By Will Atwater, Jaymie Baxley, Anne Blythe, Rachel Crumpler, Jennifer Fernandez, Rose Hoban and Taylor Knopf
Politics is likely to take center stage in the coming year since races for president, governor and high-level elected state offices will be on the ballot.
With all the campaigning as a backdrop, some might turn a hyper-political eye to health care policies and regulations. But there’s plenty happening in health care beyond what lawmakers do in the coming short legislative session. We’ll track mental health developments, changes in the oral health landscape, how Medicaid expansion will affect rural health access, hospitals’ bottom lines and more.
North Carolina Health News plans to break down those topics and keep track of other issues on the horizon in 2024. Here’s what our reporters will be focusing on in their respective beats.
Legislative action likely to drive changes to the business of health care
Perhaps because of the election, the General Assembly is unlikely to pass as many controversial bills as they did last year. Instead, everyone who is running will have an eye on November, when they’ll have to appeal to moderates in the general election, as well as their parties’ base. Until the primaries in early March, you may see some more extreme rhetoric, and then candidates will likely tack back toward the center during the general election. A lot of that depends on how competitive districts are.
After covering the legislature for more than a dozen years, I hesitate to make big predictions, but it’s pretty likely that legislators will wrap up work earlier than they did during the 2023 work session, which stretched into October.
We’ll be tracking the implementation of some measures from the 2023 session — distribution of opioid settlement money, how the legislature’s mandate that UNC Health and ECU Health work together to improve rural health access, how mental health care funded by the bonus money that came to North Carolina as a result of Medicaid expansion will shake out and the many water and sewer projects funded by federal money that came to the state as a result of the federal infrastructure bill.
North Carolina’s hospital landscape is in the midst of a restructuring. A little more than a decade ago, many small, independent hospitals dotted the landscape, but the past decade has been a tough one for small and regional hospitals. Some relief is in sight in the form of the Hospital Access and Stabilization Program, which will send $2.6 billion in federal dollars to more than 100 North Carolina hospitals over the coming year to help pay for care to low-income patients.
We’ll be keeping an eye on issues arising from the consolidation of hospital systems and the emergence of fierce competition for patient — and federal — dollars.
— Rose Hoban
How will new dental school affect the oral health landscape?
North Carolina’s only private dental school is expected to open to its first 60 students at High Point University this fall. The Workman School of Dental Medicine, for which ground was broken in September, will eventually add to the oral health workforce in North Carolina, a need as population growth outpaces the number of dentists.
The North Carolina Institute of Medicine led a task force in 2022 and 2023 that looked at opportunities to transform oral health care.
Among other issues that will be in the forefront in 2024 is how to care for the 600,000 people who gained access to oral health care through the long-awaited expansion of Medicaid.
Only about 45 percent of dentists across the state take Medicaid patients, and many of those dentists who provide care for Medicaid clients are not accepting new patients.
The Medicaid reimbursement rate for oral health care has been stagnant since 2008. Advocates say that unless changes are made, many of the new Medicaid beneficiaries will not be able to get routine preventative care.
That can have an impact on emergency rooms, where people with dental problems sometimes end up seeking help for an infection or pain that arises because of deferred care. Those visits, according to oral health providers, could be decreased if people, especially in rural parts of the state, could see a dentist more frequently.
The NCIOM task force that looked at Medicaid expansion issues also weighed whether oral health should be included in the managed care regimen that runs the state’s Medicaid program.
In 2022, after years of planning, the state transformed its Medicaid program from one based on fees for service to managed care. The dental program is still provided on a fee-for-service basis. Some oral health providers worry that if the state pushes the oral health program to managed care that it won’t adequately cover the costs for doing business.
The task force’s report is expected to be released in January.
— Anne Blythe
Extreme heat could cause health care policy change
The extreme heat of the summer of 2023 might not be on people’s minds here in the chilly early days of January.
But that won’t stop climate scientists and environmental health advocates from rallying for new policies and regulations to help protect workers, older people and school children from extended periods of heat in which temperatures hover in the 90s, with heat indexes in triple digits.
After all, there’s a reason why “what’s past is prologue” has become an adage.
Asley Ward, director of the new Heat Policy Innovation Hub at Duke University, said that last summer was not necessarily an anomaly after July 2023 was declared the hottest July on record, globally.
“It isn’t unreasonable to think this could quite possibly be the coolest heat season of our lives,” Ward told NC Health News.
Ward was heartened to see leaders at the United Nations Climate Change Conference in Dubai the first two weeks of December spend a full day on the health impacts of extreme heat.
“This was the first … in 28 years to feature a designated day for health,” Ward said in a statement posted to the Duke Nicholas Institute for Energy, Environment and Sustainability website. “Those who have worked toward this for decades were not disappointed as health became part of many conversations not only on Health Day but throughout the conference. The topic of extreme heat was especially discussed with newfound urgency on the heels of the hottest year on record. The result was unprecedented attention on needed investments in adaptation and resilience and focus on shaping global health policy to place climate change at its center.”
The state Labor Department has yet to release the results of its investigation after José Arturo Gónzalez Mendoza, a 30-year-old farmworker from Guanajuato, Mexico, died Sept. 5 after harvesting sweet potatoes in a Barnes Farming field in Nash County. Temperatures that week rose into the 90s, according to Accuweather.
Migrant worker advocates are rallying to change labor laws to protect migrant workers and others in extreme heat.
— Anne Blythe
Sharper focus on older North Carolinians
In only eight years, North Carolina is expected to have more people aged 65 and older than children younger than 18.
That brings a host of age-related health care issues to keep track of.
Gov. Roy Cooper issued an executive order in May 2023 for a “whole-of-government approach” to make North Carolina friendly to an increasingly aging population as the tail end of the Baby Boomer generation moves closer to 65.
Recommendations from that initiative are expected in the coming year.
During an election year, advocates for older voters and voters with disabilities plan to keep close watch to the impact of an amended election law.
A new provision requires precinct officials to keep a log of anyone who enters a polling place who is not seeking to vote, but who may be escorting an older or disabled voter. The log is to include the name, address and signature of that person unless they are a child younger than 18 in the care of the voter.
Rep. Diamond Staton-Williams, a Democrat from Concord, said in 2023 that she is concerned that such a provision will have a chilling effect on people who help get older and disabled voters to the polls — especially while the country is so politically divided.
Chris Brandenburg, associate state director of advocacy for AARP in North Carolina, said in 2023 that his organization would work in 2024 to make sure voters in the 50-plus age group have access to information about all the election law changes and new districts being drawn for congressional districts and state House and Senate seats.
“We’re monitoring a lot of changes,” Brandenburg told NC Health News in a phone interview in October. “We want to get accurate and truthful information to our voters.”
North Carolina is now one of the 26 states where Medicare Advantage covers the majority of Medicare beneficiaries, with 55 percent of people receiving benefits from the program getting their coverage that way. That’s up from 21 percent of North Carolina beneficiaries a decade ago.
In some parts of the state, Medicare Advantage — where private insurance companies get paid extra to provide the health care services for seniors and people with disabilities on the program — covers as many as three-quarters of beneficiaries.
But Medicare Advantage has come under increasing scrutiny from federal regulators who have been auditing program providers and clawing back federal funds after finding misleading marketing to seniors, fraudulent practices in providing care and massive payouts to private company executives using taxpayer dollars.
NC Health News plans to follow how shakeups at the federal level could affect North Carolina’s seniors who rely on Medicare.
— Anne Blythe, Rose Hoban
Child care faces a fiscal cliff
One of the big stories in children’s health for 2024 will be the expected loss of more child care facilities as federal COVID-19 relief support — which paid enhanced rates to child care providers — ends.
The so-called funding cliff, first expected in December 2023, is now expected to happen in June.
In the meantime, staffing shortages and pay issues — people can often make more money working at Target or in fast food than in child care — continue to plague the industry.
“All industries are fighting to find workers, but child care has been hit so hard because they are so underpaid,” said Kristi Snuggs, president of the Child Care Services Association.
More than 270 child care facilities closed in 2023 as of Sept. 30, according to the most recent state data available. Enrollment during that time dropped by 3,725 children.
Pandemic aid from the American Rescue Plan Act has helped child care providers boost pay and benefits and subsidized the cost of child care for many families.
Child care providers, along with legislators from both parties, state officials and the state Chamber of Commerce, unsuccessfully petitioned the General Assembly to include $300 million in the state budget to cover the loss of the federal pandemic aid to help providers maintain raises or bonuses for staff for another year.
The budget did address child care in several other ways, such as increasing the capacity of family child care homes and supporting a pilot program that shares costs among families, the state and the provider.
When the federal funding ends, North Carolina could see a total of 1,778 programs close and 155,539 children lose access to care, according to an estimate by the Century Foundation.
“I do think that the worst is yet to come,” Snuggs said.
Child care providers will be getting a survey in January about what their plans are once the federal funding ends. Snuggs said that information will be ready in time to share with the General Assembly for its short session.
“Our hope is that the legislature will step up, but we will see what happens,” she said.
Along with the child care situation, NC Health News will be keeping track of the mental health crisis affecting the state’s youth and checking on motor vehicle accidents involving teens after the state loosened rules in its graduated driver’s license program.
— Jennifer Fernandez
Fallout from changes to abortion access and trans care for kids
Access to abortion and gender-affirming care significantly changed last year, after state lawmakers passed laws adding restrictions on how the care can be provided and to whom. NC Health News covered Senate Bill 20 and House Bill 808 in 2023 from their introduction to passage, including hours of debate among lawmakers in the General Assembly, protests from medical providers and late-night veto override votes.
We’ve reported on some of the initial effects of the laws, and we know more impacts will emerge in the year ahead. That’s what NC Health News will be following and documenting. For example, how accessible is abortion in North Carolina under the exceptions for rape, incest, fetal anomalies and risk to the mother? Does the state have the resources to support more births, particularly in maternity care deserts? How do increased restrictions affect medical training and residency decisions?
We will also keep our eyes peeled to see what happens in the courts with legal challenges that could further shape access to abortion and gender-affirming care in 2024. The U.S. Supreme Court, which overturned Roe v. Wade in June 2022, will rule on abortion again this year — this time on a case regarding access to the commonly used abortion medication mifepristone. Depending on the decision, there could be significant changes to access for the drug — a pill used in about half of abortions nationwide.
There’s also an ongoing lawsuit by Planned Parenthood South Atlantic and a Duke physician to portions of North Carolina’s abortion law. U.S. District Judge Catherine Eagles issued an injunction against these requirements on Sept. 30, and a trial in federal court is tentatively set for May 6.
North Carolina’s gender-affirming care ban is also being challenged. In a federal lawsuit filed in October 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.
— Rachel Crumpler
The 2024 outlook for environmental health, environmental justice
Water-related topics will be a significant part of NC Health News’ environmental coverage in 2024.
Recently, the EPA released an annual report outlining the steps it took during 2023 to address PFAS contamination. The measures included funding to communities through the Bipartisan Infrastructure Law to support “infrastructure and treatment technologies to address PFAS in drinking water and wastewater,” according to the release.
In addition to funding, the EPA is expected to announce maximum contaminant levels for six PFAS in early 2024. Last March, NC Health News reported on the EPA’s proposed standards for select PFAS compounds, including PFOA (perfluorooctanoic acid) and PFOS (perfluorooctanesulfonic acid). The EPA is expected to regulate these compounds as individual contaminants and set maximum contaminant rates.
Microplastics are another contaminant source present in North Carolina waterways. In 2023, NCHN reported on efforts by communities across the state, such as Durham, to establish plastic bag ordinances, even as those efforts were halted by House Bill 259 — which was included in the state budget language. Proponents of the initiative believe it will reduce the amount of plastic waste in the environment where, over time, it breaks down into the smaller particles known as microplastics.
Last summer, NCHN on a freshwater fish advisory for the Cape Fear River issued by the N.C. Department of Health and Human Services. Shad and catfish are among the fish that people should limit their consumption of because they contain high levels of PFAS. The news was a blow to people who rely on the river to provide an inexpensive protein source to supplement their diet.
In 2024, the results of a saltwater fish study are expected from NCDHHS.
— Will Atwater
Changes to Medicaid will come into focus in 2024
While Medicaid expansion might have been the state’s biggest health story in 2023, we’ve yet to see the measure’s true impact.
An estimated 600,000 low-income adults became eligible for Medicaid when expansion launched in December. Half of those people were automatically moved over from Family Planning Medicaid, a limited-coverage program for reproductive health services.
But what about the state’s 300,000 other newly eligible residents, many of whom may not know they now qualify for Medicaid? The success of expansion hinges on them signing up, and that will depend on outreach efforts statewide.
We’ll be tracking North Carolina’s enrollment data in the coming months. We’ll also be checking in with health care providers, social workers and other people on the front lines of this decade-in-the-making effort to bridge the state’s health insurance coverage gap.
— Jaymie Baxley
Mental health care changes ahead
The year 2023 introduced many changes to North Carolina’s mental health landscape, and we’ll be watching and reporting on how those play out in the year to come.
State lawmakers put what some have called “once-in-a-lifetime” investments into mental health and substance use services — using more than half of the $1.4 billion federal sign-on bonus North Carolina received for expanding Medicaid. Mental health services have long been underfunded in North Carolina, and the state’s health leaders hope this influx of funds will begin to address the lack of services and the mental health workforce shortage.
As a result of the state budget, which became law in September, the state raised Medicaid reimbursement rates for behavioral health providers for the first time in a decade. The budget also invested in mental health crisis services and community-based services as alternatives to the emergency department for those in mental health crisis.
The state budget also changed the way children in the foster care system will receive mental health services by mandating that state officials create one statewide system, which should be established in the coming year. Additionally, in November, the Department of Health and Human Services consolidated the organizations that manage the state’s public dollars for mental health services, known as LME-MCOs, with the aim of better streamlining care for Medicaid recipients and the uninsured population.
These changes made late last year will have major effects on the state’s mental health system. We’ll be watching and asking you — the consumers and providers of the services — how you think it’s going in 2024.
— Taylor Knopf
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