Environment, public health

BREAKING: DHHS investigating suspected cancer cluster near Lake Norman

Zip Code 28117, one of two areas that have reported statistically higher than average incidences of thyroid cancer.

This is a developing story. Policy Watch will run a full story, including interviews with scientists and community residents tomorrow.

Two areas near Lake Norman have reported statistically higher than expected incidences of thyroid cancer, according to a May 29 letter obtained Tuesday by Policy Watch from the state Department of Health and Human Services.

Most of the cases occurred in two Zip Codes: 28115 and 28117.  The state undertook the analysis because of community reports of thyroid cancer, including several cases involving teenage girls.

Thyroid cancer is unusual in young people. It more commonly affects women in their 40s and 50s.

In preparing the assessment, the state’s Central Cancer Registry and the Division of Public Health concluded that from 1995 to 2016 the observed number of thyroid cancer cases in the 28115 Zip Code was two times the expected number.

In the 28117 Zip Code, the observed number was more than double over the same time period, and three times higher from 2012 to 2016.

Overall, Iredell County reported statistically higher rates of thyroid cancer: 1.5 times from 1995 to 2016, and more recently, 1.7 times from 2012 to 2016.

Zip Code 28115

“This investigation cannot be used to determine the cause of the observed cancers or identify possible associations with any risk factors,” the letter read. “It is important to note that the data and statistical analysis conducted at this step cannot determine if cancers observed in the community are associated with specific environmental, lifestyle, or other risk factors.”

Genetics and/or environmental exposure can increase a person’s risk for thyroid cancer. Exposure to radiation, flame retardants and perfluorinated compounds, such as GenX and PFOAs, can also enhance the risk. These compounds have been found in the Cape Fear River, a result of discharges and emissions from the Chemours plant near Fayetteville.

However, they also been detected at low levels in Lake Michie, in northern Durham County; since no industry discharges into the lake, Durham water officials believe the compounds are entering the water from the air.

Duke Energy built Lake Norman in the late 1950s and early 1960s. The utility’s McGuire nuclear power plant sits on the southern end of the lake; the Marshall Steam Station, a coal-fired power plant is also located on the lake, directly west of Mooresville.

The Occupational and Environmental Epidemiology Branch will review the data and determine the next steps, which will include reviewing the literature for environmental exposures associated with thyroid cancer risk, a DHHS spokeswoman told Policy Watch. “These steps will be completed with input from the community and others who have been involved in bringing attention to this issue. Information gathered will help inform whether a study can be done to look for a common exposure or risk factor among thyroid cancer cases in this area of North Carolina.”

SIR stands for Standardized Incident Ratio; CI is short for Confidence Interval. Source: DHHS

 

Thyroid Cancer Letter by Lisa Sorg on Scribd

agriculture, Courts & the Law, Defending Democracy, Education, Legislature, News, public health

The week’s Top Five on Policy Watch

1. A moment of extreme danger for NC public schools

There have been a lot of regressive education policies that have emanated from the North Carolina General Assembly in recent decades. Even prior to the Republican takeover that commenced in 2011, many Democratic leaders had already embraced the flawed conservative idea that our schools and students were struggling in many places because they were too “soft” and lacked sufficient “competition.” Hence, the early-century moves to introduce charter schools, dramatically expand the number of high-stakes, standardized tests and limit so-called “social promotions.”

In the last seven-plus years of GOP rule, the relative trickle of conservative education schemes has turned into a flood. Lawmakers have slashed funding, dramatically expanded charters (including for-profit, virtual charters), introduced private school vouchers, “education savings accounts,” “performance-based pay,” and state-initiated conversions of struggling schools to charter schools, and talked openly and repeatedly of privatizing what has long been understood to be a core function of government.

As unhelpful as each of these developments has been, however, they may well end up paling in comparison to the new and dangerous two-part change that’s currently making its way into law during the current legislative session.

At issue is the enormously controversial and dangerous plan to fundamentally alter the way North Carolina funds public schools by allowing individual cities to get into the business of running and funding public schools. Under the plan approved by the Senate last week, four wealthy suburbs of Charlotte that are angry with the administration of the county school system would be granted authority to fund their own charter schools and give priority admission to their towns’ students.

The plan is so radical and potentially game-changing that it actually drew negative votes from five Senate Republicans last week – something that almost never happens in that intensely partisan body – and is now attracting national attention. [Read more…]

2. In surprise revision to school safety bill, Senate Republicans seek insurance overhaul that may threaten NC’s Affordable Care Act marketplace

3. State lawmakers moving suddenly and swiftly to shut down nuisance suits against industrial hog farms

4. “Piecemeal” judicial redistricting: Lawmakers pushing a trio of bills that would impact a third of state’s residents

5. Amid anti-LGBTQ violence, NC Democrats seek expansion of state hate crimes law

Education, News, public health

In surprise revision to school safety bill, Senate Republicans seek insurance overhaul that may threaten NC’s Affordable Care Act marketplace

Sen. Ralph Hise unveiled a change in law Thursday that may have major implications for the Affordable Care Act.

A bipartisan-backed proposal to help North Carolina schools recruit campus psychologists received a major makeover in a Senate committee Thursday that may destabilize the state’s Affordable Care Act (ACA) marketplace, advocates say.

Senate Republicans unveiled the new portions of House Bill 933 at a committee meeting Thursday morning, potentially clearing surprise provisions aimed purportedly at lowering the threshold for small employers to offer self-funded health plans and, perhaps most importantly, clearing less-regulated association health plans for membership organizations like the N.C. Farm Bureau.

“These people, as I move around the state, are coming to me asking whether Farm Bureau can help them,” Farm Bureau President Larry Wooten told Senate lawmakers.

The Farm Bureau provides insurance, banking, and other benefits to their members in North Carolina. They also advocate for agricultural interests at the N.C. General Assembly.

Wooten and Sen. Ralph Hise, a western North Carolina Republican who co-chairs the Senate Health Care Committee, pitched the revisions to the school safety bill as a means of expanding health insurance options for residents complaining of soaring healthcare premiums.

The revisions come with federal officials considering new rules for skimpy short-term plans and association health plans. If approved by state lawmakers, the new rules would allow groups like Farm Bureau to offer health plans exempted from state oversight and from ACA regulations that protect individuals with pre-existing conditions from being excluded or facing higher premiums.

N.C. Farm Bureau President Larry Wooten

Asked Thursday whether the new Farm Bureau plan would cover pre-existing conditions, Wooten did not answer the question directly.

“Certainly, that would have to be something that we take under consideration as we move forward with this association health plan,” Wooten told legislators.

Yet Wooten reportedly indicated in a N.C. Health News report Wednesday that the organization wouldn’t be able to offer plans without underwriting, a practice that makes it more difficult for individuals with pre-existing conditions to secure coverage.

Wooten added for lawmakers Thursday that the Farm Bureau plan “would not be for everybody.”

“Certainly we would have to look at it carefully and we would tier it so people would have the ability to participate,” he said. “Obviously, some folks may be, if you look at underwriting, some folks may still be better off in the individual market and the ACA.”

Critics say the new North Carolina proposal mirrors existing exemptions for the Farm Bureau in Tennessee, which experts have linked to one of the nation’s shakiest ACA marketplaces. 

Hise’s rewrite would also scrap a state law that sets a 26-employee bar for small employers who wish to offer self-funded health plans. The proposed version Hise put out Thursday does away with that threshold altogether, although Hise said it’s his intent to ultimately set a minimum bar of 10 employees.

Some companies suggest that such plans may allow them to limit costs, although experts note they’re a much riskier option for employees.

Democrats seemed to struggle with the health care implications Thursday, particularly given Republicans bundled the reforms with a widely-supported school psychologist recruiting effort proposed in a school safety committee this year following a deadly shooting at a Parkland, Fla., high school. The House approved the bill unanimously last month.

Lawmakers did not take a vote on the Senate committee rewrite Thursday, although Republicans said they may hold at a vote at the panel’s still unscheduled next meeting.

Wooten said that his group has been working on the plan for two years, although the details emerged in a Senate committee Thursday with little or no public notice.

Opponents say the state Senate measure coincides with a GOP push to allow for slim plans in alternative marketplaces catered to “healthy” individuals, a push that threatens to weaken the ACA marketplace and drive up costs for sick individuals.

Critics quickly pounced on the proposal Thursday. The progressive N.C. Justice Center issued a statement calling the reforms “dangerous new provisions that would endanger critical protections for North Carolinians with pre-existing conditions.”

[Disclosure: The Justice Center is the parent nonprofit of Policy Watch.]

More from the Justice Center statement:

Read more

NC Budget and Tax Center, public health

Virginia votes to expand Medicaid for some. We can do better.

Last week, North Carolina’s northern neighbor, Virginia, voted to expand Medicaid coverage to 400,000 low-income residents, making it the 34th state to do so since the passage of the Affordable Care Act in 2010. If North Carolina wants to compete with our southern neighbors, as we so often hear in policy debates, now is the time for policymakers to move ahead with closing our state’s coverage gap.

They should do so for everyone, demonstrating their leadership by passing a more comprehensive coverage plan that doesn’t include red tape or exclusions.

Virginia’s state legislature voted to extend coverage to many uninsured Virginians. However, the inclusion of requirements that those eligible work a minimum number of hours each month will limit coverage for an estimated 50,000 individuals who would otherwise be eligible for coverage. It is a move that doesn’t acknowledge current labor market realities and is likely to cost the state more to implement. So-called “work requirements” create significant administrative burden for states, and will cost Virginia approximately $1.2 million in the next two years alone.

Furthermore, work requirements do not address the root causes of poverty, and they generally exacerbate the problem. Data show that almost all adult Medicaid recipients who do not work either have a disability, serve as a caretaker to family, attend school, are retired, or could not find work. These requirements hurt most enrollees, including the most vulnerable, such as children, adults with disabilities and those with substance use disorders, as enrollees wrestle with complex administrative requirements for reporting and documenting their work hours each month.

Let Virginia’s restricted expansion of health coverage be a signal for North Carolina lawmakers to enact better, evidence-based legislation that demonstrates their commitment to promote the health and well-being of all in our state.

Suzy Khachaturyan is an MSW/MPH intern with the Budget & Tax Center, a project of the North Carolina Justice Center. 

NC Budget and Tax Center, public health

This health program transforms children’s lives — so why aren’t more in NC using it?

If you are a parent or guardian of a child who receives North Carolina Health Check, or you provide medical services to children with NC Health Check, chances are you have interacted with EPSDT. The Early and Periodic Screening, Diagnostic, and Treatment (EPSDT, for short) is a mandated guideline that works to ensure children receive the care they need when they need it.

EPSDT requires states to cover a broad array of medically necessary and rehabilitative services for children under the age of 21.

Successful implementation of EPSDT is a component of a robust preventative care model that recognizes how to address child health priorities and social determinants of health. However, parents and caregivers, as well as medical providers need more information about how to take full advantage of EPSDT.

Unfortunately, this lack of information translates into low utilization rates. In 2016, only 57 percent of children eligible for EPSDT in North Carolina received at least one initial or periodic screening. What’s more, utilization of EPSDT greatly decreases as children age. By the time children reach adolescence (ages 15-20 years), less than one-third of eligible children are receiving some kind of EPSDT related screening.

A recent report from the Budget and Tax Center and the Health Advocacy Project provides an overview of North Carolina’s EPSDT program and examines the effectiveness of the program as it relates to identified child health priorities and social determinants of health. By highlighting best practices at both the state and national level, the report offers practice and policy models for how EPSDT delivery can be improved or modified to address social determinants of health and ultimately improve child health outcomes.

North Carolina has several child health priorities including asthma, physical activity and nutrition, and depression, anxiety, and toxic stress. These health priorities are discussed within the context social determinants of health such as housing, neighborhood characteristics, and adverse childhood experiences. When used correctly, EPSDT is well-equipped to manage and improve child health and well being. EPSDT also allows for community-based treatment and care coordination, which greatly improves continuity of care and health literacy.

Currently, EPSDT delivery can be improved so that a higher level of preventative care is delivered to North Carolina Children. Looking forward, North Carolina faces a unique opportunity with plans to transform health care and social service delivery. State leadership is working to transition North Carolina’s Medicaid system to a Managed Care model. This allows for an opportunity to establish a health care delivery process that is preventative, cost-effective, and patient- and community-centered. Furthermore, North Carolina’s Section 1115 Waiver Application includes language to address social determinants of health such as housing, transportation, food insecurity, and toxic stress.

Read the full report here.