- [Narrator] The State House takes steps on medical marijuana in North Carolina.

And the State Insurance Commissioner joins the show to share his side of the Blue Cross Blue Shield deregulation debate.

This is State Lines - [Narrator] Quality public television is made possible through the financial contributions of viewers like you who invite you to join them in supporting PBS NC.

[upbeat music] ♪ - Welcome back to State Lines.

I'm Kelly McCullum.

We have a great panel today.

Joining me, WUNC radio's Colin Campbell.

Senator Mike Woodard of Durham County.

Beside him, North Carolina Commissioner of Insurance, Mike Causey and our good friend Billy Ball of Cardinal & Pine Welcome gentlemen.

We have a lot to get through.

I don't have time to to chit chat today.

We have business to take care of.

Senate Republicans filed a bill that will establish new guidelines for future state elections, if passed.

Senate Bill 747 would require absentee ballots be received by Election Day.

Board of Elections, could not receive private donations to support election operations.

The public could inspect absentee ballots.

Same day registration voters would cast provisional ballots.

Mailed in ballots would be screened by signature verification software and Senate Republicans say they're pointing at polls in the past saying half of North Carolinians back in 2021, believe that the 2022 elections, Colin, would be free and fair.

So we have stuff, bills that could affect law going forward, but we're looking back at 2021 polls and people aren't as, I don't know, are they trustworthy of elections as they were say 2012?

- I think the change has largely been not necessarily because of any instance that have happened in North Carolina that would make people less trusting of elections, but just really the national narrative.

Depending on which cable news network you wanna watch, you're gonna hear a very different narrative about how trustworthy, not North Carolina, but the United States elections are.

And that sort of percolates down to the state level and you get this pressure, particularly on Republicans, to make some changes to show that they're doing something.

Now the minutia in this bill particularly with respect to things like signature matching, I don't think the average voter really has a sense for how that works.

And that's not necessarily something they're clamoring for.

'Cause they don't really realize how the process actually works to process absentee ballots.

- Mike, you can speak for every Democrat in North Carolina I guess on this issue.

I've seen the press release outta Dan Blue's office.

And the word suppression is out there and all the talking points.

And on the flip side we're getting the Republican talking points.

Parse this for us.

Anything in this reasonable?

Or are we playing politics with this bill?

- Well, I think we're playing politics and I think there's some unreasonable things there.

If this bill were in place in the 2020 election, 30,000 voters who mailed their ballots in and they were received after election day, their ballots would not have been counted.

30,000 voters would've been disenfranchised.

Now interesting you might say, which way did it break down by party affiliation?

Interesting, a third, a third, a third, Democrat, Republican, unaffiliated.

- Everybody loses some votes.

- That's right.

But if you lose 30,000 votes, that's the difference in the Supreme Court race, a governor's race a few years back, some council of state races would've changed.

I just don't see how we can disenfranchise 30,000 voters, because they did everything right.

They got their ballot, they filled it out properly they got two signatures and then they dropped it in their mailbox.

We're counting the US mail to be the thing that disenfranchises votes.

- Commissioner Causey, 30,000 votes.

Some of those would've gone your way, if they hadn't been lost, they wouldn't have, you know.

- Well, I do understand some of the concerns about the bill, but you know, one thing that was brought to my attention made me think about when I was serving overseas in the United States Army, the first time I voted, was by absentee ballot.

My concern would be if our military folks overseas cast their ballot, they have no control over the postal service and how long it takes.

But I think there does need to be some defined amount of time where it comes in.

- Billy, how do we get this sorted out?

In 2016, the Russians gave the presidential election to Trump and then Biden stole the election four years later.

And so everybody's just all ticked off about elections.

- I think regardless of the narratives on the cable news networks that Colin alluded to a moment ago the numbers show that voter fraud is vanishingly rare in the United States of America.

And when it happens, it's not impacting elections.

So I think that what's happening at the legislature right now in North Carolina is not happening in a vacuum.

You can look at dozens of Republican controlled legislatures who are doing things just like this to cut back, vote by mail, especially.

Because those numbers tended not to favor former President Trump in the last election.

- Is it okay to be skeptical of whether you're a Democrat or a Republican?

'Cause we are inundated with social media with allegations and with cable news.

I mean, people love cable news more than local news, it seems.

- Absolutely.

I always support skepticism, especially, when it comes to social media.

There's a lot of bogus stuff out there, but there's not any credible source that's gonna tell you that voter fraud is a huge problem in our elections in America.

That it's swinging elections.

- All right, Billy - Let the data drive the decision.

I mean, the last couple elections, three, four, 5 million votes cast, you have a handful of cases where ballots were cast fraudulently.

- All right.

- It's not there.

- All right, Billy, coming back to you house speaker Tim Moore was telling reporters this week, there might be or is an appetite for possible casino legislation.

He says lawmakers in his caucus at least may quote, "Take a look at how casinos could help North Carolina's economically depressed areas by creating entertainment districts and an entertainment district pairs a nice casino with shopping, dining and entertainment options."

The speaker admits the House Republican caucus needs to internally discuss any gaming options before any bill is moved.

Billy, that casino in Danville, Virginia.

Sure made some conservatives less conservative on this issue, I would, daresay.

- Certainly got them talking.

I am glad the legislature is talking about this and specifically thinking about economically distressed areas of the state.

Anyone who watched what happened out in Canton, knows that there are economies that are struggling in parts of this state that need some help.

I'm not saying casinos are the answer.

There are pros and cons with casinos that anybody who has researched them can tell you.

It can be done thoughtfully to think about casinos, to work on casinos and say, as long as we are thinking about problem gambling and the other sorts of issues that come with legalizing casinos, but.

I am certainly glad that legislators are looking at things they can do for counties that are struggling.

- Mike, I think it's interesting that they're saying if we're gonna look at it, we're gonna look at areas where a casino can bring economic viability, jobs, and of course, the tax revenue.

Is this the free market speaking?

Is a fair assessment coming?

- Well, I think if you went across the state to our churches you wouldn't find much appetite for casinos in North Carolina.

And as I heard somebody say, they were talking about all the new revenue that would come in.

This is revenue that people may be taking from their groceries or their children or their families.

So there's just a lot of concerns.

We had this same debate back when we were looking at the state lottery and the the state was divided as we saw, the Senate was quite divided, and so the state lottery narrowly won.

And I've heard people say, yeah, we need to get in on the action, we've got surrounding states with casinos.

But the people that I talk to, are not much in favor of it.

- Senator Woodard, is this an area where the left and the hard right could come together for differing reasons to protect the poor?

I remember that debate being pretty loud a decade or so back on other issues involving gambling.

- It was loud just this week we were talking about online sports gambling, that passed the Senate just this week, and is going to the the House for concurrence next week according to the speaker, and we heard that.

My most liberal colleagues, the most conservative members of the Republican caucuses were voting together against this for some of the concerns that the commissioner talked about.

- Why not let the adult make their decision if they wanna put their last $5 on the blackjack table?

It's a free world out there and if the market doesn't support a casino in town, it will close down, right?

- That's the free market argument.

And on Monday, Memorial Day, I drove up to Danville for some research to see what was there.

And I would say 70, 80% of the cars, based on license plates, were North Carolina plates.

- I think that's why you see Rockingham County as one of the locations they're looking at, hometown of Senate leader, Phil Berger, who's just 30 minutes away from Danville.

- That's right.

- Did you win anything?

- Came out a dollar and 55 to the good.

- How was the buffet?

- They didn't have buffets yet.

- Yeah, okay.

- So anyway.

- Colin, why can't all these gaming issues be rolled into one giant bill?

If we get our horse racing, our video poker, our video gaming, and our casinos all in one bill we can all read?

- Well that's something House Speaker, Tim Moore, brought up as a possibility this week, that he sort of immediately backtracked a day later to say, I don't think that's how it's gonna go.

Initially the thought was maybe that we'd pair casinos with the sports betting legislation.

I think that's now looking like it's gonna go separately, that the House will vote next week to concur and send that bill to the governor as is, leaving these other issues to go further.

I think they worked so hard to get consensus and the right number of votes on sports betting, it barely failed last year.

The folks pushing that bill really don't wanna tie in some of these other issues 'cause the political calculus changes.

There may be some additional opposition to things like casinos that you'll see.

And if you run that as a separate bill, you don't necessarily derail the sports betting bill.

- Senator Woodard, but in that rural area, when that factory closes as it did in the mountains, a casino comes and does bring jobs, you will work, and you will not starve working there.

- Sure.

You look at the casino in Danville, it sits literally on the side of the former Dan River Mill.

They knocked down the building, they left the smoke stacks up as a historic memory of that former huge textile facility.

But it's right on the Dan River, where that textile plant was.

- Back in March, the State Senate passed medical marijuana legislation by a vote of 36 to 10.

This week a House committee began a discussion-only process, on what's called the Compassionate Care Act.

The Senate legislation establishes the healthcare conditions under which a patient, a patient, could legally purchase cannabis, license up to 10 official cannabis growers, and then up to 80 medical cannabis centers to sell the product in the marketplace.

House Speaker Tim Moore says, medical marijuana legalization has a greater chance than ever of passing the House.

Billy, the bill's passed the Senate twice now, 36 to 10, tells me the people have spoken at least to those senators in those same 100 counties, why is the House only discussing it?

- I think that the divide between the House and the Senate on this issue is really fascinating, 'cause I think a few years back we might have seen it completely flipped in terms of where you would see more support for this idea.

But I am glad the legislature's talking about it.

I think sometimes that when people title a bill, it could be misleading, but this one has the word compassion in it.

And that's because we're talking about the benefits that medical marijuana can have for people, especially, we're talking about veterans, mental health care, so many things that could help them.

- Commissioner Bill, Bill Raven, there's not a Democrat bone in his body, but he says, that product, cannabis, helped him really survive cancer several years ago.

- Well, I will say Senator Raven makes some compelling arguments and he feels strongly about that.

But I've been all over the state, I was in Columbus County this week, talking with folks just asking, and the only reason I was asking, I had some folks come to my office, and first time I'd really even looked at this bill to raise concerns about how this has raised automobile insurance rates in other states that have passed it and and wanted us to take a look at it.

I had other citizens express concerns, what's this going to do to my health insurance rates?

So in talking with the people around the state, I don't see the support for it.

And I'm not sure how it's going to go in the House, but I believe it'll be a divided vote for certain.

- Senator Woodard, you're from Durham County, known for tobacco.

- Sure.

- And so we like to smoke in North Carolina at least something.

What are your take on the medical cannabis bill?

The House is gonna take a slower approach.

Is this a negotiating tactic with the Senate over the budget, technically, 'cause Bill Raven's a powerful senator.

- I'm sure there will be a negotiation.

Senator Raven, to his credit, was walking the halls.

My office is in the middle of a bunch of House offices in the legislative office building.

And Senator Raven was walking the floor, answering questions and maybe whipping votes to some extent, but telling his very compelling story.

And so I think we're gonna pass it this time, I think there's a need for it.

I'd be glad to start sending the commissioner my emails because what I hear from folks is overwhelmingly in support of this, whether it's for pain, PTSD, some of the things that Billy talked about.

So people want it, but remember, it's not just smoking, there are many different applications of this through pills or gummies or topical applications that can help people.

So there are a lot of different ways.

It truly is a medicine, this is medicinal marijuana.

- Heavily regulated, no doubt about it.

What's the difference in hearing Bill Raven Republican give a personal story of how it helped him with cancer versus a Representative Kelly Alexander down in Mecklenburg County who's pushed for relaxation of marijuana laws for over a decade?

- Well, the big concern I think in the House Republican caucus is does this lead to recreational legalization?

Kelly Alexander has been pushing for both.

He'd like to see medical marijuana and he'd like to see recreational marijuana.

And so there's sort of a distrust of that argument.

Bill Raven's argument is very much this has to be very tightly controlled, only for conditions like PTSD, Parkinson's that are very severe and you know, where there's some proven element that this can serve as a treatment and that that won't lead to further legalization down the road.

But Raven keeps pointing to Hawaii as an example.

They've had medical marijuana for about a decade or so and there's not been a successful push for recreational there.

So I think that's gonna be the crux of it, is proving that North Carolina will be more like a Mississippi where it's a very conservative state.

They've done it but they haven't gone very far in that direction.

- All right.

Last week on "State Lines", the panel discussed the effort to deregulate Blue Cross and Blue Shield of North Carolina.

A bipartisan group of lawmakers say Blue Cross should be allowed to create a new holding company.

It gets complicated but the new holding company would have flexibility to take business actions that Blue Cross supporters say would help the company better compete in the modern healthcare marketplace.

One gentleman watching this show or at least somebody told you about it, Commissioner Causey, they were talking about you.

- I saw it.

- Let's be, 86/26 in the House.

I don't know what was in this- - 41 to five I think, but I'm not gonna rub it in.

- Why are you doing this and why go up against that kinda headwinds?

- I lost the bill.

- The Blue Cross Blue Shield, give them a holding company, let them be competitive.

- Well, look, the passage of this bill demonstrates the power and authority that Blue Cross and Blue Shield has in North Carolina.

They are by far the major health insurer in the state.

In 2021, they had nearly 83% of the personal health insurance market and almost 80%, 79.6% of the group health insurance market.

And if you take all the premiums that come in for all types of insurance, Blue Cross is above 30% of all insurance premiums.

So for Blue Cross to argue they can't compete, that was pretty demonstrated with the passage of the bill.

The way in which they went about this is what I had an issue with.

They left out the Department of Insurance and our subject matter experts and we learned about it the day the bill was filed.

And the problem I saw with it was the lack of details.

Because what they're saying in this bill is Blue Cross can take this money and I will argue that this is policy holder dollars that's been accumulated.

Sure they've got some investment returns and some federal tax dollars there, but since the 1930s, Blue Cross has had an advantage up to the 80s.

They did not pay premium tax.

When I started in the insurance business, other health insurance companies paid premium taxes but not Blue Cross and Blue Shield.

And they've had all of these advantages and the federal government changed that in 1986.

But we had actuaries look at this, we had financial experts look at it, we had consumer folks and nobody thought it was a good idea.

And I will say when this bill first was up in the House, in the House Health Committee, there was total division, it was almost a 50/50 split.

Now, the chair moved it out and then the next two meetings, they had no discussion but there was a very limited discussion and debate and Blue Cross won.

They had the fire power, they had the political support.

But if you go talk to business owners and families that I talked to, there was not a lot of support from the public.

So I say the legislature was not in sync with the voters on this particular bill.

And I used the example of Western Carolina Industries, WCI, they represent the 300 largest businesses in Western North Carolina.

They were adamantly opposed to it but it was too little, too late, so.

- Equal time there are we, Blue Cross, Blue Shield, you've heard his take on it, are you listening to the people or are you listening to an insurance company which admittedly people love the Blue Cross if they have it.

So I mean.

- I love working with the commissioner but he and I part ways on this one because I believe the legislature did legislate tours and and legislature itself did listen.

You saw tour constituents, tour policy holders and to the people who benefit.

Blue Cross, Blue Shield is a 90 year old company in this state.

It is a not-for-profit, that's an important thing to remember.

So throughout its existence, there have been certain rules that are in place, certain controls over them as a not-for-profit that the commissioner has most of the controls on those levers there.

And to some extent it has limited Blue Cross's ability to do certain things that their for-profit competitors have not been able to do.

Don't forget Blue Cross writes all lines of insurance in all 100 counties.

Their for-profit competitors pick and choose which markets they want to go into.

So there are some things Blue Cross does.

Remember, a lot of those investments and the commissioner knows this, Blue Cross invests those in things that benefit not only their policy holders but all of us as well.

Example, they've invested in a lot of the emergency medical centers that pop up on your corners.

Blue Cross dollars help put those there.

Investing in food deserts for healthy food so that people live a healthy lifestyle.

The argument has been that, well, premiums are gonna go up.

I don't think there's evidence of that.

We've seen similar holding companies established in other states.

New Jersey just began theirs and we have not seen that kind of record that was alleged that's gonna happen under this bill.

I actually think that we're going to, and the commissioner's still gonna have a large role to play.

This bill is passed, it's on the governor's desk, it will be law in a few days.

And then I know this commissioner is gonna bird dog this issue.

He's going to follow the law and he's gonna do a good job helping us implement what I think is good policy.

- Commissioner, you look ready.

- Well, I will give credit to Senator Woodard.

He came to my office early on, probably less than a month that this bill had been filed, and we sat down for almost an hour and had a discussion.

Now he didn't buy what I was selling, but you know, I was able to articulate, you know, these are our concerns.

But yeah, there's no doubt about it, we still have oversight over Blue Cross, the insurance company, but once that money leaves Blue Cross, the insurance company, we have no say and there's no oversight.

So there's no transparency, there's no accountability.

And I certainly applaud Blue Cross for those things they've done to help in the counties with healthcare, but we still have to have oversight and hold health insurance companies accountable - To the basic level, in your opinion, short answer, when and if, it looks like it's going to be when it goes through, are Blue Cross customers going to be better served even if you don't like losing political power as a result?

- I hope that Senator Woodard's right, the premiums don't go up, but I've seen in other states where they've done this and this is not new, they've been trying to do this for 25 years and they had the political clout to get it done this year.

But, I think that the day will come, in my opinion, North Carolina will rule the day that this bill passed.

I'm hoping that's not the case, but the legislature has put their faith and trust in Blue Cross to do the right thing and that's what we're hoping Blue Cross will do.

- Mike, same question to you.

How are North Carolinians gonna be served when you get your way on the Blue Cross deregulation issue?

At least letting them get more in the marketplace?

- I think the policy holders, I think consumers, and people who are seeking healthcare are gonna benefit in the end.

And it wasn't that we as legislators put our faith in Blue Cross.

We put our faith in Blue Cross and we put our faith in this commissioner as well as the Attorney General and others who have a lot of oversight.

There are guardrails there.

We might disagree about what all those guardrails mean, and that was a real crux of our debate over these last few weeks with the commissioner and other advocates.

But we also put our faith and trust in those folks to continue to provide critical oversight of these insurers.

- The oversight of the insurance company we have, but once the money leaves the insurance company, there is no oversight, so that's the problem.

- You said money leaves the insurance company and it's gonna go to a holding company that then is controlled by-- - By Blue Cross.

- And you don't regulate that?

- No, sir.

- Well, yeah, I think there is some, there is some oversight there.

And of course, there was always the, their concern has always been if Blue Cross someday says we want to be a for-profit company.

And some times during their history, they have tried to do that.

Not successfully.

They were not able to do that.

And the key thing is, would all the assets of Blue Cross Insurance, Blue Cross Holding Company come together and come back to the public good?

This bill says it will.

- Well Blue Cross has stated publicly that they're not going to raise premiums.

So we'll hold those statements accountable.

But, the Department of Insurance is gonna look closely at all health insurance companies going forward to make sure that they're giving proper customer service, because the customer service has been lacking.

We've had people that have had to jump through too many hoops to get a legitimate claim paid and that's not right.

- Billy, just yeah, go ahead.

- They'll take some of that money and invest in improving their systems.

I've seen their systems that are a little bit lacking compared to some of their for profits.

- That would be good.

- And that's one of the things that I have been assured by the leaders of Blue Cross, they want to invest in technology in ways that they have not been able to do so far.

- I've got about a minute left.

We'll stay outta the elected guys way.

What do you take on this?

What's the take on this bill?

- You know, this is interesting 'cause it comes against the backdrop of the state health plan shifting out of Blue Cross the next few years and switching to Aetna, which is a decent chunk of Blue Cross's customer base, essentially.

So that's really what it comes down to is they're trying to make sure they're, I guess, a viable company going forward and using the political clout that they have.

The challenge on this issue is, as we just discussed, it's extremely complicated.

The average voter doesn't understand any of that.

They will understand whether their premium goes up or down in the few years, so the proof will be in that essentially.

- 30 seconds, Billy, you get the last word on healthcare in North Carolina.

What is the take from your side?

30 seconds.

- I think that the right question is: Is this going to help or hinder the average North Carolinian?

I don't think North Carolinians are sitting around worried about the competitiveness of Blue Cross/Blue Shield and their work.

So I think it's will it benefit them or will it hurt them?

So I'm glad we're asking that question.

- All right, Billy, thank you.

Commissioner Causey, thank you.

Senator Woodard, thank you.

Collin, always good to see you, my friend.

- Great to be here.

- And thank you for spending a half hour with us.

Email your thoughts and opinions to the email address, statelines@pbsnc.org.

As always, I read every email and I'll write back to the nice ones and even the mean ones.

I'm Kelly McCullen and thank you so much for watching "State Lines" and we will see you next time.

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