By Will Atwater, Jaymie Baxley, Anne Blythe, Rachel Crumpler, Jennifer Fernandez, Rose Hoban and Taylor Knopf
Politics is prone to take middle stage within the coming 12 months since races for president, governor and high-level elected state places of work might be on the poll.
With all of the campaigning as a backdrop, some would possibly flip a hyper-political eye to well being care insurance policies and laws. However there’s loads occurring in well being care past what lawmakers do within the coming brief legislative session. We’ll observe psychological well being developments, modifications within the oral well being panorama, how Medicaid growth will have an effect on rural well being entry, hospitals’ backside traces and extra.
North Carolina Well being Information plans to interrupt down these subjects and preserve observe of different points on the horizon in 2024. Right here’s what our reporters might be specializing in of their respective beats.
Legislative motion prone to drive modifications to the enterprise of well being care
Maybe due to the election, the Basic Meeting is unlikely to cross as many controversial payments as they did final 12 months. As an alternative, everybody who’s working could have a watch on November, after they’ll need to attraction to moderates within the common election, in addition to their events’ base. Till the primaries in early March, you may even see some extra excessive rhetoric, after which candidates will seemingly tack again towards the middle in the course of the common election. A whole lot of that relies on how aggressive districts are.
After overlaying the legislature for greater than a dozen years, I hesitate to make massive predictions, but it surely’s fairly seemingly that legislators will wrap up work sooner than they did in the course of the 2023 work session, which stretched into October.
We’ll be monitoring the implementation of some measures from the 2023 session — distribution of opioid settlement cash, how the legislature’s mandate that UNC Well being and ECU Well being work collectively to enhance rural well being entry, how psychological well being care funded by the bonus cash that got here to North Carolina because of Medicaid growth will shake out and the various water and sewer initiatives funded by federal cash that got here to the state because of the federal infrastructure invoice.
North Carolina’s hospital panorama is within the midst of a restructuring. A bit greater than a decade in the past, many small, unbiased hospitals dotted the panorama, however the previous decade has been a tricky one for small and regional hospitals. Some aid is in sight within the type of the Hospital Entry and Stabilization Program, which can ship $2.6 billion in federal {dollars} to greater than 100 North Carolina hospitals over the approaching 12 months to assist pay for care to low-income sufferers.
We’ll be maintaining a tally of points arising from the consolidation of hospital techniques and the emergence of fierce competitors for affected person — and federal — {dollars}.
— Rose Hoban
How will new dental faculty have an effect on the oral well being panorama?
North Carolina’s solely non-public dental faculty is predicted to open to its first 60 college students at Excessive Level College this fall. The Workman College of Dental Drugs, for which floor was damaged in September, will ultimately add to the oral well being workforce in North Carolina, a necessity as inhabitants development outpaces the variety of dentists.
The North Carolina Institute of Drugs led a process drive in 2022 and 2023 that checked out alternatives to rework oral well being care.
Amongst different points that might be within the forefront in 2024 is the best way to look after the 600,000 individuals who gained entry to oral well being care via the long-awaited growth of Medicaid.
Solely about 45 p.c of dentists throughout the state take Medicaid sufferers, and lots of of these dentists who present look after Medicaid shoppers will not be accepting new sufferers.
The Medicaid reimbursement price for oral well being care has been stagnant since 2008. Advocates say that except modifications are made, most of the new Medicaid beneficiaries will be unable to get routine preventative care.
That may have an effect on emergency rooms, the place individuals with dental issues generally find yourself searching for assist for an an infection or ache that arises due to deferred care. These visits, in keeping with oral well being suppliers, could possibly be decreased if individuals, particularly in rural elements of the state, may see a dentist extra incessantly.
The NCIOM process drive that checked out Medicaid growth points additionally weighed whether or not oral well being ought to be included within the managed care routine that runs the state’s Medicaid program.
In 2022, after years of planning, the state remodeled its Medicaid program from one based mostly on charges for service to managed care. The dental program remains to be offered on a fee-for-service foundation. Some oral well being suppliers fear that if the state pushes the oral well being program to managed care that it received’t adequately cowl the prices for doing enterprise.
The duty drive’s report is predicted to be launched in January.
— Anne Blythe
Excessive warmth may trigger well being care coverage change
The acute warmth of the summer season of 2023 may not be on individuals’s minds right here within the chilly early days of January.
However that received’t cease local weather scientists and environmental well being advocates from rallying for brand spanking new insurance policies and laws to assist defend employees, older individuals and faculty youngsters from prolonged intervals of warmth wherein temperatures hover within the 90s, with warmth indexes in triple digits.
In any case, there’s a purpose why “what’s previous is prologue” has grow to be an adage.
Asley Ward, director of the brand new Warmth Coverage Innovation Hub at Duke College, mentioned that final summer season was not essentially an anomaly after July 2023 was declared the most popular July on document, globally.
“It isn’t unreasonable to suppose this might fairly probably be the best warmth season of our lives,” Ward informed NC Well being Information.
Ward was heartened to see leaders on the United Nations Local weather Change Convention in Dubai the primary two weeks of December spend a full day on the well being impacts of utmost warmth.
“This was the primary … in 28 years to function a delegated day for well being,” Ward mentioned in a press release posted to the Duke Nicholas Institute for Power, Atmosphere and Sustainability web site. “Those that have labored towards this for many years weren’t dissatisfied as well being grew to become a part of many conversations not solely on Well being Day however all through the convention. The subject of utmost warmth was particularly mentioned with newfound urgency on the heels of the most popular 12 months on document. The end result was unprecedented consideration on wanted investments in adaptation and resilience and give attention to shaping world well being coverage to put local weather change at its middle.”
The state Labor Division has but to launch the outcomes of its investigation after José Arturo Gónzalez Mendoza, a 30-year-old farmworker from Guanajuato, Mexico, died Sept. 5 after harvesting candy potatoes in a Barnes Farming subject in Nash County. Temperatures that week rose into the 90s, in keeping with Accuweather.
Migrant employee advocates are rallying to alter labor legal guidelines to guard migrant employees and others in excessive warmth.
— Anne Blythe
Sharper give attention to older North Carolinians
In solely eight years, North Carolina is predicted to have extra individuals aged 65 and older than youngsters youthful than 18.
That brings a bunch of age-related well being care points to maintain observe of.
Gov. Roy Cooper issued an government order in Could 2023 for a “whole-of-government method” to make North Carolina pleasant to an more and more ageing inhabitants because the tail finish of the Child Boomer technology strikes nearer to 65.
Suggestions from that initiative are anticipated within the coming 12 months.
Throughout an election 12 months, advocates for older voters and voters with disabilities plan to maintain shut watch to the influence of an amended election regulation.
A brand new provision requires precinct officers to maintain a log of anybody who enters a polling place who just isn’t searching for to vote, however who could also be escorting an older or disabled voter. The log is to incorporate the title, tackle and signature of that individual except they’re a baby youthful than 18 within the care of the voter.
Rep. Diamond Staton-Williams, a Democrat from Harmony, mentioned in 2023 that she is anxious that such a provision could have a chilling impact on individuals who assist become old and disabled voters to the polls — particularly whereas the nation is so politically divided.
Chris Brandenburg, affiliate state director of advocacy for AARP in North Carolina, mentioned in 2023 that his group would work in 2024 to ensure voters within the 50-plus age group have entry to details about all of the election regulation modifications and new districts being drawn for congressional districts and state Home and Senate seats.
“We’re monitoring lots of modifications,” Brandenburg informed NC Well being Information in a cellphone interview in October. “We wish to get correct and truthful data to our voters.”
North Carolina is now one of many 26 states the place Medicare Benefit covers the vast majority of Medicare beneficiaries, with 55 p.c of individuals receiving advantages from this system getting their protection that means. That’s up from 21 p.c of North Carolina beneficiaries a decade in the past.
In some elements of the state, Medicare Benefit — the place non-public insurance coverage firms receives a commission further to offer the well being care companies for seniors and other people with disabilities on this system — covers as many as three-quarters of beneficiaries.
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However Medicare Benefit has come below growing scrutiny from federal regulators who’ve been auditing program suppliers and clawing again federal funds after discovering deceptive advertising and marketing to seniors, fraudulent practices in offering care and big payouts to non-public firm executives utilizing taxpayer {dollars}.
NC Well being Information plans to comply with how shakeups on the federal degree may have an effect on North Carolina’s seniors who depend on Medicare.
— Anne Blythe, Rose Hoban
Little one care faces a fiscal cliff
One of many massive tales in youngsters’s well being for 2024 would be the anticipated lack of extra youngster care services as federal COVID-19 aid assist — which paid enhanced charges to youngster care suppliers — ends.
The so-called funding cliff, first anticipated in December 2023, is now anticipated to occur in June.
Within the meantime, staffing shortages and pay points — individuals can usually earn more money working at Goal or in quick meals than in youngster care — proceed to plague the business.
“All industries are combating to search out employees, however youngster care has been hit so laborious as a result of they’re so underpaid,” mentioned Kristi Snuggs, president of the Little one Care Companies Affiliation.
Greater than 270 youngster care services closed in 2023 as of Sept. 30, in keeping with the latest state information accessible. Enrollment throughout that point dropped by 3,725 youngsters.
Pandemic assist from the American Rescue Plan Act has helped youngster care suppliers increase pay and advantages and backed the price of youngster care for a lot of households.
Little one care suppliers, together with legislators from each events, state officers and the state Chamber of Commerce, unsuccessfully petitioned the Basic Meeting to incorporate $300 million within the state finances to cowl the lack of the federal pandemic assist to assist suppliers preserve raises or bonuses for employees for one more 12 months.
The finances did tackle youngster care in a number of different methods, resembling growing the capability of household youngster care properties and supporting a pilot program that shares prices amongst households, the state and the supplier.
When the federal funding ends, North Carolina may see a complete of 1,778 applications shut and 155,539 youngsters lose entry to care, in keeping with an estimate by the Century Basis.
“I do suppose that the worst is but to come back,” Snuggs mentioned.
Little one care suppliers might be getting a survey in January about what their plans are as soon as the federal funding ends. Snuggs mentioned that data might be prepared in time to share with the Basic Meeting for its brief session.
“Our hope is that the legislature will step up, however we’ll see what occurs,” she mentioned.
Together with the kid care scenario, NC Well being Information might be protecting observe of the psychological well being disaster affecting the state’s youth and checking on motorcar accidents involving teenagers after the state loosened guidelines in its graduated driver’s license program.
— Jennifer Fernandez
Fallout from modifications to abortion entry and trans care for youths
Entry to abortion and gender-affirming care considerably modified final 12 months, after state lawmakers handed legal guidelines including restrictions on how the care may be offered and to whom. NC Well being Information coated Senate Invoice 20 and Home Invoice 808 in 2023 from their introduction to passage, together with hours of debate amongst lawmakers within the Basic Meeting, protests from medical suppliers and late-night veto override votes.
We’ve reported on a number of the preliminary results of the legal guidelines, and we all know extra impacts will emerge within the 12 months forward. That’s what NC Well being Information might be following and documenting. For instance, how accessible is abortion in North Carolina below the exceptions for rape, incest, fetal anomalies and danger to the mom? Does the state have the assets to assist extra births, significantly in maternity care deserts? How do elevated restrictions have an effect on medical coaching and residency choices?
We can even preserve our eyes peeled to see what occurs within the courts with authorized challenges that would additional form entry to abortion and gender-affirming care in 2024. The U.S. Supreme Courtroom, which overturned Roe v. Wade in June 2022, will rule on abortion once more this 12 months — this time on a case concerning entry to the generally used abortion remedy mifepristone. Relying on the choice, there could possibly be vital modifications to entry for the drug — a tablet utilized in about half of abortions nationwide.
There’s additionally an ongoing lawsuit by Deliberate Parenthood South Atlantic and a Duke doctor to parts of North Carolina’s abortion regulation. U.S. District Decide Catherine Eagles issued an injunction towards these necessities on Sept. 30, and a trial in federal court docket is tentatively set for Could 6.
North Carolina’s gender-affirming care ban can also be being challenged. In a federal lawsuit filed in October by Lambda Authorized and the Nationwide Well being Regulation Program, attorneys argued that Home Invoice 808 is unconstitutional as a result of it discriminates on the premise of intercourse and transgender standing and infringes on dad and mom’ rights to make medical choices for his or her youngsters.
— Rachel Crumpler
The 2024 outlook for environmental well being, environmental justice
Water-related subjects might be a major a part of NC Well being Information’ environmental protection in 2024.
Lately, the EPA launched an annual report outlining the steps it took throughout 2023 to handle PFAS contamination. The measures included funding to communities via the Bipartisan Infrastructure Regulation to assist “infrastructure and remedy applied sciences to handle PFAS in ingesting water and wastewater,” in keeping with the discharge.
Along with funding, the EPA is predicted to announce most contaminant ranges for six PFAS in early 2024. Final March, NC Well being Information reported on the EPA’s proposed requirements for choose PFAS compounds, together with PFOA (perfluorooctanoic acid) and PFOS (perfluorooctanesulfonic acid). The EPA is predicted to manage these compounds as particular person contaminants and set most contaminant charges.
Microplastics are one other contaminant supply current in North Carolina waterways. In 2023, NCHN reported on efforts by communities throughout the state, resembling Durham, to determine plastic bag ordinances, at the same time as these efforts have been halted by Home Invoice 259 — which was included within the state finances language. Proponents of the initiative consider it would scale back the quantity of plastic waste within the surroundings the place, over time, it breaks down into the smaller particles often called microplastics.
Final summer season, NCHN on a freshwater fish advisory for the Cape Concern River issued by the N.C. Division of Well being and Human Companies. Shad and catfish are among the many fish that folks ought to restrict their consumption of as a result of they include excessive ranges of PFAS. The information was a blow to individuals who depend on the river to offer a cheap protein supply to complement their eating regimen.
In 2024, the outcomes of a saltwater fish research are anticipated from NCDHHS.
— Will Atwater
Adjustments to Medicaid will come into focus in 2024
Whereas Medicaid growth may need been the state’s greatest well being story in 2023, we’ve but to see the measure’s true influence.
An estimated 600,000 low-income adults grew to become eligible for Medicaid when growth launched in December. Half of these individuals have been mechanically moved over from Household Planning Medicaid, a limited-coverage program for reproductive well being companies.
However what concerning the state’s 300,000 different newly eligible residents, lots of whom could not know they now qualify for Medicaid? The success of growth hinges on them signing up, and that can rely on outreach efforts statewide.
We’ll be monitoring North Carolina’s enrollment information within the coming months. We’ll even be checking in with well being care suppliers, social employees and different individuals on the entrance traces of this decade-in-the-making effort to bridge the state’s medical insurance protection hole.
— Jaymie Baxley
Psychological well being care modifications forward
The 12 months 2023 launched many modifications to North Carolina’s psychological well being panorama, and we’ll be watching and reporting on how these play out within the 12 months to come back.
State lawmakers put what some have known as “once-in-a-lifetime” investments into psychological well being and substance use companies — utilizing greater than half of the $1.4 billion federal sign-on bonus North Carolina acquired for increasing Medicaid. Psychological well being companies have lengthy been underfunded in North Carolina, and the state’s well being leaders hope this inflow of funds will start to handle the shortage of companies and the psychological well being workforce scarcity.
On account of the state finances, which grew to become regulation in September, the state raised Medicaid reimbursement charges for behavioral well being suppliers for the primary time in a decade. The finances additionally invested in psychological well being disaster companies and community-based companies as options to the emergency division for these in psychological well being disaster.
The state finances additionally modified the best way youngsters within the foster care system will obtain psychological well being companies by mandating that state officers create one statewide system, which ought to be established within the coming 12 months. Moreover, in November, the Division of Well being and Human Companies consolidated the organizations that handle the state’s public {dollars} for psychological well being companies, often called LME-MCOs, with the goal of higher streamlining look after Medicaid recipients and the uninsured inhabitants.
These modifications made late final 12 months could have main results on the state’s psychological well being system. We’ll be watching and asking you — the customers and suppliers of the companies — the way you suppose it’s getting into 2024.
— Taylor Knopf
