NC’s health care scene in 2023

By Will Atwater, Anne Blythe, Rachel Crumpler, Clarissa Donnelly-DeRoven, Thomas Goldsmith, Rose Hoban, Taylor Knopf

What will a Republican supermajority in Raleigh mean for health care?

This year will be the first legislative “long session” since 2019 that won’t feature heavy reliance on video hearings and remote work as the pandemic recedes from people’s lists of concerns. 

The General Assembly will return in mid-January to swear in dozens of new representatives and senators. Then they’ll leave town and won’t return until several weeks later when they’ll really knuckle down to work until midsummer. 

One other change from the past three legislative years is that the spigot of federal money that bolstered states’ budgets – including North Carolina’s – during the pandemic will likely not be flowing with as many new dollars. But North Carolina has billions in reserve that it has available for spending on legislative priorities and lawmakers’ preferred projects, if lawmakers choose to dip into the rainy day fund.

Top health care issues that will likely receive attention on Jones Street will include proposals around new restrictions on abortion, another run at Medicaid expansion, and the increasing likelihood that hospitals will have to swallow changes to long-standing laws and rules around competition in the health care space. 

I also expect that nurses – encouraged by the success of their SAVE Act in the state Senate – will try again to get legislation through the General Assembly to loosen the laws around their licensure.

U.S. Army Spc. Jabari Ashanti, a Combat Medic with the 1st Battalion, 114th Infantry Regiment, New Jersey Army National Guard (NJARNG), checks a resident’s blood pressure at the New Jersey Veterans Memorial Home at Menlo Park in Edison, N.J., April 17, 2020. The Home, which is run by the New Jersey Department of Military and Veterans Affairs, has residents who have served in every war since World War II. Photo credit: Senior Master Sgt. Andrew J. Moseley, U.S. Air National Guard Credit: NJ National Guard

Other health care issues that I’ll be watching for in 2023 include something to address the current mental health crisis (particularly in children) and access to opioid treatment. Children’s advocates are hoping that lawmakers will pass funding for a gun safety initiative. 

On top of that, there’s always surprises at the General Assembly. We’ll be there to follow them!

— Rose Hoban

Tracking water quality across the state

One of the things we’ll be following in 2023 is whether environmentalists seeking legislation to reduce single-use plastics will receive support from local governments. Environmental groups in Asheville, Boone and Durham represent a growing number of advocates calling for change.

As NC Health News has previously reported, single-use plastics often end up in landfills and waterways, where they break down into smaller particles known as microplastics. Those minute plastic particles are ingested by marine life and have also been found in the human digestive system.

 A 2019 study suggests that humans may be digesting as much as 5 grams of plastic, roughly the amount found in a credit card, on a weekly basis. The study states that both tap and bottled water are primary contributors to human ingestion of microplastics.

To limit the flow of plastic waste into local waterways and, eventually, into the ocean, riverkeepers assigned to each of the state’s watersheds rely on volunteer cleanup days. The cleanups also provide an opportunity for riverkeepers to spread awareness about water quality issues to the public. In 2022, riverkeepers across the state installed trash trouts in watersheds across the state to trap plastic waste and prevent it from ending up in the ocean.

Several environmental activists and organizations are encouraged by bans/ordinances that are being put in place across the country — nine states have banned plastic bags and more than 300 U.S. cities have implemented bans or fees for use of plastic bags. What’s more, in 2022, Wegmans, a national food chain, stopped carrying plastic bags in its stores. There are four Wegmans located throughout the Raleigh-Durham area — Chapel, Raleigh, Cary and Wake Forest.

— Will Atwater

How are current — and potentially future — abortion restrictions impacting people?

New abortion restrictions are certainly to be discussed this legislative session, though the outcome of any potential legislation remains unclear. 

An estimated one in 5,000 people have EDS, but some say the true number is likely higher. Credit: Elvert Barnes

Both House Speaker Tim Moore (R-Kings Mountain) and Senate leader Phil Berger (R-Eden) have expressed interest in imposing greater restrictions. They did not pursue any last year because they knew efforts would be useless since Democratic Gov. Roy Cooper, an abortion rights supporter, said he would veto any legislation imposing further restrictions.

Republicans had hoped to gain a supermajority in the state General Assembly in the midterms to overcome this issue, but ultimately fell one seat short in the House of Representatives. Under the new balance of power, Republicans still cannot override a veto from Cooper along party lines. However, with the help of just one Democrat, a veto would be possible, allowing legislation to pass if all Republicans are on board. The question is whether Republicans can gain the support of a Democrat for abortion restrictions. It’s likely a tough sell for a party that campaigned hard on protecting abortion rights, though not impossible.

Moore has expressed his confidence that he’s got a “working supermajority” in his chamber. 

NC Health News will be following what legislative action is taken regarding abortion. We will also be watching the state’s abortion clinics and talking to physicians who provide abortions to continue to understand and uncover how various stakeholders are adjusting to the new reality of life without Roe v. Wade. What are the implications of reduced abortion access? Do we have the infrastructure to serve a continued influx of out-of-state residents seeking abortions in North Carolina? Do we have the resources to support additional births if fewer abortions end up meaning more births in the state? 

— Rachel Crumpler

Health care during and after incarceration

It’s well-established that people with substance use disorders and mental illnesses are overrepresented in U.S. jails and prisons. Federal statistics show nearly two-thirds of people who are incarcerated have a substance use disorder and about 2 in 5 people have a history of mental illness. Historically, treatment for these conditions has been inaccessible but there is growing recognition that they should not go untreated.

Last year, providing opioid use disorder treatment in jails found new momentum after the U.S. Department of Justice issued guidance stating that it is a violation of the Americans with Disabilities Act if correctional facilities do not continue individuals on the medications they were receiving to treat their addiction in the community prior to incarceration. 

We will continue to build on our past coverage of how jails and prisons roll out programs to treat opioid use disorder. We will also be looking into more emerging programs that seek to better address mental health conditions, such as Forsyth County jail’s behavioral health unit. Guiding these stories will be a search to understand what is both allowing progress and holding it back — are the problems due to budgets, staffing, stigma?

Aside from the health care people receive while incarcerated, we are interested in how individuals fare after leaving incarceration. About 98 percent of people incarcerated in North Carolina are eventually released back into the community. Without effective reentry resources, they could end up reoffending and/or experience health care challenges. Incarcerated and formerly incarcerated people are frequently sicker than the general population, with higher rates of diseases such as diabetes or hepatitis C.

— Rachel Crumpler

Rural health and Medicaid

I was trying to think of a throughline for the stories I’m working on and thinking about for the coming year, and what kept popping up for me is access. 

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