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Carter Wrenn: Free markets vs the hospitals, how power works in the legislature

"Republican legislators, for years, have stood up and spoken up for free markets," writes veteran Republican consultant Carter Wrenn in his blog, Talking About Politics.

"It’s part of their creed. They don’t like government picking ‘winners and losers.’ But when a group of Republican legislators in Raleigh decided to sponsor a bill to break the hospitals’ monopoly on outpatient surgeries and put the free market to work – it didn’t appeal to the Hospital Association at all.

Right now, before, say, an orthopedic surgeon can do outpatient surgeries in his office instead of in a hospital, he has to get a permit called a ‘Certificate of Need’ from the state. And his chances of getting that certificate are slim to none.

Cost of hospital care could become easier to access

The state Senate passed a bill Thursday to make hospital bills more transparent and easy to understand.

The bill would require hospitals to post prices and payments for the 100 most common hospital services, similar to the hospital data released by the federal government Wednesday. The Senate bill goes farther; hospitals would list the prices they charge, the amount paid by an uninsured patient, the amounts paid by Medicare and Medicaid, and the amounts paid by large insurers.

Unlike shopping for a house or television, patients seldom know ahead of time the price of hospital care and how much they owe. Patients typically find out days or weeks later when the explanation of benefits arrives. This makes it almost impossible to shop for the best price.

The bill, which now goes to the state House, prohibits more extreme forms of bill collecting: Public hospitals could no longer garnish a patient’s wages, and no hospital or ambulatory surgical center could put a lien on a delinquent patient’s primary residence.

North Carolina’s hospitals have been under heightened scrutiny since last April, when The News & Observer and The Charlotte Observer published a series of stories revealing nonprofit hospitals’ high profits, huge markups on drugs and tough stances against patients struggling to pay their bills. —Staff writer Joseph Neff

Morning Memo: Pray-in targets lawmakers, Foxx to join Obama administration

CIVIL DISOBEDIENCE AT LEGISLATURE: Clergy and students will participate in an act of civil disobedience Monday at the Legislative Building "in response to the collective acts of the legislature," said the Rev. William Barber, president of the state NAACP. The action, from 5 p.m.- 6 p.m., will be a "form of a pray-in," Barber said. The House convenes at 4 p.m., the Senate at 7 p.m. The NAACP has opposed the legislative actions reducing unemployment benefits, state House approval of photo voter ID, and other legislative measures.

FOXX TO TAKE OBAMA POST: President Barack Obama on Monday will nominate Mayor Anthony Foxx to be secretary of transportation, a White House official said Sunday on the condition of anonymity. The nomination of Foxx, whose city hosted last year’s Democratic National Convention, would make him the only African-American selected for a Cabinet opening in Obama’s second term. (More below.)

***Good morning. Welcome to the Dome Morning Memo -- a full roundup of North Carolina political news and analysis below. ***

Morning Memo: Gift ban repeal dead, Hahn investigation seeks motive

TILLIS SAYS LOBBYIST GIFT BAN WILL REMAIN INTACT: House Speaker Thom Tillis took to Twitter this week to declare Republican Robert Brawley's bill to lift the ban on lobbyists giving lawmakers gifts is dead. "Benny, does the fact that the bill is dead give you any idea?" @thomtillis wrote. The speaker's office confirmed the 10:10 p.m. Tuesday tweet was legit. Tillis addressed the response to Benjamin Ray, an operative at the N.C. Democratic Party pushing Tillis on the issue and tying it to his office's controversial past with lobbyists and the fact the bill came from one of his committee chairman.

MOTIVE FOR JAMIE HAHN'S STABBING TURNS TO CAMPAIGN MONEY: As the Triangle mourned slain political strategist Jamie Hahn on Wednesday, attention turned to whether the man who police say stabbed her had made questionable campaign finance reports while working for Hahn’s firm. More on the story below.

***Thanks for reading the Dome Morning Memo -- click below for much, much more from a busy day in N.C. politics. Send news and tips to dome@newsobserver.com. ***

Morning Memo: McCrory to announce Medicaid overhaul; big day at statehouse

McCRORY TO ANNOUNCE MEDICAID SYSTEM OVERHAUL: Gov. Pat McCrory rejected a Medicaid expansion earlier this year saying the system was broken and Wednesday morning he is expected to describe how he plans to fix it. The Republican has talked frequently about the rising costs of the healthcare system for select low-income and disabled residents and issued a video preview Tuesday saying he would create a "partnership" that will help keep costs low. Check Dome later today for more details from the 10 a.m. press conference.

***It's a jam-packed day in North Carolina politics. Get the full scoop on all the big stories from the Dome Morning Memo below. Send tips and news to dome@newsobserver.com.***

Morning Memo: McCrory promises big changes; Democrats hit Ellmers

GOV. MCCRORY PROMISES BIG CHANGES COMING: Days after releasing a modest state budget and weeks after a tepid State of the State address, Republican Gov. Pat McCrory is promsing big things. "Now we're moving into policy," he told a Chamber crowd Wednesday. The News-Record hits the highlights of what we should expect: "McCrory said the state Department of Transportation will be “revamping” how it finances and distributes money. ... McCrory said he’ll have “major announcements on Medicaid reform” next week, and that his administration is “completely revamping” the state’s commerce department. ... He said his tax plan should be ready within weeks and reaffirmed a desire to cut income and corporate tax rates to the lower levels of neighboring states. ... He said major announcements are coming on the state’s job recruitment efforts at the N.C. Department of Commerce, which new director Sharon Decker said last week may privatize many of its functions."

TODAY AT THE STATEHOUSE: The Senate convenes at 11 a.m. to hear a Mecklenburg property tax measure. The House meets at noon to hear a bill to repeal taxpayer funded judicial elections and another bill that favors Blue Cross Blue Shield. At the Capitol, McCrory and Public Safety Secretary Kieran Shanahan will announce at 10 a.m. the new Highway Patrol commander, Alcohol Law Enforcement director and State Capitol Police chief at a swearing-in ceremony.

Also on the political calendar: Mayors Against Illegal Guns is promoting a day of action to push its background-check legislation; a group of area university and college professors host a 5 p.m. forum at Duke University titled, "Save Our State: Scholars Speak Out on North Carolina's New Direction"; and former Florida Gov. Jeb Bush appears at Guilford College for a 7:30 p.m. event with former U.S. Sen. Bill Bradley, hosted by PBS's Gwen Ifill. This is likely Bush's his first visit to the state since the release of his book and open talk about running for president in 2016.

***Good morning! Happy "Friday" to state employees with tomorrow's holiday. Thanks for reading the Dome Morning Memo -- the source for North Carolina political news. Send tips and news to dome@newsobserver.com. More headlines below.***

Rucho, Brown bill: Take mystery out of hospital bills

Taking aim at a hospital billing system that is shrouded in mystery, two N.C. senators introduced legislation Wednesday that they say would make it far easier for patients to shop for the best prices on medical procedures, The Charlotte Observer's Ames Alexander writes.

Hospitals would be required to publicly disclose their prices on their most common medical procedures under the bill, sponsored by Republican senators Bob Rucho of Matthews and Harry Brown of Jacksonville.

The legislation would also set up financial rewards for hospitals that provide low-cost care – and would ban a type of double-billing now common in radiology.

The legislation was prompted by a series of stories last year in The News & Observer and The Charlotte Observer, “Prognosis: Profits,” which found that nonprofit hospitals in North Carolina are inflating prices on drugs and procedures, sometimes as much as 10 times over cost.

Find the full story here.

Morning Memo: Hagan hires campaign manager, GOP '14 field unsettled

HAGAN HIRES FORMER REID AIDE AS CAMPAIGN MANAGER: The 2014 U.S. Senate race is taking shape with Democratic incumbent Kay Hagan hiring Preston Elliott as her campaign manager. Elliott most recently served in the same role to help U.S. Sen. Jon Tester win re-election in Montana, one of the closely watched races of the 2012 campaign cycle. In 2010, Elliott worked as coordinated campaign director for U.S. Senate Majority Leader Harry Reid in his re-election effort, another high profile race. The big hire signals that Hagan expects a big fight in 2014. "He has a proven track record of success, and with his help and the help of North Carolinians of all walks of life, I expect to cross the finish line with a victory in November 2014," Hagan said in a statement.

WHO WILL HAGAN FACE?: A new Public Policy Polling survey -- set for release later Tuesday and obtained exclusively by Dome -- shows its a wide open race among Republican primary voters. Republican Lt. Gov. Dan Forest leads the field with 18 percent, according ot the Democratic polling firm. PPP added Forest's name to the potential field for the first time this month and he still managed to outpace Congresswoman Virginia Foxx (13 percent) and Labor Commissioner Cherie Berry (12 percent). The only announced candidate, tea partier Greg Brannon, gets 4 percent and at least a quarter of voters weren't decided on any of the nine names PPP tested. (More from the poll below.)

***Thanks for reading the Dome Morning Memo -- the source for North Carolina political news and analysis. Send news and tips to dome@newsobserver.com. Much more Memo below.***

Audit: Hospitals overcharged for inmate care

A state audit found the Department of Public Safety spent too much on inmate care when hospitals overcharged the prison system.

The audit looked at the 10 largest hospital claims during the 12 months that ended June 30, 2012 and found that half overbilled the state. The amount paid for the 10 claims came to about $1 million. The Division of Adult Correction paid about $105,000 too much.

Because the audit was limited to 10 claims, the results cannot be used to draw conclusions about the 893 hospital claims the Division of Adult Correction reported it paid, the audit said.

The audit recommends the division try to get the money back and hire a professional audit firm. In its response, the Public Safety Department said it is looking to hire a claims management contractor that can prevent overpayments.

Morning Roundup: Cate Edwards may testify Tuesday for father's defense

On Tuesday, Cate Edwards, the 30-year-old daughter of the one-time Democratic presidential hopeful, is on the list of possible witnesses in the John Edwards trial. A Harvard law school graduate who’s married now, living in Washington, D.C. and running her late mother’s foundation, Cate Edwards has been in the courtroom for most of the testimony. She occasionally leans in to discuss legal points with her father.

More political headlines:

--A sarcastic Barry Saunders asks in his column: Say, didn’t we just vote to get rid of those people? A week after North Carolina voters joined the 19th century and 30 other states by voting to approve a constitutional ban on gay marriage, you can still see gay people working, walking down the street, at the gas station and at the mall. If they aren’t going anywhere, what the heck was that vote for?

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