By Will Atwater, Anne Blythe, Michelle Crouch, Rachel Crumpler and Rose Hoban

For hundreds of thousands of North Carolina residents, 2023 will be the year the state finally expanded Medicaid and gave them access to health care that had eluded them for more than a decade.

Much more was going on in the health care world in 2023, as North Carolina Health News focused on in its reporting over the past 12 months.

The culture wars roiling political platforms across the country came to North Carolina, leading to new laws restricting abortion access and reproductive health care, as well as delaying gender-affirming care for transgender youth.

Environmental advocates continued to raise concerns about forever chemicals and PFAS. Extreme heat concerns intensified, particularly for thousands of incarcerated folks living in prisons without air conditioning and migrant workers who spend long hours in the blazing heat.

NC Health News readers homed in on these and other stories over the past year.

Many of these themes will continue into the coming year, so we’ve developed synopses to help refresh your memory about a small portion of our reporting from 2023.

Social issues loom large at the legislature

Across the country, state legislatures waded into social issues. North Carolina was no exception, with lawmakers passing new restrictions on abortion access and gender-affirming care for transgender youth. 

After the Supreme Court’s Dobbs decision in June 2022 handed decision-making about abortion access to individual states, North Carolina lawmakers didn’t take immediate action to restrict access. That changed on May 2 when Republican lawmakers unveiled Senate Bill 20. The 47-page abortion bill limits access to the procedure after 12 weeks of pregnancy and places more requirements on women seeking abortions and on their providers, such as requiring an in-person appointment for state-mandated counseling at least 72 hours before an abortion.

Lawmakers moved swiftly to debate and pass the bill within 48 hours of it being presented to the public — a highly criticized fast-tracking. During two days of hours-long, contentious debate, Republican lawmakers called the bill “a mainstream abortion compromise” while Democrats and medical providers strongly protested the bill as “medically unnecessary” and interfering with the patient-physician relationship.

Gov. Roy Cooper vetoed the increased restrictions at a rally attended by nearly 1,000 people on May 13. However, just days later, on May 16, the House and Senate voted to override his veto along party lines — an outcome made possible after Rep. Tricia Cotham switched her party affiliation in April.

Since the new restrictions took effect July 1, patients, medical providers and abortion clinics have worked to navigate a new era of reproductive health care. Data shows, in the three months following the implementation of restrictions, the number of abortions provided in the state has dropped significantly as patients and providers confront more logistical hurdles to care. 

In addition to abortion restrictions, many Republican-led legislatures across the country have introduced a record-number of anti-transgender legislation this year. North Carolina took part in this legislative wave, passing three laws affecting transgender youth.

House Bill 574 bans transgender females from competing on middle school, high school and college sports teams that align with their gender identity. It’s unclear how many transgender athletes this affects, though rough estimates and anecdotal evidence suggest a few dozen — at most — across North Carolina.

Senate Bill 49, dubbed the “Parents’ Bill of Rights,” requires schools to tell parents if their child asks to use a different name or pronouns at school, and it restricts instruction about gender identity and sexuality in kindergarten through fourth-grade classrooms.

House Bill 808 prohibits doctors from providing gender-affirming care to minors, including puberty-blocking drugs, cross-sex hormones and surgeries. Only minors who began receiving this type of care before Aug. 1 may continue treatment in North Carolina with their parents’ consent.

The trio of laws brought contentious, often emotional, debate. Transgender youth, their parents and other advocates for transgender rights made many trips to Raleigh to vocally oppose the bills they view as unnecessarily targeting an already vulnerable group. They shared personal accounts of gender-affirming care being life-saving, sports participation serving as a positive social outlet and relying on teachers and school counselors for trusted, sensitive conversations. Final passage of the bills saw the halls and legislative galleries filled with advocates from both sides of the issue.

Gov. Roy Cooper voiced his opposition, vetoing the laws in July. In his veto message, he argued that “for campaign purposes only, Republicans are serving up a triple threat of political culture wars.”

Republican lawmakers argued that they are needed to protect children and, with supermajorities in each chamber, easily overrode Cooper’s vetoes on Aug. 16 — mostly along party-line votes.

However, North Carolina’s gender-affirming care ban is being challenged in court. In a federal lawsuit filed on Oct. 11 by Lambda Legal and the National Health Law Program, lawyers argued that House Bill 808 is unconstitutional because it discriminates on the basis of sex and transgender status and infringes on parents’ rights to make medical decisions for their children. 

As a result of these new laws, transgender youth face more restrictions in health care, sports and school, and it’s now up to them and other advocates for transgender youth to figure out how to function in a more constrained environment. 

— Rachel Crumpler

Proposed UNC/ ECU restructure and the aftermath

The proposal first turned up in Senate Bill 743, which would have given UNC Health, the health system based out of UNC Chapel Hill with 11 hospitals on 13 hospital campuses, the ability to extract itself from the state employee benefits system. This initial bill also would have given UNC Health protection from antitrust scrutiny at the state and federal levels and made it possible for the system to expand as it saw fit. 

In the past, UNC has been called on by ailing hospitals around the state to either come in and provide management services — such as at the Boone-based Appalachian Regional Healthcare System — or to take over the hospital outright, which has happened in locations as far-flung as Rockingham County, Henderson County, Robeson County and Siler City. 

Notably for employees, the bill would peel UNC Health out of the state employees health and the state retirement plans, allowing the system to devise a richer, more attractive benefits package to compete with well-heeled private hospital systems, such as Duke, which sits a mere 12 miles away. 

The bill was heard in and passed the state Senate, then languished once it got to the House. The proposals re-emerged once the public was able to see a draft of the final state budget, except that proposal also gave ECU Health — the state’s other academic medical system — the ability to do the same as UNC. 

The final state budget ordered UNC and ECU to collaborate on building capacity for care in the rural eastern part of the state and gave both systems the ability to create the new benefits packages, but it stripped out the antitrust language. 

Now, the two systems will collaborate on creating new rural health clinics and a new children’s hospital, among other initiatives. And come Jan. 1, 2024, the two systems’ benefits packages will have an overhaul, even as many of the details remain unclear.  

— Rose Hoban

After UNC campus shooting, students demand gun safety laws

Six days into the fall semester at UNC Chapel Hill, college students, faculty and staff were forced to shelter in place after a gunman shot and killed a chemistry professor.

Confusion reigned on campus for hours as law enforcement officers from multiple agencies flocked to the area to search for the suspect who ended the life of Zijie Yan, a professor in the UNC-CH Department of Applied Physical Sciences.

After the violence, students who grew up with school shooting drills, an age group often described as “the lockdown generation,” were galvanized by the incident and rallied in mid-September inside and outside the Legislative Building in Raleigh for gun safety laws.

They said they were fed up with the “thoughts and prayers” that typically flowed after school shootings and mass killings, and they tried, unsuccessfully, to persuade lawmakers to adopt “common sense” gun laws and to stop dividing voters over this hot-button social issue.

In North Carolina, firearms are now the top cause of death for children. From 2012 to 2021, there has been a 47 percent increase in gun-related deaths in this state.

The students, who were joined by peers from N.C. A&T University and other campuses across the state, lobbied for safe storage bills, purchase permit requirements for long guns and “red flag laws,” which would give a judge the authority to temporarily confiscate a firearm from someone found to be a danger to themselves or others.

Republicans, who have supermajorities in the state House and Senate, took the opposite tack in the 2023 legislative session and repealed a law that required gun purchasers to pass a background check at a local sheriff’s department to get a pistol permit. Federal background checks are still required for public pistol sales, but not for private transactions, a loophole that troubles gun safety advocates.

The students accused lawmakers who did away with the extra background checks of being oblivious to mounting trauma created by firearms.

“Until they do what it takes to save lives, they can save those thoughts and prayers. Keep ’em,” said Samuel Scarborough, one of the Chapel Hill students at the rally.  

— Anne Blythe

Extreme heat in NC

As 2023 comes to a close, the extreme heat of the summer can seem like a distant memory. And while a debate about climate change is a social issue that divides many Americans, according to NASA, it’s undeniable that the summer of 2023 was the Earth’s hottest on record.

Although North Carolina logged many days with temperatures in the high 90s, and even topped triple digits on occasion, there have been hotter summer months in the state record books.

Nonetheless, scientists in North Carolina and elsewhere waved caution flags about heat index values and climate changes that are likely to make heat seasons like the one in 2023 more pronounced and more routine in the years ahead.

“It isn’t unreasonable to think this could quite possibly be the coolest heat season of our lives,” Ashley Ward, director of the new Heat Policy Innovation Hub at Duke University, said during a July webinar.

Given that, Ward and others are urging government entities to develop extreme heat policies for housing standards, schools, the workforce and health care.

For instance, in North Carolina, there has been incremental progress on outfitting the state’s prison facilities with air conditioning.

Schools have been forced to weigh student and athlete safety in sports seasons that begin in August.

Migrant workers and their advocates have rallied for extreme heat labor protections after a seasonal worker from Mexico died while harvesting sweet potatoes. 

“As the heat in North Carolina continues to intensify and become more humid, we must take long-overdue action to protect essential workers from preventable harm. We must prioritize the lives of North Carolina workers and protect them from the extreme weather conditions they face,” a petition circulated by the Farmworker Advocacy Network states. 

— Anne Blythe

PFAS consistently remains in the news

Reports about per- and polyfluoroalkyl substances (PFAS) were a constant fixture through the 2023 news cycle.  

Brunswick County community activist Veronica Carter, a liaison between community residents and researchers, had a busy year keeping up with the twists and turns in this ongoing story. 

“It’s almost like we haven’t had time to be proactive yet where we can wave our little cheerleader flag because we’re too busy being reactive.”

Early in 2023, NC Health News reported on a study that found PFAS contamination in freshwater fish. The news served as a wake-up call for anglers who enjoy fishing in waterways near current or past industrial sites contaminated by ‘”forever chemicals,” a term used to describe PFAS because the compounds take a long time to decompose.

In the spring, the Environmental Protection Agency announced proposed maximum contamination levels for PFAS. The EPA’s proposal includes calls for two PFAS — PFOA (perfluorooctanoic acid) and PFOS (perfluorooctanesulfonic acid) — to be regulated as individual contaminants, with maximum contaminant levels for both chemicals at four parts per trillion. Activists were pleased by the announcement and anticipate the standards will be finalized sometime in 2024.

Another moment on the PFAS timeline occurred in the fall, when N.C. Newsline reported that the EPA granted Chemours permission to import PFAS waste from the Netherlands to its Fayetteville Works facility. However, in November, citing problems with the request submitted by Chemours, the EPA rescinded its permission.

Throughout the year, researchers with the Gen X Exposure Study worked to increase the enrollment of African Americans and people of color in their work, and get a handle on the extent of human contamination by the chemicals.

— Will Atwater

NC kids needing foster care sleep in county offices

For the state’s foster care system, 2023 was one of the worst years in recent memory.

The number of foster homes in North Carolina has plunged in recent years, creating a crisis that forced children across the state to sleep in offices, hotel rooms and converted storage closets.

Charles Bradley, youth and family services division director in Mecklenburg County, told NC Health News earlier this year that the situation was “as bad as it’s ever been” in his 19 years at the department.

In Wake County, where the number of foster homes dropped by half, up to 11 children at a time spent the night in county offices.

Many children come into county custody after allegations of abuse, neglect or abandonment. While the number of children coming into care statewide hasn’t increased significantly, more foster children — like other kids across the country — have mental or behavioral health issues that make it difficult to secure appropriate placements for them. 

In addition, high turnover among social workers and higher caseloads for those that remain mean that foster families have less support, said Gaile Osborne, executive director of Foster Family Alliance, a statewide association of foster, kinship and adoptive parents.   

“At the end of the day, foster parents are feeling frustration from every angle,” Osborne said. “We’re losing families faster than we are bringing them in.”

The number of licensed foster homes in North Carolina is down 34 percent since 2021, according to federal data. That leaves the state with only 5,616 foster homes for more than 10,200 foster children.

In response to the crisis, state lawmakers boosted the monthly stipend for foster families and changed the law to allow foster families to have more than five children in their home in some instances. Osborne said she is optimistic that those changes will eventually make a difference.

— Michelle Crouch

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