanderson, Craven, Carteret, and Pamlico
Representative George Cleveland, Onslow
Representative John Bell, Craven, Lenoir, Greene, and Wayne
Senator Bill Cook, Beaufort, Camden, Currituck, Dare, Gates, Hyde, Pasquotank, and Perquimens
Representative Paul Tine, Beaufort, Dare, Hyde, and Washington
Representative Phil Shepard, Onslow
Representative Chris Millis, Onslow and Pender
Representative Pat McElraft, Jones and Carteret
Representative Brian Brown, Pitt
Representative Michael Speciale, Craven, Beaufort, and Pamlico
Representative Larry Pittman, Cabarrus
Representative George Graham, Craven, Lenoir and Greene
Representative Marilyn Avila, Wake (especially wanted to thank her for her work on a CON Reform bill)

The final paragraph in the letter given to each reads…

“As you can imagine, there are several bills currently being considered that we support because they move toward accomplishing our goals. Examples include Senator Norman Sanderson’s NC Firearms Freedom Act (a good beginning, but we’d like to see it strengthened), Senator Bill Cook’s Property Insurance Fairness bill, and Representative Marilyn Avila’s bill to Amend Certificate of Need Laws. There may be others that have not yet come to our attention. We are very willing to work to support any bill that is in alignment with our beliefs about good governance. If we can help you by supporting something we mutually agree is worthy of it, please let us know how.”

The first person we met with was Representative Pat McElraft. She is a very pleasant person. We discussed the three things in the paragraph above with her. She reacted positively to two of them, but was negative about the need to reform Certificate of Need (CON) laws. If you know anyone who might have influence with her, please ask them to work on changing her mind. Also, we really should invite her to our public meeting on April 21 at which Jay Singleton, M.D. will speak on the reasons CON law needs to be reformed. (In a nutshell, let the free market significantly reduce health care cost while increasing patient safety. And nobody can lay out that case better than Jay!)

After that, we met with Representative George Cleveland. Actually, George wasn’t in his office when we first arrived, and we met with his Legislative Assistant, Pamela (can’t remember her last name, darn it). She is a very sharp and knowledgeable person. Very likeable, too. She and Kim had a long talk about Common Core in particular and education in general. They were in complete harmony. It was fun to listen and occasionally kibitz. When George got there, we discussed the usual suspects with him, plus Kim brought up a bill he is sponsoring that ties data collection and sharing among drivers’ licensing, work force info, and students (preschool to age 20) in a way that seems inappropriate and potentially dangerous to free choice. We met with resistance on that topic. Again, George Cleveland seems like a fine, basically conservative gentleman. If any of you has his ear, please “bend” it on this topic.

Senator Norman Sanderson wasn’t in his office when we got there, and we had a good chat with Kathy Voss, his Legislative Assistant. Another personable, smart, charming person. In fact, it would be hard to exaggerate just how high the quality is in each and every Legislative Assistant we met with. Each of them we talked to is a very impressive person who is smart and who has excellent “people skills.” I’m not sure how our legislators have done it, but they surely have found talented people.

Norm and Linda Sanderson arrived, and we had a nice visit with them. I may not have shown proper appreciation to Norm for his work on the NC Firearms Freedom Act. I complained of what I see as its two weaknesses. It only pertains to weapons and ammunition manufactured in North Carolina, and punishment for persons who don’t abide by the act will be based on breaking the law’s being only a misdemeanor. Norm was pretty clear that he’s unwilling to buck the way the “interstate commerce clause” has been interpreted, but he is willing to try to increase the seriousness of an infraction so that it will be a felony. I really appreciate that.

Norm and I also got into a discussion about his work toward North Carolina’s requesting an Article V Convention. Kathy had told us earlier that someone had given Norm a very hard time yesterday about this very topic. In doing so, the person had made reference to CCTA. I explained that CCTA is divided on this subject with some of us (including me) strongly opposing it and some of us strongly favoring it. Since we are divided, CCTA does not have an “official” position. I revisited some of the reasons I oppose an Article V Convention (I’d sent him a long email previously), and Norm listened patiently, explained he thoroughly understood those ideas, but feels “it’s a conversation we need to have.” It just seems to be one of those times when two people with the same basic goals had an honest disagreement about how to get there.

Representative John Bell was not in, but we had a really rewarding talk with his Legislative Assistant, Susan Horne. Susan shared some information with Kim about some of the things she’s following for us, and asked some very astute questions about the pros and cons of CON reform.

Jordan Hennessey, Senator Bill Cook‘s LA was also very helpful; he always is.

Hazel Speciale was her usually welcoming, cheery, smiling self, and we visited with her learning more about how things work until Representative Michael Speciale arrived and joined the conversation. Discussion among the six of us was wide ranging. We learned some more about the various CON reform bill proposals. A bill has been proposed in the Senate that would absolutely eliminate the need for a Certificate of Need in North Carolina. Passage of that would be perfect. But can it pass? There is a lot of opposition to CON reform. The opposition comes from people and entities with money and power. Will a proposal to do away with CONs altogether bring out a full court press of opposition, while just removing a few might work? I just plain don’t know, but I wonder, don’t you?

Some of the discussion revolved around the Article V Convention issue. Michael thinks much the way I do, but he expresses it better.

Representative Larry Pittman and his wife and Legislative Assistant, Tammy, walked by the office door on the way home for Easter. We waylaid them, gave Larry his letter, and wished them a Happy Easter.

We then returned to Michael’s office, wished him and Hazel “safe travel home,” and left to head home ourselves.

Respectfully submitted,


Raynor James, Chairman, CCTA’s Legislative Action Committee

Wakeup Call 03-13-2015

Continued from last week. Discussion with Dr. Jay Singleton about NC Certificate of Need law.

Wakeup Call 03-13-2015
Wakeup Call

00:00 / 24:01

Wakeup Call 03-06-2015

Dr. Jay Singleton and Certificates of Need.

Wakeup Call 03-06-2015
Wakeup Call

00:00 / 23:59

NC Certificate of Need

Is it time for North Carolina to get rid of the Certificate of Need (C.O.N.)?

Tune in to Wakeup Call tomorrow morning at 6:30 am to listen to what we have uncovered about this law that drives medical cost sky high.
Or click on Wakeup Call to listen online.

Many “CON” laws initially were put into effect across the nation as part of the federal “Health Planning Resources Development Act” of 1974.  Despite numerous changes in the past 30 years, about 36 states retain some type of CON program, law or agency as of 2014. North Carolina is one of them and we think it’s time for it to go.

It is pretty clear that North Carolina hospitals are adamant about using the state’s Certificate of Need (CON) regulations to shield themselves from the free market. After all, what law better protects their fortresses from potential competitors who could possibly provide more innovative services in less expensive settings?

Forbes (read more)

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