Two new bills target transgender rights, health care

Two new bills filed this week target transgender North Carolinians, part of a wave of anti-trans legislation filed by Republicans across the country.

Senate Bill 514 would prohibit transgender people under the age of 21 from receiving medical care related to gender transition, even if judged medically necessary by their parents and doctors.

The bill closely mirrors a similar legislation filed across the country, including in Arkansas this week where a similar bill was passed into law this week. To enact the law, that state’s legislature overturned the veto of Republican governor Asa Hutchinson, who condemned it as “government overreach.”

But in several respects SB 514 goes beyond the law passed in Arkansas.

The bill would also require state employees, including teachers and counselors, to inform parents in writing if they have knowledge of a minor who exhibits “gender dysphoria, gender nonconformity, or otherwise demonstrates a desire to be treated in a manner incongruent with the minor’s sex.”

Gender non-conformity can include anything from young men who paint their nails and young women who prefer to dress in clothes traditionally considered masculine to non-binary and gender-fluid people who do not identify strongly as male or female. The bill would require those children’s teachers and counselors to report them to their parents if they “exhibit symptoms” of gender non-conformity, even if they do not consider themselves transgender.

The bill also seeks to legally protect so-called  “conversion therapy,”  a scientifically discredited practice  that attempts to “cure” lesbian, gay, bisexual and transgender people. The practice, which research has repeatedly found causes depression, anxiety and suicidal thoughts, has been banned in 20 states. In 2019 Gov. Roy Cooper issued an executive order forbidding taxpayer money to be used to pay for its use on minors in North Carolina. Polling shows overwhelming support for banning the practice in North Carolina, but multiple bills to do so have gone without a hearing or a vote.

Taken together, these provisions of the bill establish a legal mandate to identify and report children who may be transgender, prevent their parents and doctors from making medical decisions about their care and legally protect methods of “curing” them that have been established to be harmful.

“It’s heartbreaking – though not unexpected – to see these direct, repeated attacks on trans and gender-nonconforming youth in North Carolina and across the country,” said Kendra Johnson, Executive Director of Equality NC, in a statement Wednesday. “These attempts to control the bodies and medical decisions of parents and their transgender children are invasive, inappropriate, and outright dangerous.”

“Decisions about a child’s medical welfare should be made between that child, their doctor, and their parents or guardians – not lawmakers.,” Johnson said. “We cannot legislate the transgender community out of existence. It is the job of all lawmakers to understand the entirety of their constituency and mitigate challenges instead of creating barriers.”

At the heart of the bill are arguments about whether transgender identity exists and whether certain of their rights are protected by law. These are disputes that have already been largely resolved by the scientific community, federal policy and the U.S. Supreme Court.

Significantly, gender dysphoria is mischaracterized throughout the bill. The American Psychiatric Association makes clear it is not a mental illness, instead defining it as “a conflict between a person’s physical or assigned gender and the gender with which he/she/they identify.”

More than 40 years of research into and treatment of transgender people experiencing dysphoria has led psychiatric and medical professionals to conclude the most effective course of treatment is gender transition — aligning one’s life socially and sometimes physically to better match their gender identity. Not all transgender people choose to medically transition, but for those for whom it is judged necessary, medical experts agree that it can be life-saving.

The bill would also legally prohibit any state government health plan or state provided insurance from paying for that care.

Blue Cross/Blue Shield of North Carolina, which administers the State Employee Health Plan, recognizes the necessity of transition care. It has, since 2011, recognized dysphoria as a serious medical issue and covered treatments related to transition, including hormone therapy and gender confirmation surgery. But as Policy Watch has reported, the trustees of the state health care plan cut off that coverage to state employees.

The board of trustees of the state health care plan voted to begin covering treatments for gender dysphoria at the end of 2016, near the end of Janet Cowell’s term as State Treasurer. The change was necessary to comply with the Affordable Care Act. When Republican Dale Folwell came into office in 2017, he opposed the move, calling care related to gender dysphoria elective and unnecessary. The plan’s trustees allowed the coverage to expire at the first opportunity and have never reinstated it. Transgender state employees and employees with transgender family members cut off from their coverage sued the state over the change.

Ignoring scientific consensus and federal law that recognizes transgender peoples’ identities and upholds their rights, the bill seeks to legally conflate gender identity and biological sex. It describes sex as “the biological state of being female or male, based on sex organs, chromosomes, and endogenous hormone profiles, and is genetically encoded into a person at the moment of conception, and it cannot be changed.”

Making no distinction between biological sex , gender and gender identity, the bill characterizes transgender people as confused and says that if they are not encouraged to transition, any gender dysphoria they experience will naturally dissipate.

That judgement is opposed by every major legitimate medical and psychiatric association that has examined the issue.

A second bill, Senate Bill 515, would allow any medical provider  to refuse to perform any form of care or service “on the basis of conscience, whether such conscience is informed by religious, moral, ethical, or philosophical beliefs or principles.” That would including providing referrals to others who may provide the care or service. LGBTQ advocates call it a “license to discriminate” against lesbian, gay, bisexual and transgender people among, among others, for religious reasons.

“This is the latest in a series of coordinated attacks on healthcare access for trans and gender-nonconforming youth across the country, the true aim of which is to push trans and non-binary people out of public life,” said Chantal Stevens, Executive Director of the ACLU of North Carolina, in a statement Wednesday.

“Not only are these bills rooted in falsehoods, hate, and fear-mongering, but they also invade the private interactions between each of us and our medical providers,” Stevens said. “Just as North Carolina is recovering from the damage wrought by HB2 on our reputation and economy, let’s move forward together to build equitable communities rather than doubling down on being a state that legislates hate.”

These two bills follow the filing last month of House Bill 358, which would bar transgender women from competing against other women in sports at schools and universities in North Carolina.

Rev. Jasmine Beach-Ferrara, Executive Director of the Campaign for Southern Equality, warned the current wave of ant-trans legislation could lead to the sort of division and harmful backlash that accompanied HB2, the law that excluded LGBTQ people from non-discrimination protections five years ago.

“Our state learned a lesson all too painfully with HB2,” Beach-Ferrara said in a statement Wednesday. “Extreme bills that target LGBTQ people harm individuals, communities, and the fabric of our state itself.”

“We’re working toward building communities across North Carolina where every LGBTQ person can thrive,” Beach-Ferrara said. “That means being treated with dignity and respect, it means living free from discrimination, and it means being able to access the health care you need and deserve in your hometown.”

Colonial spill prompts bill that would require DEQ to study potential public health, environmental effects of gasoline pipelines

A map of the US showing the gas transmission and hazardous liquid pipelines; the Colonial Pipeline enters North Carolina near Charlotte and proceeds northeast through the Piedmont.

The Colonial Pipeline enters North Carolina south of Charlotte, represented by a red line on this map, and travels northeast through the western Piedmont before entering Virginia. (Map: National Pipeline Mapping System)

The NC Department of Environmental Quality would receive $200,000 to study the “condition, safety and environmental impact” of pipelines that transport petroleum through or within the state, according to a bill filed yesterday.

Democratic Sen. Natasha Marcus filed SB 459 in response to the nation’s largest gasoline spill in two decades, which occurred last August in Huntersville, part of the senator’s district. Colonial Pipeline is responsible for the incident, which released 1.2 million gallons of gasoline in the Oehler Nature Preserve and near several residential neighborhoods.

No drinking water wells have reportedly been affected, according to Colonial, but the groundwater is heavily contaminated with chemicals found in gasoline, such as benzene.

The pipeline is part of a 5,500-mile route that extends from Texas to New Jersey; it passes through several counties in southern and west-central North Carolina. The spill was Colonial’s 32nd in the state since 2000, according to federal safety records. The cleanup in Huntersville is ongoing, and will likely take years, if not decades.

Just last week the federal Pipeline and Hazardous Materials Safety Administration issued a Notice of Proposed Safety Order saying “conditions may exist on the Colonial Pipeline System that pose a pipeline integrity risk to public safety, property or the environment. The conditions that led to the failure potentially exist throughout the Colonial Pipeline system.”   

Sen. Natasha Marcus, a Democrat representing Huntersville. (Photo: NCGA)

Sen. Marcus said in a press release: “We cannot allow a tragic mess like this to happen again. Our state can and should monitor aging hazardous liquid pipelines, rather than rely solely on the pipeline company and the federal government to be our watchdogs. My bill calls on the NC DEQ to study what can be done at the state level to protect us in the future.”  

At the end of the two-year study DEQ would report its findings and recommendations to the Joint Legislative Commission on Energy Policy.

“This bill will give NC DEQ the resources it needs to look out for our health and safety in light of the risks posed by aging hazardous liquid pipelines.  For starters, I believe residents find it unacceptable that the state does not currently monitor such pipelines for leaks. We need to change that.” 

The NC Utilities Commission has a Natural Gas Pipeline Safety Section that inspects and monitors natural gas pipeline systems operating in North Carolina. However, the section’s authority doesn’t extend to petroleum pipelines.

 

Democrats in the NC legislature decry racial health disparities in their renewed push for Medicaid expansion

Democrats in the legislature renewed their press for Medicaid expansion, saying a Tuesday news conference that getting more people insured will reduce racial health disparities and help the economy.

Sen. Mike Woodard, a Durham Democrat, said there are signs that Republicans in the legislature who have long opposed Medicaid expansion are willing to talk about it.

“I think there are glimmers of hope,” he said.  “I think there are frameworks for us to move forward.”

North Carolina is one of a dozen states that has not adopted Medicaid expansion as allowed under the Affordable Care Act.  Last session, Senate Republicans said they did not like an expansion-like proposal called Carolina Cares that House Republicans crafted. The Carolina Cares bill never got out of the House.

Expansion is a top priority for Gov. Roy Cooper, and he once again has included it in his budget proposal.

Estimates for how many more people in the state would be insured with expansion start at 500,000. Many are childless adults younger than 65.

The most recent federal relief package includes financial incentives for more states to expand Medicaid. North Carolina would see a net gain of $1.2 billion, according to a Kaiser Family Foundation estimate.

Senate leader Phil Berger, an Eden Republican, told the Associated Press that the extra federal money is time limited and that coverage gaps could be addressed without “creating a whole new level of entitlement in the state of North Carolina.”

Senate Republicans this year have shown interest in allowing adults who use Medicaid to keep it under limited circumstances.

Three Republican senators, including Sen. Joyce Krawiec, one expansion’s fiercest opponents, are the main sponsors of a bill filed Monday that would allow women who use the government insurance program while they’re pregnant to keep the coverage for a year after giving birth rather than have it cut off after 60 days.

House Democrats, including Rep. Verla Insko of Chapel Hill, filed a similar bill last month.

The American Rescue Plan allows states to expand what’s called pregnancy Medicaid to 12 months postpartum.

Doctors, policy experts and others say that 60-day cut off doesn’t give some mothers time to have their postpartum medical visits or seek treatment for postpartum depression.

The American College of Obstetricians and Gynecologists has made extending postpartum Medicaid coverage a priority, saying it will help reduce the rate of maternal deaths. Medicaid pays for more than half the births in North Carolina.

At their press conference, Democrats highlighted  the racial disparities in maternal and infant deaths to make their case for Medicaid expansion.

The latest state data, from 2019, shows that Black and Native American babies in North Carolina are more than 2.5 times more likely to die before their first birthdays than white infants.

“The longer we wait to expand Medicaid, the more babies we will see die unnecessarily, particularly Native American and African American babies,” said Rep. Charles Graham, a Democrat from Robeson County who is Lumbee.  “This is not acceptable.”

At 6.8 deaths per 1,000 births, North Carolina has the 12th highest infant mortality rate in the nation, according the Centers for Disease Control and Prevention.

The CDC reports  wide racial disparities in maternal mortality.

Black and Hispanic adults are more likely to fall into what’s called the coverage gap, where they make too much to qualify for Medicaid and too little to qualify for subsidized premiums in the health insurance marketplace, according a 2020 report from The Commonwealth Fund.

The same report said that states that expanded Medicaid had helped reduced the racial disparities in health care coverage so that Black residents in  states that expanded Medicaid were more likely to have health insurance coverage than white residents of  non-expansion states.

The uninsured rate in North Carolina varies wildly by race and ethnicity, said Sen. Natalie Murdock, a Durham Democrat. Nine percent of Asian -American residents are in the coverage gap she said, while 12% of Black residents and 31% of the Latinx population are in the gap.

At the press conference Insko said military veterans are among those who would benefit from Medicaid expansion.

“We should look at the broad picture of what we’re doing and who we’re hurting by not expanding Medicaid,” she said. “We’re hurting the uninsured, we’re hurting their families, we’re hurting the state because it increases the cost for everyone.”

Expanding Medicaid ensures that essential workers can live free of medical debt and fear, said Rick Glazier, executive director of the NC Justice Center. (NC Policy Watch is a Justice Center project.)

”Medicaid expansion is one of the best policy interventions the General Assembly can take to reduce health care disparities, and make sure communities of color can get the care they need particularly during a time when communities of color have borne the brunt of the COVID epidemic,” he said.

Cooper proposes asking voters to approve $4.7 billion for school and state building projects.

Gov. Roy Cooper has again proposed that voters approve borrowing money for statewide construction and renovation projects.

But the idea of borrowing, no matter who comes up with it, has proven to be hard to get legislative approval recently. Senate Republicans prefer paying for buildings with direct appropriations.

As part of his budget this year, Cooper has proposed putting a $4.7 billion bond to a vote in November.

-$2.5 billion would go to K-12 school construction.  A report from the State Board of Education and the  Department of Public Instruction based on a 2015-16 survey found school districts needed $8 billion for buildings, additions, renovations, and other capital costs.

-$500 million would go to community colleges

-$783 million would go to UNC campuses. The largest project is a new Brody School of Medicine building at East Carolina University, at $187 million.

The recommendation includes money for renovations at two of the state’s development centers and two of its neuro-medical centers, the state alcohol and drug treatment center in Black Mountain, and money to expand TROSA, a residential addiction treatment center based in Durham, to the Triad.

The bond recommendation includes $229 million to move the state Department of Health and Human Services from the Dorothea Dix campus in Raleigh to Blue Ridge Road.

Assorted state attractions would get a total of $460 million, including $70 million for NC Zoo exhibits.

Cooper included a $3.9 billion general obligation bond as part of his 2019-20 recommended budget that the legislature did not consider.

The state House has been amenable to the idea of asking voters to approve borrowing for capital projects. In the last two years, House Republicans have put together their own bond proposals, and passed them with little opposition.

In 2019, House Speaker Tim Moore cosponsored a $1.9 billion school construction bond bill that moved swiftly through the House and died in the Senate.

approval.

The House tried again last year, passing a $3.1 billion bond bill with the money to go to school construction and transportation projects. That bill also died in the Senate.

With only a quarter of state’s landslide areas mapped, DEQ asks lawmakers to renew funding for key program

Source: DEQ presentation to Joint Appropriations ANER Committee

At this very moment, there are nine active landslides in the mountains of western North Carolina. These are not rivers of mud surging down steep slopes, but a slow-motion disaster as the dirt loses its grip on its underpinnings.

Of the 350 landslides recorded in the western part of the state since 1990, 78 of them have occurred in the last two years. Climate change, in part, has created weather conditions that favor landslides: droughts followed by biblical amounts of rain.

However, a lack of state funding has hamstrung the NC Department of Environmental Quality from comprehensively mapping the 19-plus counties that are prone to landslides.

The Joint Appropriations on Agriculture, Natural and Economic Resources Committee today heard from state environmental officials who asked for funding to continue mapping landslide areas in western North Carolina.

The legislature appropriated $3.6 million for the project in 2018, but that funding is scheduled to expire this year. Brian Wrenn, director of the Division of Energy, Mining and Land Resources, did not specify a dollar figure, but much of the mapping work for such a vast region remains unfinished.

The mapping project began after a landslide disaster that killed four people occurred in Macon County on Sept. 16, 2004. That night, as remnants of Hurricane Ivan traveled up the Appalachians, “a layer of soil liquefied and began flowing down Peeks Creek,” at about 30 mph, according to the National Weather Service. The massive debris flow destroyed about 15 homes in a matter of seconds.

Nineteen counties were declared disaster areas and received state money from the Hurricane Recovery Act of 2005. However, money for the mapping project ended in 2011 and was not renewed until 2018.

These red dots represent the 5,237 recorded “landslide points” where these disasters have occurred since the early 1900s. (Source: DEQ)

Six of the 19 original counties have been mapped: Macon, Haywood, Buncombe, Henderson, Watauga, Polk and Jackson.

Mapping is in progress in Rutherford County and the northern part of Cleveland County. A master’s student from Kent State in Ohio is mapping McDowell County.

Wrenn of DEMLR told lawmakers that eight counties have been added to the mapping area since 2018. Steep slopes and other geological vulnerabilities prompted scientists to include these areas: Surry, Stokes, Wilkes, Yadkin, Alexander, Graham, Cherokee and Clay.

In addition, some existing maps need updated because advanced technology allows for more detailed analysis of vulnerable areas.

Meanwhile, within the past two years, a landslide disrupted the water supply for the city of Franklin; 13 landslides were reported in the area in April 2020, with a debris flow nearly a mile long.

A Bright’s Creek landslide damaged a natural gas pipeline, incurring $4.5 million in costs to Duke Energy. In Swain County alone, there have been 32 landslides since 2019.

The governor is expected to release his budget as early as this week, followed by the first draft of the legislature fiscal priorities this spring.