North Carolinas Top Health Topics For 2023

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By Jaymie Baxley, Anne Blythe, Rachel Crumpler, Jennifer Fernandez, Rose Hoban and Taylor Knopf

For tens of thousands of North Carolinians, 2023 will be the year the state permanently expands Medicaid, giving them access to health care they've been denied for more than a decade.

Much more happened in the world of health in 2023 as North Carolina Health News focused its coverage on the past 12 months.

The problems affected the growing population aged 65 and over. Mental health initiatives received increased funding thanks to new federal stimulus funds for Medicaid expansion. It appears that medical marijuana legalization still has time before reaching budget negotiations that prevent new legislation until 2023.

NC Health News readers have received this story and others over the past year

Many of these themes will continue next year. That's why we've created a summary to help you remember a handful of our 2023 reports.

Cooper's big retirement plan

The number of people over 65 in North Carolina is expected to grow significantly over the next decade, and senior advocates and others say new statewide strategies are needed to address changing demographics.

There may be a greater need for assisted living and day care for the elderly, as well as efforts to reduce the cost of social and medical interventions, which place a financial burden on the families of the 1.8 million people over 65.

78 of North Carolina's 100 counties are expected to see an increase in their senior population. According to the Office of Budget and Management, Wake and Mecklenburg counties, urban areas with attractive health care facilities and other amenities, may be disproportionately affected by the new wave of seniors. North Carolina State.

Gov. Roy Cooper issued an executive order in May outlining a "whole-of-government approach" to building a state that respects its aging population. In just seven years, North Carolina will surpass the number of children for the first time

With that, Cooper announced "NC for All Ages, All Stages: A Guide to Aging and Living Well."

Demographers say that by 2031, one in five North Carolinians will be over 65, and more people will be 17 or younger. According to Cooper's order, the number of Alzheimer's and dementia diagnoses is expected to reach 400,000 within two years.

"We know there's a serious shortage today to take care of seniors and make sure they get the care they need," Cooper said.

2024 is an election year. State-mandated term limits mean this will be Cooper's last year as governor. Any state-sponsored aging plan released next year will need approval from North Carolina lawmakers and the next governor, who control the budget.

- Anne Blythe

Medical marijuana is a topic of debate and disagreement in state legislatures.

State lawmakers have been divided for years on whether to allow the legal use of marijuana, or even hemp products. In this year's session of the Assembly, there was also a debate between them on this issue.

Influential Senate Committee Chairman Bill Rabon (R-Southport), a colon cancer survivor, has been pushing for the legalization of medical marijuana for several years. This year, he spoke extensively publicly about his substance abuse while undergoing chemotherapy. Many conservative members of the House of Representatives currently reject any form of legalization.

Those members brought people who said they or their family members were injured in traffic accidents caused by impaired drivers after smoking or using marijuana to speak at a public hearing on Raban's Compassionate Care Act. If passed, the bill would allow limited use of medical marijuana for certain diagnoses.

Rabon's bill passed the Senate, but failed after reaching the House of Representatives.

Meanwhile, House Democrats have proposed a bill against delta-8-tetrahydrocannabinol (THC), the psychoactive compound found in small amounts in legal cannabis.

The 2018 North Carolina Farm Bill legalized the cultivation and sale of hemp as long as it has a delta-9 THC concentration of less than 0.3% by dry weight.

Baca Juga

Manufacturers of hemp products quickly realized that the definition meant they could sell products containing delta-8-THC, delta-10-THC and even delta-9-THC as long as the concentration remained within legal limits. Some manufacturers exploit this gap by selling different products that allow users to upgrade.

Several members of the House of Representatives have voted for House Bill 563, which would mark the end of what they call the "Wild West" of hemp products. The bill passed the House of Representatives and is headed to the Senate, where it could stall as members of both chambers negotiate a path forward.

-Rose Hoban

Medicaid expansion

In December, North Carolina became the 40th state to expand access to Medicaid under the Affordable Care Act, making more than half a million low-income residents eligible for health insurance.

The expansion comes after opposition from Republicans in the General Assembly. The promise of $1.8 billion in federal financial stimulus this year forced state Republican leaders to rethink it, and the measure ultimately advanced with bipartisan support.

Gov. Roy Cooper signed the expansion into law on March 27, but one final hurdle remains: The bill requires the general assembly to approve the state budget before the expansion takes effect.

Budget negotiations dragged on over the summer, forcing the North Carolina Department of Health and Human Services to postpone a planned expansion in October.

As lawmakers debated the budget, Medicaid enrollees largely lost coverage. A federal mandate that prevented states from removing beneficiaries from the rolls during the first three years of the COVID-19 pandemic expired in April, thanks to North Carolina, for the first time since March 2020.

From June to November of this year, more than 22,000 North Carolinians were deemed eligible for Medicaid under the state's pre-expansion criteria. Many of these people could have gotten coverage if the expansion hadn't been delayed.

The budget impasse ended in late September, when both houses of the legislature agreed to move forward with a nearly $30 billion spending plan. Although Cooper strongly opposed some aspects of the budget, he allowed it to become law without his signature to avoid further delays in its expansion.

The state officially implemented the expansion on December 1. About 273,000 Planned Parenthood Medicaid enrollees, a program with limited coverage for reproductive health services, were automatically upgraded to full coverage. According to DHHS, another 300,000 adults with incomes below 138 percent of the federal poverty level will be added to the list.

"This is a milestone that will change North Carolina for the better and improve the health of our nation and our economy," DHHS Director Cody Kinsley said after the expansion began. "This is the largest health care investment in North Carolina history."

- Jamie Baxley

What does Blue Cross Blue Shield NC do?

In the spring, lawmakers introduced a bill that would change the regulations and allow Blue Cross Blue Shield of North Carolina to create a holding company that would become the parent company for the insurer and all of its nonprofit subsidiaries. When business lobbyists spoke about the bill, they argued that the regulations slowed companies down in a rapidly changing and highly competitive business environment.

But the proposal immediately raised concerns from state Insurance Commissioner Mike Causey, state Treasurer Dale Falwell and lawmakers on both sides of the aisle, as well as many health and consumer advocates across the state.

As of early 2023, BCBSNC's reserves were over $7 billion. The company, which has not been profitable since its founding in the 1930s, has paid corporate taxes since at least the mid-1980s but has also raised capital in a profitable environment.

In the 1990s, lawmakers passed legislation that would have required BCBSNC to establish a process for tax-free asset returns if the company decides to transition to nonprofit status. This can take the form of a charitable trust to serve the health care needs of the state, as when Dogwood Health Trust sold the nonprofit Mission Hospital in Asheville to the for-profit HCA.

In an interview with NC Health News, the company's chief financial officer, Mitch Perry, estimated the company's "legal capital" at about $4.7 billion, money that could potentially go to the holding company. However, he said at the time that he could not provide an estimate of the company's fair market value.

This potential transfer of funds was the main reason for conflict in the Legislature over whether to allow the rule changes to take effect. The conflict was seen in the insurance environment, where consolidation has created larger national insurance entities with increasing influence over health care providers. And while Blue Cross NC is a major player in North Carolina, accounting for about 80% of the state's group insurance market, it's a relatively small player compared to national insurance giants like UnitedHealthcare or Aetna.

Lobbying for the bill in the Legislature was intense: 14 BCBSNC employees represented the company at the Capitol, while consumer advocates worked the phones and hallways to block the bill's passage. The lawyers found an ally in Causey, but in the end he couldn't stop the company's push.

After Blue Cross NC made some concessions, lawmakers overwhelmingly approved House Bill 346, forming a holding company for the company to move forward. In October, Blue Cross NC reached an agreement with Raleigh-based urgent care provider FastMed to acquire that company's North Carolina clinics. Blue Cross NC has been a minority investor in FastMed since 2012.

The terms of this agreement have not been disclosed.

-Rose Hoban

Psychiatric hospitals do not provide a safe and therapeutic environment

Earlier this year, federal authorities threatened to cut off Medicare funding for a psychiatric hospital in eastern North Carolina after a series of inspections at the facility. An 11-year-old patient was allegedly assaulted and sexually abused during the argument.

State regulators made a surprise visit to Brynn Marr Hospital, a private facility in Jacksonville, after NC Health News/News & Observer/Charlotte Observer released a joint report detailing alleged abuse and assault of children in their care. Among other violations, state regulators alleged that hospital staff "failed to provide adequate supervision to provide a safe and therapeutic environment for patients with conduct disorders" and "failed to provide daily visits by a psychiatrist."

State and federal regulators conducted investigations into Bryn Mar in December, January, February and March. In February, regulators placed the hospital in "imminent danger" after learning that a teenage patient had escaped from the facility. "Other risk" is the most serious notice a hospital can receive from federal authorities. Indicates that serious harm, injury, disability or death has occurred or is likely to occur to one or more patients and immediate action is required.

The hospital was ordered to make the necessary changes to return to compliance by June 2 or risk losing its ability to bill for government-funded programs. According to the spokeswoman of the Ministry of Health, the hospital has taken the necessary measures before the deadline.

"A recent inspection of Bryn Marr Hospital on May 25 did not find the hospital to be in substantial compliance with federal rules or regulations that were found to be noncompliant in a previous inspection," a department spokeswoman said in an email. Email statement in December. . "In other words, Bryn Marr has made the necessary changes to reflect the results of the evidentiary investigation and its IJ (immediate jeopardy) status."

DHHS also provided NC Health News with a copy of Brynn Mar's corrective action plan, which outlines the hospital's training and safety measures as a result of the investigation.

-Taylor Button

Changes for new drivers

Thanks to a law change passed by the General Assembly last year, which will go into effect Jan. 1, teenage drivers won't have to train for another year before getting a limited provisional license.

Now, teenagers have just nine months of supervision before moving on to the second stage of the state's graduate driver's license program, a provisional restricted driver's license.

During the COVID-19 pandemic, this period was shortened to six months in 2022 and again at the end of 2023 to reduce the burden of new drivers waiting for mandatory tests. The delay was created by the pandemic, when face-to-face contact was reduced, and then exacerbated by a lack of driver training staff behind the wheel.

Another change to the law, which took effect last August, allows teenagers to drive on a temporary restricted driver's license - even if they are not allowed to have the license under their supervision - as long as they can carry a passenger of their own. second under age. 21. I am going to school now.

Child health advocates and driver education officials point to data from other states showing that the increased distraction of another passenger and less driving practice lead to more crashes among young drivers.

Mike Chappell previously told NC Health News that he saw a big change after the state passed the driver's license law in 1997 while still working as a driver's education instructor.

"It was a huge relief for me because I knew the child was going to be with me for six hours ... but the parents had him for a year," said Chappell, the school's director of human resources. Garner's Jordan Driving, which provides chauffeurs for children. Wake County Public Schools. Education class

After North Carolina switched to a driver's license program in 1998, the number of crashes among 16-year-old drivers dropped 38 percent, according to the UNC Highway Safety Research Center. The number of accidents with death and serious injuries has decreased by 46%.

There are no data on the effect of switching from a 12-month training period to a nine-month training period.

"The number one reason teenagers are involved in accidents is their lack of experience," Natalie O'Brien, senior research associate at the UNC Traffic Safety Research Center, told NC Health News before the law change. "It's just a dangerous thing. Learning is hard. You can't just learn to own something."

-Jennifer Fernandez

Advanced training nurses strive for greater independence

For more than a decade, registered nurses in North Carolina have called for more freedom in their practice. Doctors have resisted the subsidy for some time, arguing that oversight improves patient safety.

For a brief moment, the balance seemed to be tipping this year: that advanced practice nurses could gain the independence they've long wanted through Medicaid expansion.

That's because the Senate originally included practice modification options for more trained nurses, anesthesiologists and midwives as part of the Medicaid expansion proposal. However, the House rejected the idea, and the language was ultimately left out of the Medicaid expansion agreement between the two chambers in March.

Nurses recommend pushing for changes to what they say are overwhelming supervisory requirements. For many nurses, supervision means two meetings a year, perhaps with a supervising physician who does not live in the same region or state. Many advanced practice nurses report paying a fee of $1,000 per month for the supervision that allows them to practice their chosen profession.

To gain more autonomy than dozens of other states already allow, advanced practice nurses are mobilizing their support for a separate bill: the Conservation Act. The bill has been introduced in every legislative session since 2015, and this year the bill had 59 sponsors in the House and 21 in the Senate . Senate Majority Leader Phil Berger (R-Eden) — one of North Carolina's most influential politicians — has expressed support for the SAVE Act and the role of advanced practice nurses in addressing the provider shortage.

However, the bill has not been advanced this year. In fact, there is still a lot of resistance, especially from doctors and anesthesiologists who want to maintain stability.

More freedom for a small group of advanced practice nurses came from an unexpected place this year: a provision in the state's 47-page abortion law that eliminates the need for certified midwives to supervise medical care.
Advocates hope this is just the beginning of lawmakers pushing for a policy change that would loosen total practice restrictions for North Carolina's 17,000 registered nurses.

-Rachel Crumpler

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