Sunday, February 05, 2006

More on the eye exam bill


Critics Say Eye Exam Flap Is Symptom Of Closed Budget Process

POSTED: 3:14 pm EST February 5, 2006

RALEIGH, N.C. -- Rep. Edd Nye feels fortunate that his optometrist took the time to photograph the back of his eyes with an expensive camera during an exam last fall.

Otherwise, Nye, one of the chief budget-writers in the state House of Representatives, wouldn't have known that a cancerous lesion nearly 2 inches wide sat behind his right eye, a sign of ocular melanoma.

The optometrist? House Speaker Jim Black.

"If you don't control it, it will spread on to the body," said Nye, D-Bladen, who has received radiation treatment that has shrunk the lesion. "I'm sure a lot of people don't know about it and don't pay attention to it."

Black, D-Mecklenburg, hasn't gone so far as to use Nye's illness to defend a new law the speaker inserted into last year's budget bill -- called a special provision -- requiring all public school children to get a comprehensive eye exam before entering kindergarten, starting this fall.

But some critics believe the closed legislative process that led to the new requirement means not enough questions were asked about its high costs to some parents, and about whether the exam is truly necessary.

While well-intentioned, the eye exam law is "the poster child as to why special provisions are a bad way to do legislative business," said Ran Coble of the nonpartisan North Carolina Center for Public Policy Research. "A lot of special provisions may be good policy ideas, but they need the normal legislative debate to find out their weakness."

The newly required exam is more extensive than a vision screening performed by a pediatrician during the physical checkup already required of children entering school. The exam, conducted by an optometrist or ophthalmologist, is supposed to check for seven different disorders.

"Since 80 percent of what we learn is through vision, comprehensive eye exams are probably one of the most important early intervention steps we could take," Black said in a statement last week.

But the exams cost $100 or more. The law set aside $2 million for what's called the "Gov.'s Vision Care Program," money aimed at helping parents pay for exams not covered by Medicaid or other government programs. But some parents of the 130,000 kindergartners entering the public schools this fall, especially those without private vision care insurance, have told legislators they want the law repealed or delayed, as have pediatricians and school officials.

"We really didn't understand the full implications of how this written and what it would do," said Leanne Winner, a lobbyist with the North Carolina School Boards Association.

The program wasn't in Gov. Mike Easley's original budget proposal last year and didn't appear in the Senate budget bill approved in May. That measure went to the House, where the requirement for the new vision exam was inserted in the budget passed in June.

Budget negotiations began soon after, but there was little public discussion over whether the eye exam requirement was a good idea, according to several lobbyists. A House-Senate budget subcommittee on the Department of Health and Human Services only met once in public during the budget negotiations.

Most of the haggling over the $17.1 billion budget occurred behind closed doors in legislative committee rooms and the offices of Black and Senate leader Marc Basnight, D-Dare. While the issue was discussed during those negotiations, it got little attention on the House and Senate floors before the final budget vote in August.

"Nobody raised questions about it," said Sen. Walter Dalton, D-Rutherford, co-chairman of the Senate Appropriations Committee. "That opportunity was there."

The recent spate of outspoken opposition to the vision exam requirement comes as a beleaguered Black sits in the middle of several investigations, including a formal inquiry starting Wednesday into his campaign finances and the political action committee of the state's optometrists.

Black has received tens of thousands of dollars in donations from his colleagues. The speaker has said the donations had nothing to do with the exam requirement.

"This is not about Speaker Black," Winner said. "This is about what is in the best interest of children."

But Dalton is one of several senators who wants the eye exam requirement blocked for this fall. Black said recently he will seek changes to the law, but won't try to repeal it.

"I wanted to announce my proposed changes so that people can be assured that I am listening to their concerns and plan to take action," Black said.

It would have been better had concerns been discussed before the exam requirement became law, Coble said. He suggests lawmakers should ban the practice of creating new programs, taxes or study commissions in the annual budget bill, and instead insist they be considered in separate measures so that the pros and cons of each can be weighed in public.

"It really boils down to getting more accountability and more openness in the process," said Bob Phillips, of the advocacy group Common Cause North Carolina.

Republicans at the Legislature have been complaining about special provisions in recent years, although the GOP used the practice when it controlled the House in the mid-1990s. When Black became speaker in 1999, he actually reduced the number of provisions in the House budget that were unrelated to spending, but the numbers have creeped back up.

"We need to cut out everything in the budget that is done at the last minute without any debate whatsoever," said House Minority Whip Mitch Gillespie, R-McDowell. "I would hope a Republican speaker would change the way business is done here in Raleigh."

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