This week at the NC General Assembly: Reproductive health, nursing practice scope, paid family leave and more

By Grace Vitaglione and Rachel Crumpler

Some weeks at the North Carolina General Assembly are busier than others. This week was one of those, in part because of the March 25 Senate deadline for filing bills. Senators filed 283 bills just on that day, bringing the Senate’s tally for this session to 760 legislative proposals.

Each chamber has its own deadlines for filing policy bills, which come pretty early in the legislative session. That means lawmakers need to get busy drafting and filing policy bills in February and March. They spend time trying to sell their favorite initiatives to other lawmakers (more co-sponsors gives bills a better chance at passage) and drum up support. 

It’s important to get those bills moving early, because there’s another legislative deadline called “crossover.” This year’s crossover date, May 8, marks the point by which any bill that’s purely policy — and lacking any state appropriations — needs to be approved by at least one chamber, or it dies until the beginning of the next biennium. 

There were dozens of health care bills filed and considered this week; NC Health News will run down a handful of them.

Bevy of bills on reproductive health, LGBTQ+ issues

Democratic lawmakers from the House and Senate filed more than 10 bills seeking to expand and protect reproductive and LGBTQ+ rights this week amid a state and federal backdrop of increasing restrictions. 

Among them are proposals to codify the right to contraception and in-vitro fertilization, ban conversion therapy, eliminate sales tax on menstrual products and increase regulation of crisis pregnancy centers. 

“Freedom requires control over what happens to your body and what happens to your family,” said Sen. Natalie Murdock (D-Durham) at a news conference on March 25 at the statehouse building as dozens of advocates stood outside in support. 

“Freedom means being able to decide how to live and who to love. No one knows what’s best for you and your future better than you. It’s long past time for politicians to get out of our bedrooms, keep their hands off of our bodies and provide freedom to all.”

Democratic lawmakers have introduced these bills in past legislative sessions, but they have failed to move in the Republican-controlled legislature. The bill sponsors conceded that they’d likely meet a similar fate this year. 

Still, they said, it’s important to keep raising the issues and fighting for increased protections.

Rep. Julie von Haefen (D-Apex) told NC Health News that the last legislative session was particularly difficult and emotional for her. North Carolina Republicans rolled back rights by enacting three laws — over then-Gov. Roy Cooper’s vetoes — restricting transgender youth from accessing gender-affirming health care, participating in sports and exploring gender identities at school. In 2023, lawmakers also passed a stricter abortion law that reduced the time frame for seeking most abortions from 20 weeks of pregnancy to 12 weeks.

“I feel very motivated by the advocates, by the people who are affected by these terrible bills and their positive feedback that they see us and we need to keep going,” von Haefen said.

Senate leader Phil Berger (R-Eden) told reporters during an informal news conference after his chamber’s session on Thursday that he doesn’t anticipate any legislation relating to abortion to come up during this session — with a caveat. 

“Members have ways of doing committee substitutes and amendments and that sort of thing,” he said.

March 25 was a day for about 100 advocates to come to Raleigh to walk the halls of the General Assembly in support of LGBTQ+ and reproductive rights and to rally outside the legislative building for “Rainbow Repro Advocacy Day,” where they voiced their concerns and opposition to further restrictions.

“It is so important to show up and let our legislators know that we are not just numbers, we are not just figures,” said Jazmynne Cruz, communications director at Equality North Carolina.

That’s why Katie Day, a transgender woman from Cary who began transitioning in 2022, came to Raleigh. She told NC Health News she feels like a target in the current environment but wanted lawmakers to see there is nothing to be scared of. She said she was pleasantly surprised to have a conversation with a Republican lawmaker about House Bill 503, titled “Don’t Tread on Me Act,” that calls for individual freedoms, including in health care decisions.

On the same day as Democrats and other advocates pushed for more protections for reproductive rights and the LGBTQ+ community, some state Republicans signaled that they were interested in pursuing further restrictions on the transgender community.

In North Carolina — a state with 10.5 million residents — an estimated 8,500 youth ages 13-17 identify as transgender, as do 71,300 adults, according to a 2022 report by UCLA’s Williams Institute.

Sen. Vickie Sawyer (R-Mooresville) filed Senate Bill 516, titled “Women’s Safety and Protection Act,” which would codify the definition of sex to include only male and female. The bill would also prevent people from changing the gender on their birth certificates or driver’s licenses after they’ve had gender reassignment surgery. 

And in an echo of 2016, the bill seeks to regulate which bathrooms people can use in some state buildings — a provision that is reminiscent of the state’s “bathroom bill,” known as HB 2, which prohibited transgender people from using restrooms that align with their gender identity.

“We need to be done with that,” said Sen. Julie Mayfield (D-Buncombe) about returning to the days of HB 2, which cost the state billions of dollars. “We need to recognize who people are. We need to allow them to live their lives, and we need to be done with treating people as anything less than full human beings deserving of respect and dignity.” 

Berger said the bill is similar to legislation introduced in other states, where it didn’t generate much of an outcry.

“We’re in a totally different place as far as people’s perceptions of some of those issues today than we were 10 years ago,” he said.

Proposal would ease restrictions on nurses

Advanced practice nurses are once again pushing for legislation that would allow them to practice to the full extent of their educational training and experience. House Bill 514 and its Senate companion, Senate Bill 537, would allow these nurses to practice without supervision from a physician. 

A couple hundred nurse practitioners gathered at the legislature March 26 to push for the change, saying it would make health care more accessible and affordable.

The supervision currently afforded to advanced practice nurses — nurse practitioners, nurse midwives, nurse specialists and certified registered nurse anesthetists — has long been a point of contention. The nurses argue that this supervision does not mean a doctor constantly looks over their shoulders, instead it usually entails meeting every few months to review a handful of cases. 

Most egregious to the nurses is that this supervision usually entails handing over a check to ensure that the physician continues in a contract that allows the advanced practice nurse to continue working.

Jamie Gallagher, a doctorally-prepared, board-certified family nurse practitioner, owns a women’s health clinic focused on menopause called Peri and Pause in Fuquay-Varina. She hires other nurse practitioners as contractors to see patients, and they each must have a supervising physician. One of her nurse practitioners pays just under $1,000 a month to retain a supervising physician, Gallagher said.

If the law were changed, Gallagher said, she could expand her business to meet growing demand in the booming bedroom community.

“It will free me up to pay my nurse practitioners exactly what they’re worth and the money that they earn, rather than having to pay another profession — physicians — to sign a piece of paper, because no physician sees my patients,” she said.

Similar language to the bill made an appearance in a version of the 2023 Senate budget but was eventually carved out of the final document. 

Rep. Carla Cunningham (D-Charlotte), who made her living as a nurse for decades, said some representatives who did not support the bill are now gone.

“We’re going to just have to keep on trying to change minds,” she said. “And we have new members that came in, and those new members need to be persuaded to support the act.”

The nurses touted research supported by the NC Nurses Association, a professional organization for registered nurses, purporting that North Carolina could save between $647 million and $6.4 billion in health care spending annually by passing the legislation. 

The association cited a 2015 report from Duke University’s Center for Health Policy and Inequalities Research that was updated in 2023. The report cited, in part, the economic value of output, jobs, wages and benefits and taxes generated by the estimated increase in advanced practice nurses that the change would bring.

Doctors have repeatedly fought the legislation, arguing that advanced nurse practitioners are not trained to practice individually but rather as part of a coordinated care system in which doctors have the education, training and experience to lead these teams. 

The NC Medical Society released a statement March 25 in opposition to the bill, saying it would remove a “fundamental patient safety requirement.” And, in anticipation of the nurses’ bills, emails from the advocacy group the North Carolina Patient Safety Coalition began hitting inboxes in January.  

“This General Assembly decided to require physician supervision of nurse practitioners so that people who are experiencing illness can be sure they have the best-trained and most-experienced health care team,” said Medical Society interim CEO Steve Keene. “To dismantle that the way HB 514 does is not a good idea.”

But nurse practitioners point to decades of accumulated research showing that patient safety is not adversely affected when an advanced practice nurse is in the lead of care. Gallagher said she’s well-trained and competent —she knows when to bring in specialists or refer to physicians.

“It truly has become a financial issue in the name of safety,” she said.

The nurses also point out that they were allowed to practice without supervision under temporary waivers during the pandemic and, more recently, for those living or working in the areas of western North Carolina affected by Hurricane Helene. 

Bonnie Meadows, an advanced practice nurse and president-elect of the NC Nurses Association, said that there were no patient safety issues as a result of the Helene waiver.

Banning vapes on school grounds 

Two related bills sponsored by Rep. Carla Cunningham easily passed the House Health Committee meeting on March 25. House Bill 328 would ban hemp-derived consumable products, Delta 8 and Delta 9, from school grounds. The products pose potential negative health effects for minors, such as impaired cognitive function and judgment, Cunningham said.

The bill clarifies that vapor products would be banned as well. Cunningham said that at Leesville Road High School in Raleigh, students vaping in bathrooms triggered the fire alarms so frequently that the school closed half of their bathrooms.

Mecklenburg County reported over 758 incidents of vaping devices used last school year, as well as students saying they vaped in bathrooms and locker rooms, she said.

The rule would apply to the adults on public school grounds as well as the kids, Cunningham said.

House Bill 329 encourages nonpublic schools to implement these rules as well.

Creating access to paid family and sick leave

House Bill 499 and companion Senate Bill 480, filed March 24 and 25, would create a program for paid family and medical leave insurance for eligible beneficiaries. That could include those who are caring for a new child or for a family member with a serious health condition, as well as people with serious health conditions themselves.

Sen. Sydney Batch (D-Raleigh) is a cosponsor of the Senate version. She said the bill “would change the fabric of North Carolina” by expanding access to paid family and medical leave for workers who otherwise have to choose between income and health.

About 4 million people in North Carolina — 78 percent of the workforce — don’t have paid family leave, according to the National Partnership for Women and Families, a national organization that advocates for equality for women.

Eshawney Gaston lives in Durham and is a mother to three children. When she gave birth to her oldest, she was working at three restaurants and had no paid sick leave. She lost one of her jobs as a result of giving birth. 

“It’s unfair that I have to worry about how my kids are going to get clothes, or how I’m going to provide doctors for them, when I’m putting in all this work for a job,” she said at a news conference at the legislature in support of the measure.

Batch and Rep. Laura Budd (D-Matthews), who’s sponsoring the House version, said that as small business owners, it’s hard to provide workers with competitive benefits like paid family and sick leave. This bill would level the playing field for small businesses owners to compete for talent, Budd said.

The Division of Employment Security of the N.C. Department of Commerce — which administers the state’s unemployment insurance program — would establish and administer the paid leave. Similar to how they pay into the unemployment system, employees and employers would contribute to a Paid Family and Medical Leave Fund to share the cost, according to the bill.

A beneficiary caring for a new child could receive benefits for up to 12 weeks in an application year under the program.

Batch said her Republican colleagues haven’t had an appetite for taking up this issue in the past. 

“We are just exhausted by the fact that we sit on the floor and we work with colleagues in this building who espouse that they care about families, that they care about women, that they care about North Carolinians —and yet when they can act, they do nothing,” she said.

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