- The race for governor in North Carolina is proving difficult to track.

Polls are varying widely.

And lawmakers reopen a conversation about possibly expanding the Right to Try law.

This is "State Lines".

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

I'm Kelly McCullen.

We have a great panel today to my right, Mitch Kokai of the John Locke Foundation, representative Allen Buansi of Orange County, to his right, representative Erin Pare represents Wake County, seat four filled by Cardinal and Pine managing editor and our good friend Billy Ball.

Hello, everyone.

Let's start with an easy one, the fluctuating gubernatorial polls, Mitch.

Campaign 2024 slowly ramping up across our state.

You can expect it will reach a higher gear once lawmakers adjourn the legislative session, hopefully in a few weeks, according to the lawmakers.

That's not stopping groups from engaging our sentiment as voters on the candidates.

Let's look at the Governor's race.

It's proving very difficult to gauge this month.

This week, the Cook political report says Democrat Josh Stein and Republican Mark Robinson are now statistically tied.

As such, Cook considers the North Carolina Governor's race a toss up from lane Democratic.

It's appearing that Mr. Robinson will be the best funded Republican gubernatorial candidate in state history, and Josh Stein has already banked tens of millions of dollars for his campaign.

Mitch, we'll kick this one off with you.

Is the rollout of funds and ads and social media now starting to shape this race to give Mark Robinson in this case a slight bump as we end May?

- I'm not sure that we are getting a bump from the ads, 'cause I haven't seen a whole lot of ads yet.

I think they're gonna be coming up a little bit later in the campaign season.

I'm also not surprised that we're seeing this race being considered a toss up.

Our organization does a poll, and our last poll had them at both 39% with a bunch of people undecided, which means a lot of work still needs to be done to convince the people who can be convinced one way or the other.

I think the other thing that we should point out in terms of the Cook political report switching this to being a toss-up race from lane Democratic, is there's a recognition now that we're not talking about Roy Cooper.

Roy Cooper has been somewhat unique among Democrats in being able to be seen as popular despite what's happening anywhere else up and down the ballot among Democrats.

Josh Stein is not Roy Cooper.

He would like to be seen in that same vein to get some of those spillover voters from people who support Donald Trump, but would also support the Democratic candidate for governor.

And we also I don't think have seen yet what the folks who are marginal voters, the ones who aren't really paying attention yet, what they think about Mark Robinson.

He's incredibly popular among the Republican base, very much disliked among the Democratic base.

But what about the people in the middle who are going to decide this?

We don't really know yet what they think about Mark Robinson.

- Representative buoyancy Orange County is gonna be a democratic stronghold.

There's no, statistically that's a fact.

However, in a race that could be decided by 10 to 20,000 votes, if it's that close, votes outta your county that go to Mr. Robinson in this case would be very big votes.

What's your role as a state legislator and a Democrat when you see polls that show a tie race or within one to two points, which is within the margin of error?

- Right, well, North Carolina is a battleground state.

I mean, clearly, over the past several years, we've had very close statewide races from gubernatorial race to even Supreme Court, State Supreme Court.

And so to your point, this is gonna be a close race.

I do think it's early, and certainly, as you said, we haven't really seen folks roll out in full in terms of messaging, in terms of advertising.

And so that's gonna have some influence on folks one way or the other.

But as a state legislator, one thing that I'm particularly concerned with, that I really made a big part of my work in the state legislature is voting rights, and making sure that folks have what they need, our citizens have what they need to go out, register to vote and exercise their right.

And so it's gonna come down to turnout, not just in my county, but in every county across our state.

And certainly this election will be close.

- When it comes to doing that kind of groundwork, when do you really start engaging yourself to put your physical energy into making sure people can vote or they understand where to vote and how to vote?

- Yeah, well, I've already started.

- Okay.

- I mean, this is a big election year for many, many reasons that folks on both sides of the spectrum can say, but I've started going out myself.

I know that there are other candidates, state legislative candidates who have also been hard at work, knocking doors, talking to voters.

And certainly in my county, Mr. Stein, he's got a strong connection there.

His record as Attorney General has been a great one.

He's done a lot for North Carolinians, especially on the opioid settlement.

And so my job as a legislator is really to engage with folks at that ground level and try to motivate as many people as possible to come out and vote.

- Representative Pare coming from Wake County down southern part of Wake County, a lot of votes are there.

How do you, from the Republican side, how do you keep the energy up?

Mark Robinson's up to a tie now, which means he could go to the lead or he could slip back down, and all sorts of things with the congressional race there practically being settled.

So, is turnout gonna be an issue with Republicans down your way?

Could they take it for granted and just kind of waltz to the polls?

- Well, I don't think that we're gonna see a low turnout in November.

I think that's for sure.

But I think this poll is happy news for Republicans.

I mean, they like to see our candidate doing well, at least to the toss up level.

But I think that we need to look at history and probably what we're seeing is what we should be seeing.

Because in 2020, Mark Robinson did earn more statewide votes as Lieutenant Governor than Josh Stein did for Attorney General.

Josh Stein did not perform as well in the suburbs as Roy Cooper did.

So I think that you're looking at a candidate in Josh Stein that has consistently underperformed on the ballot, and perhaps that's why we're looking at Mark Robinson may be doing a little bit better in the polls.

But I think the suburbs, that's what I represent in Wake County in Southern Wake County is a suburban area, and I think that those voters are very key to all candidates, especially Josh Stein and Mark Robinson.

So we'll see, we'll see how well they do.

We still have five months left.

- Representative Buansi back to you before we go to Billy about that idea that Josh Stein is not Roy Cooper, and clearly he's not.

They're two different gentlemen with different, similar career arcs though, as Attorney General, what do you make of that?

How does Stein take some of that Cooper glow?

Cooper won when Trump did as well.

- Well, like you said, Mr. Stein is his own man, his own candidate.

And the work that he has done speaks for itself, the work he's done on settlements to try to get North Carolinians better access to care, especially when it comes to the opioid abuse and epidemic that has really struck folks, especially in rural areas, pretty hard.

And the fact is, even in these close elections, the past, I guess, two cycles, I mean, Cooper the first time, that was by a very close margin that he won.

And it was a little bit wider mar margin in 2020.

But the fact is these races statewide are just gonna be close.

And over the next several months, Mr. Stein's gonna have a great opportunity to tell folks who he is, what he stands for, and let the record speak for itself.

- Representative Wendy, Wendy you step up, get really active in this campaign season because it's more than just you down there running on the ticket and you're a well known name.

- Oh, well thank you.

Well, I don't ever stop.

That's just the reality of my job, and probably Allen is the same way to some extent.

But in the suburban areas, we're in sort of a toss up area.

I mean, my district leans Republican, but in some of the urban areas, depending on what happens at the top of the ticket or what's happening nationally can make a difference down ballot.

So I think for me, it is always important to keep that name ID up and to keep communication open with my constituents about the good things that we're doing and that I'm doing in the legislature.

And so far that has worked very well for me in my area.

- All right, Billy tie race for the Governor's race, what a couple points between Trump and Biden and North Carolina.

Do those tight polls that bleed down the ballot?

Or is there a certain point voters go, "Okay, I just wanna know about a couple of races and move on?"

- North Carolina's a weird state at the ballot box sometimes, and it's been pointed out before that you'll see a democratic governor elected and a Republican Lieutenant Governor elected in the same election, and that's happened a number of times.

I don't want to impugn the work of pollsters, but I don't pay too much attention to them at this point in the campaign.

I think they're important for the politicians who are in those campaigns, but for the public, I think it's hard to gauge.

I will say that I never thought that Josh Stein was gonna run away with this race.

I think sort of, Roy Cooper ran away from Dan Forest a few years ago, but there were some outliers there.

You had COVID going on, and COVID policies really, Cooper's COVID policies really ballooned him.

So I think though that one thing that I think will be really interesting to look at in this Robinson/Stein race is the comparison between Robinson and Trump.

Because like Trump, Robinson says a lot of things that a lot of folks consider inflammatory or very polarizing, Trump tends to get away with them.

It doesn't tend to hurt him so much in the polls.

But not everyone's Trump.

So, I'm curious about how those undecided, that small segment, responds to some of the more inflammatory comments that Robinson has said, and whether they make a difference at the end of this campaign?

- Nope, and remember, Kelly, at the beginning of his campaign, Josh Stein drew attention to Mark Robinson, had tried to set himself up as an alternative, but we really haven't seen a whole lot of that since then.

So, this is going to be ramping up during the course of the campaign, and that's when we'll see how the people who only start thinking about these elections in the fall, once they actually sit down and start looking at this, that's when we'll know what they think about Robinson.

- Can you imagine $50 million or more in local ads, Representative Pare?

- Yes, I think when you look at the inflammatory comments you're talking about, there is an opposite side of that coin and that is that Mark Robinson is able to ignite enthusiasm among the voters, as well, and I'm not sure that Josh Stein can do that.

So, it'll be interesting to see how people react down the line after all these ads start coming out over the next five months.

- Plus, you'll also, I'm sure, see the Robinson ads trying to make people see Josh Stein as not Roy Cooper, but Joe Biden, and saying, you know, "Stein, Biden," I'm sure everything that he runs about, Josh Stein will mention Joe Biden.

- Well, I mean, one of the things about the history of North Carolina and governors, I mean, we have a track record of electing moderate governors.

And, I mean, the kind of rhetoric that we have heard Mr. Robinson engage in it's gonna be interesting to see how voters feel about that ultimately, because, I mean, this is not an extreme state one way or the other, but we've seen one person kind of express some extreme views on a whole range of issues.

- It's a tight race, Billy, I do wanna ask a point you brought to us, we always kind of get together in a pregame meeting where you point out a poll at Elon University.

They do great work there.

78% of of the voters Elon polled recently say they're worried about this artificial intelligence, these AI deepfake campaign ads.

78% are worried about it, that it will be used negatively in the campaign trail.

And Elon concedes, they were asking about federal races, Trump, Biden with AI deepfakes, we've seen it in the Mark Walker race, a pretty good one if you weren't paying attention, we covered it here on "State Lines."

Your take on this, the margin of error on this poll was only 3.2% and 78% of the people had a strong opinion so that we know people are worried about AI.

Could a fake ad sway an election?

- Absolutely.

Absolutely, it could sway an election.

I think that said there, you know, we have such a huge diverse media ecosystem now.

So, one fake ad in one spot isn't going to swing things like it might have some years ago, but I think you're absolutely right.

78% of people concerned about it.

I'm surprised it's not a little bit higher.

I think we have to have a lot of sympathy for the news consumer right now because it is wild out there.

It's a jungle and the deepfake AI-type content is something that everyone should be concerned about, regardless of their political affiliation.

Telling the truth in the advertising that we see out there, I think what we need to see is a really serious and earnest effort from those social media companies where this stuff is spreading.

I know Facebook has talked about tagging deepfakes for people, Facebook and Instagram, and I think that that's a start.

But, you know, I think that there's a lot of reason to be truly concerned about this and I see that we need people to get a better idea of where their information is coming from.

I mean, I tell my kids about stranger danger.

It's like multiplied times a thousand on the internet.

Everyone needs to be, like, stranger danger, to where's that coming from?

You need to not only look at the information, you need to look at who's bringing it to you.

- Representative Pare, when you're criticized as a state legislator, because it's Pare in a buoyancy brand, if you will, in the public sphere.

How would AI affect you personally if you saw an ad out there?

Maybe you've seen one, I don't know?

Where someone clearly took and manipulated either your image or someone else's image talking about you.

- Well, I am no stranger to misinformation in campaign mailer, sometimes I open my mailbox, I'm going, "Wait, I did that?"

You know, [laughs] so from the AI perspective though, I think that's interesting because the poll, yes, eight to one people thought that this was a problem in elections.

But in that same poll over the majority, definitely over 50% of those people also said that they don't know that they could detect it if it was presented to them.

And I think that that's interesting because they know it's a problem, they don't like it, they want something to be done about it, but they don't know that they are really able to detect what's artificial versus real, and how does that affect how they interpret the information that's given to them?

I agree with Billy that it is going to be effective, but when you have an electorate that really doesn't trust the information they're being given, it's gonna be interesting to see how that actually plays out and how effective those ads are with that bottom-line perspective from the majority of voters in play.

- Representative Buansi does AI have, it has to have a role.

It's coming and it's here already.

What role can it play to help us all be better voters or to be more educated about state politics in this case?

I mean, we're worried about it being a bad thing.

- Yeah, well, it's a good question.

I mean, certainly I share concerns about the negative consequences and impacts that it can have, especially without some kind of, you know, regulatory framework to just set some ground rules for how this can be used, especially in the political election context.

But my wife always tells me, you know, "Allen, you gotta look at the bright side of things too."

And so, you know, with AI in particular, I think if we can pass some common sense legislation, just establishing some kind of bottom line ground rules for how this technology can be used, especially in the kind of political context, you know, I think myself and a lot more folks would feel better.

But until we get there, we're kind of in a wild, wild west right now, - Mitch, you know, there's a state effort to try to regulate deepfakes and AI, but how do you get your hands around it?

Because a deep fake ad bought on a social media platform can come from anywhere.

- Yeah, it's difficult to see how they're going to come up with good rules that will affect what could be potentially a problem.

What I see is not necessarily as a major problem is the AI, where you see these fake ads and you can tell it's fake.

Like, in this recent congressional race in the triangle area where there was a photo of one of the candidates draping his arm around President Biden.

I think anyone watching that said this is fake.

What worries me is once when they start doing the ads and you can't tell it's fake and you think that what is faked on that ad is actually true and the person comes out and said, "No, I didn't do this.

This isn't me."

And people don't believe it because it's so realistic.

That's the type of thing I don't think we've seen yet in North Carolina, but we probably will.

- I know, how do you know when to ignore an ad?

Because if you bring it up, say it wasn't me, you sort of fueled your own fire that's burning you up I would think, so.

- Yeah, it's gonna be difficult.

And I think it also feeds into something that has been a problem over the last couple of election cycles, and that is less trust in the process and in the information.

And that's bad for everyone.

You want people to kind of have a good idea of what candidate A and candidate B believe and make a choice between them or candidate C as well, and not have this specter hovering around it of, well, did they really say this, or was this a fake, or what can I believe about this?

- Yeah, well, let's stay on the bipartisan train since there's some agreement between the Republicans and Democrats on this issue.

Switching to healthcare, in fact, where our state currently allows patients with life-threatening or terminal illnesses to try at least some non-FDA approved medical treatments when traditional medical options fail.

The senate is discussing an expansion of what's called Right to Try so that it can cover experimental genetic treatments.

This would include drugs that may be approved in other countries, just not here in the United States.

The rules are vast, but basically insurance companies are never required to cover Right to Try treatments, and drug companies would not be held liable for any results of Right to Try procedures.

Representative Buansi, this bill, the law that's on the books is about 10 years old now.

Moving into genetics, where does that take us when you just say, hey, terminally ill people may try, why not?

Why add genetic treatments to this?

Why isn't that already covered?

I just don't know.

- Yeah, well, you know, like we were saying with the previous topic, I mean, healthcare technology treatments, I mean, it is fast evolving.

And certainly I think it's been pointed out as well that in Europe, Western Europe, you've got treatments that have been approved there that haven't been approved here in the States.

And I think, you know, it's really important that folks, especially folks who are faced with a terminal illness or something that's life threatening, that they be able to have options.

And, you know, this particular bill kinda hits me personally because just a few years ago I lost a loved one to cancer, and I certainly would've wished that she had as many options as she could at her own choosing to, you know, get the kind of care or treatment that could potentially save her life.

And so this bill in particular, you know, with the genetic piece, I think it's just kind of part of what we're seeing as every year passes by, the advancement of medication and treatment.

And I think this bill tries to make an effort to account for that as well.

- This one seems straightforward with the support it seems to have.

Are there any downsides to rapidly passing a bill that includes genetic treatments as part of Right to Try?

Or is this as clear cut as it?

Seems genetic medicine is here and we should be accommodating it with state law.

- Well, I think that perhaps some people hit the brakes a little bit when they think, wow, we're letting people try things that are not FDA approved, and what is that gonna do for patient safety?

But in this particular bill, in this situation that we're talking about, we're talking about a process where a physician has to sign off on this.

I mean, there's a stringent, informed consent requirements associated with this.

We're talking about people who have already exhausted every single option available to them, and they're in an end-of-life situation.

So I think this is the right thing to do, and I think it's probably good for North Carolina to embrace this subject as they are becoming more and more an international leader when it comes to the health sciences.

So I think that this is a good thing that we can do, and that's why we see some broad support in the senate.

I would also mention there is a bill in the house that is sort of a mirror image of this.

It's house bill 1029 that's gonna be heard on Tuesday.

- My script didn't include it.

I wrote this story.

Doctors are protected as well.

Is that right?

I mean, I cover insurance companies and the person can try it.

So doctors are covered as well.

- Yeah, there's no liability.

Yes, correct.

- Billy, the future's now it seems.

This is an interesting bill.

I know we cover a lot of animosity here, but some of these issues just seem to bring people together.

- If you don't understand deep down what it feels like to see someone going through something where they're out of options, right, where there's nothing left but desperation, then I think almost everyone can relate to that and they understand it.

You want someone in that position to have options that could potentially make a difference.

And I think representative Parra is right.

We're not talking about like giving people horse tranquilizers as a medicine or something like that.

We are talking about medicine treatments that could possibly make a difference for some people.

So I could see people kind of having to back off of, are we giving people wild treatments?

I don't think that's the case.

I think this is an empathy bill and understanding that people out there face illnesses and they've fallen on their last options.

- And I've never heard of anyone who was opposed to Right to Try when you're out of options.

That's just a fact in my life I've never seen that.

I do wanna talk about the Senate considering a House bill Representative Parra to allow out-of-state doctors to come into North Carolina and practice medicine more easily.

I guess there's a doctor shortage statistically, the bill would fund.

The bill would have North Carolina join a multi-state agreement or pact allowing just to come in, set up shop, practice medicine, serve patients.

The House passed that bill, but the state Senate has added a new permission that would allow nurse practitioners to practice some medicine without being under a doctor's oversight and Representative Parra, that's where the snag has been hit, I think.

- Sounds good.

- Let's talk about the doctor shortage.

Is it so bad you need to change state law to allow more doctors?

- Yes, I think that we could use some more doctors in North Carolina and I think that's what the Compact actually does.

So that was a clean bill out of the House.

It was the interstate medical licensure Compact.

There's 40 states that are part of this Compact.

So the bill out of the House would've added North Carolina as a member state to that Compact.

And what that would've done, it would just have accelerated a pathway for licensure for physicians out of state to work in North Carolina.

And I think that's important because it would've address the healthcare shortages that we have in our state.

And overall it's very positive.

In fact, there's no cost to the state and the outcomes have been very positive.

In 2022, 17% of all new licenses obtained by physicians in the US came from this Compact.

And over 31% of new licenses issued by the member states were from the IMLC.

So we passed the bill unanimous, goes over to the Senate, they add some provisions on, right.

And so the provisions that you're talking about, one in particular would be to expand the scope of what nurse practitioners can do without the oversight of a physician.

And I think that brings up some patient safety concerns.

- All right, Representative Boincy of Orange County.

People picture Chapel Hill and it's a little city in itself.

A lot of rural areas out your way.

You talking nurse practitioners possibly coming in under new freedoms and allowing out-of-state doctors.

Your take on this bill, this one is not as clean cut as Right to Try?

- Well, well first off, chapel Hill is still a town.

- It's a town, not a city.

[laughs] - A very large town.

- Yes, a large town.

But to the question, so, you know, I actually had a friend recently graduate and she's gonna be a nurse practitioner pretty soon.

And I mean, one thing that's clear is we've got a shortage of healthcare coverage in our state.

And certainly nurses, nurse practitioners are, you know, one form of healthcare provider that can provide, you know, folks who need care, the care that they need.

You know, I'm not quite sure what this bill ultimately is gonna look like 'cause I think it came out of a senate committee.

May see some more changes.

But I will say that, you know, I'm open to any bill that is gonna connect folks who need the care to the care that they need.

- So you believe the right bill, written the right way could get over a hundred votes in the House probably in support.

- Sure.

- Alright, Mitch, I got about a minute.

So - Yeah, I think we've been supportive at the Locke Foundation on getting rid of a lot of the regulatory barriers that have blocked healthcare innovation.

And that's especially going to be needed now that we have Medicaid expansion with so many more people going to the healthcare facilities in North Carolina.

You need to have more availability.

Having more doctors will be good.

Having the nurses practice to the full extent of their training is gonna be good.

All of that is something we should be looking at.

- Billy, 15 seconds.

- Let me add as well that these nurse practitioners we're talking about, they are experienced professionals and when you're looking at a big problem like this healthcare shortage, you need to bring in a whole bunch of different solutions.

So, you know, it's not just someone coming off the street, they're trained professionals.

- Alright, thank you panel and down to my last 20 seconds of this show.

Thank you for investing a half hour into this discussion.

Email your thoughts and opinions to statelines@pbsnc.org.

We'll read every email.

I appreciate you watching and tuning in every week.

I'm Kelly McCullen.

Thank you so much for watching.

We'll see you next time.

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