By Will Atwater, Jaymie Baxley, Anne Blythe, Michelle Crouch, Rachel Crumpler, Jennifer Fernandez, Rose Hoban, Taylor Knopf, Grace Vitaglione
Trump administration could test Medicaid expansion in its 2nd year
When we last gave our predictions of the issues we’d be following in the coming year, I wrote that North Carolina had yet to see the “true impact” of what was perhaps the state’s biggest health story of 2023: the decade-in-the-making passage of Medicaid expansion.
It’s been little over a year since the measure took effect, and we now have a clearer picture of what it accomplished: more than 600,000 low-income North Carolinians received health insurance through expansion, surpassing in just 12 months a milestone the state estimated would take at least two years to reach.
But in the wake of November’s election, outgoing Gov. Roy Cooper and others who fought for expansion fear its success could be undone by President-elect Donald Trump.
Some cabinet nominees for Trump’s second administration have expressed interest in reducing or eliminating federal funding for Medicaid to make up the revenue lost by anticipated tax cuts. There have also been calls to compel participants to work for their benefits.
We’ll be closely following the incoming administration’s movements on Medicaid and related health policies in the weeks and months ahead. You can also expect to see more reporting on the plight of rural communities in western North Carolina that have only just begun their long road to recovery from Helene.
— Jaymie Baxley
Tracking the evolution of multiple environmental health issues statewide
In 2025, North Carolina Health News’ environmental coverage will include tracking the spread of the highly pathogenic avian influenza, commonly known as bird flu. We’ll follow this evolving story as the disease has spread to cattle and humans. According to our coverage of the ongoing outbreak that’s spread across the world in the animal kingdom, states from California to Texas have reported contamination among commercial cattle herds and people, with 64 confirmed human cases.
The CDC also reported that one person was hospitalized in Louisiana recently with a severe case.
We also will continue to track water-related issues, such as discoveries of microplastic contamination in creeks and rivers across the state and the ongoing saga of contamination by so-called forever chemicals. The North Carolina Environmental Management Commission is expected to set groundwater standards for three PFAS — PFOA, PFAS and GenX — in 2025. Earlier this year, the North Carolina Department of Environmental Quality and advocates asked the commission to follow the EPA’s lead and set standards for eight PFAS.
We will keep our eye on western North Carolina’s Helene recovery, including in Mitchell County, where the Town of Spruce Pine continues efforts to restore its wastewater treatment facility, as well as monitoring the massive storm debris cleanup underway across the region. Thus far, more than half a million cubic yards of waste have been removed from Buncombe County, including from the Town of Black Mountain and the City of Asheville, according to information provided by Buncombe County.
Another thing we’ll follow is how cities across our state address extreme heat. In 2024, we reported on the urban heat island effect in Durham and Charlotte and the steps these two cities are taking to protect their most vulnerable populations as periods of extreme heat become more frequent and intense.
— Will Atwater
Lawmakers will need to address funding for child care centers
Funding for child care will likely take center stage in legislative discussions once more in 2025, with providers expecting to reach another financial cliff in March.
The legislature passed $33 million in funding in late November to keep child care centers afloat until March, when the legislature will be back full time for the long legislative work session that takes place in the years after biennial elections.
House Rep. Donny Lambeth (R-Winston Salem) said lawmakers have been working with the industry and looking at creative models in the time away from the General Assembly in Raleigh.
Senate Health Care Committee Co-Chair Jim Burgin (R-Angier) said all the health policy chairs will gather during the early part of the 2025 legislative session to come up with a long-term plan to support child care centers.
With the end of pandemic-era federal supports for child care centers earlier this year, many centers across North Carolina faced a steep dropoff in funding. State lawmakers extended funding twice — first in June and again in the fall — each only for a short time.
If more money doesn’t come through before the funding is expected to dry up in March, some centers could close their doors or raise tuition for parents.
Child care providers and lawmakers have expressed desire for a long-term solution to sustain the child care industry in the state. But it likely won’t be an easy problem to solve — many other states are struggling with making child care affordable and accessible.
The National Conference of State Legislatures forecasts that child care will be a hot topic for many state legislatures in 2025. Some states have directly appropriated general revenue funds to support child care programs, while others created cost-sharing models with businesses, the conference found.
Still others funded efforts to make staff in licensed child care programs eligible or prioritized for child care subsidies for their own children.
The National Conference of State Legislatures also predicted addressing the health care workforce shortage as another top issue for state legislatures next year. Researchers are predicting North Carolina could be short 21,000 nurses within a decade.
— Grace Vitaglione
Reproductive care in contention
For much of the past year, abortion access has been a recurring topic of NC Health News’ coverage as we documented the impact of North Carolina’s stricter abortion law — from increased logistical barriers to care to changes in OB-GYN training. That won’t change in the year ahead; we will continue to follow whatever impacts come into focus.
In particular, NC Health News will closely monitor actions at the federal level by the incoming Trump administration, which could bring more restrictions that affect physicians and patients in North Carolina.
For example, the Heritage Foundation’s Project 2025 document and other conservative groups are calling for the U.S. Food and Drug Administration to revoke the 2000 approval of the abortion pill mifepristone despite decades of data affirming the medication’s safety. A change in access to mifepristone would be far-reaching; medication abortion using the pill now accounts for the majority of U.S. abortions — including in North Carolina, where it was used in about two-thirds of abortions in 2021.
Other coverage of reproductive health over the coming year will include how communities navigate maternity care deserts.
— Rachel Crumpler
Prison reentry as a social determinant of health
NC Health News will also continue to track actions taken in 2025 to meet North Carolina’s Reentry 2030 goals of dramatically reducing reentry obstacles for formerly incarcerated people returning to the community.
Cooper made bolstering reentry support for the roughly 18,000 people who leave North Carolina prisons every year one of his final priorities, initiating the work through Executive Order No. 303 in January 2024. Now, going into a new year, we will be watching how new leadership — Gov. Josh Stein and Leslie Cooley Dismukes at the helm of the N.C. Department of Adult Correction — shapes the vision and momentum around these efforts.
— Rachel Crumpler
Health policy changes at the state and federal level will affect North Carolinians
Health policy may be unpredictable in the coming year; the incoming Trump administration will likely shake things up at the national level — and some of that will invariably trickle down to states.
Trump expressed contradicting sentiments about health policy topics. For example, he’s taken aim at the high prices of pharmaceuticals, but many expect his administration to attempt to weaken Medicare drug price controls enacted by the Biden administration.
Recently, Trump took aim at pharmacy benefits managers, which have been getting more attention from the media for the ways that they have driven up prices. Advocates in North Carolina have floated legislation at the General Assembly that would rein in pharmacy benefits managers in this state, but they haven’t gotten much traction up to now. Shifting political winds at the national level may give those advocates some momentum.
Another big question is how the Trump administration will treat hospitals, which keep consolidating and growing. In the past several years, Biden’s Federal Trade Commission has quashed several hospital mergers (including one proposed by North Carolina’s Novant Health) and taken a more critical look at the growing local monopolies in the hospital industry. At the state level, outgoing North Carolina Treasurer Dale Folwell has been taking aim at the state’s hospitals — nonprofits in particular — for their consolidation, aggressive collection tactics, lack of price transparency and high prices.
It’s unclear how his successor, Brad Briner, will treat hospitals and insurers. Briner may have his hands full in the early days of his administration, given that the State Health Plan will be changing over from longtime third-party administrator Blue Cross Blue Shield of North Carolina to Aetna on Jan. 1.
There’s also an ongoing shortfall in the number of health care providers throughout North Carolina, particularly in rural areas but increasingly in population centers. As the legislature convenes for its long work session this year, advanced practice nurses will be looking to pass legislation to give them the ability to practice more independently.
— Rose Hoban
The RFK Jr. effect on oral health
Robert F. Kennedy Jr., Trump’s nomination to be the next secretary of the U.S. Department of Health and Human Services, has sparked a lot of debate about the future of vaccines and long-established vaccination programs.
Kennedy, a longtime vaccine critic and a conspiracy theorist, also has roiled many in the oral health community by calling fluoride “an industrial waste associated with arthritis, bone fractures, bone cancer, IQ loss, neurodevelopmental disorders, and thyroid disease.” Kennedy posted on X, formerly Twitter, that “on January 20, the Trump White House will advise all U.S. water systems to remove fluoride from public water.”
Throughout much of the past half-century, at least, fluoride has been touted as a public health success story in helping to reduce tooth decay in children and adults. The Centers for Disease Control and Prevention describe community fluoridation as “the most cost-effective method of delivering fluoride to all members of the community.”
Nonetheless, some North Carolina counties and cities have discussed banning fluoride in public water systems. Union County took that step last year.
Those opposing community water fluoridation argue that individuals should have a choice about whether to ingest fluoride. They point out that fluoride is in toothpaste and rinses offered at dental practices. Those who support community water fluoridation point out that research linking fluoride to some of the ailments Kennedy has highlighted are based on much larger amounts than what is included in U.S. public water systems. They also tout the reduced burden of dental caries and associated disease on, in particular, low-income households.
If Kennedy is confirmed as the federal health secretary, his position of influence could play a large role in whether other counties, towns and cities have fluoride bans. Even if a presidential advisement is not forthcoming, the doubt created by Kennedy’s statements on fluoride could have the effect of encouraging more communities to remove the substance from their water systems.
— Anne Blythe
Immigration, extreme heat and health care impacts
Climate change has led to more extremes in the weather, a phenomenon that came home to western North Carolina this year when the remnants of Hurricane Helene ravaged mountain communities. In addition to more intense rainstorms, climate change has led to hotter summer temperatures, as 2024 marked the hottest year on record.
President Joe Biden got the ball rolling during his administration on what could be the first national heat standard.
In North Carolina, where farmworker advocates have been rallying for more workplace protections in agricultural fields, at construction sites, in warehouses and elsewhere, the possibility of required water breaks and shaded areas comes as good news.
Many are watching to see whether the Trump administration will roll back the standards or allow the new protections to go into place.
The coming administration’s vows to focus on immigrant deportations not only could have an impact on many of the migrant workers who come through North Carolina, it could have many health care implications for immigrant communities, as well.
— Anne Blythe
Medical debt forgiveness, rising health care costs and billing practices
In 2025, North Carolina hospitals will begin forgiving unpaid medical bills dating back to 2014 for nearly 2 million low- and middle-income patients, part of a new state program that aims to ease the burden of medical debt.
The program also incentivizes hospitals to make significant changes to their financial assistance policies in 2025, including offering discounts ranging from 50 percent to 100 percent for low-income patients, proactively screening all patients for financial aid eligibility and agreeing not to report medical debt to credit agencies.
In exchange, the hospitals will receive millions of dollars in boosted federal payments tied to the state’s expansion of Medicaid.
Despite those steps, concerns related to rising health care costs, insurance denials and confusing billing practices are likely to persist in 2025.
One focus could be facility fees — the extra charges hospitals tack on to a patient’s bill when they receive care at a hospital-owned facility, even if the care didn’t take place at a hospital.
Patient advocates say the fees are unnecessary and unfairly inflate medical bills. Hospitals say the fees are crucial to cover the higher costs associated with hospital-level care.
North Carolina Sen. Jim Burgin (R-Angier), who co-sponsored legislation in 2023 and 2024 to limit the fees, said he will try again in 2025.
Other key issues for patient advocates include improving health care billing transparency and requiring nonprofit and government hospitals to do more to earn their tax exemptions.
Hospitals and physicians are expected to continue to advocate for limits on prior authorization, which requires insurers to approve medications and treatments.
— Michelle Crouch
Youth mental health, access to vaping and cannabis
For child advocates, mental health issues among youth continue to be a concern in the new year. The most recent North Carolina Youth Risk Behavior Survey showed some improvement, with fewer high school students reporting they seriously considered suicide and fewer middle and high school students reporting that they felt sad or hopeless. But the numbers are still higher than before the pandemic, and it remains to be seen how much of a long-term impact Hurricane Helene will have on youth in western North Carolina.
The state Child Fatality Task Force is once again recommending that the General Assembly increase numbers of school nurses, psychologists, social workers and counselors in public schools “to support the physical and mental health of students.” The state remains far behind nationally recommended ratios for these support personnel.
Task force members also want the legislature to tackle youth access to vapes and intoxicating cannabis products.
While cannabis-infused products are cropping up in a lot of stores, vape shops have become “the catch-all for all of these products,” Special Agent in Charge Josh Batten from North Carolina’s Alcohol Law Enforcement told the task force in December. The agency can’t regulate vape shops because the state does not require that they be licensed, unlike stores selling alcohol, which undergo extensive regulation.
A bill that would have addressed many of the cannabis issues raised by the task force stalled in the rules committee of the N.C. House of Representatives last year. Rep. Jeffrey C. McNeely (R-Stony Point), a lead sponsor of that bill, told NC Health News he planned to tackle the issue “first thing” in the upcoming session.
— Jennifer Fernandez
New mental health initiatives expected to roll out from funding provided in 2023
In the final weeks of 2024, the North Carolina Department of Health and Human Services released a flurry of news releases announcing several new mental health policies and initiatives using funds from the 2023 state budget, which allocated $835 million for behavioral health. The historic, one-time investment in behavioral health was made possible due to the federal sign-on bonus North Carolina received for expanding Medicaid. Though the money was designated for these programs over a year ago, many are just getting started. We will follow along to see how these programs pan out in the coming year.
One of these long-awaited initiatives include $20 million for a pilot program to transport mental health patients under an involuntary commitment from emergency rooms to psychiatric facilities. Under state law, counties are responsible for providing secure transportation between hospitals, and in most cases law enforcement officers have been tasked with this role. Officers frequently transport patients in handcuffs in marked police cars or vans. Patients and their families report feeling blindsided by the arrival of law enforcement officers and say their presence, and the use of handcuffs, are traumatic and stigmatizing.
The state is investing more in peer support services, with the recent opening of a peer-run respite house in Wake County and the announcement of $4 million to expand family peer support services statewide. Peer support specialists are people who have lived through similar experiences — such as navigating a mental illness or incarceration or homelessness — which puts them in a unique position to help others in a relatable way.
Another program just getting underway in Pitt County Detention Center is a capacity restoration program for those accused of a crime who are considered too mentally unstable to stand trial in court. For years state health leaders have explained how people in this condition end up in state-owned psychiatric facilities for long periods of time, often occupying beds that could be used for members of the community. Bringing mental health services to detainees in jail is supposed to help them access care faster so they can move through their legal proceedings.
The Pitt County program will be modeled after a Mecklenburg County pilot program, which is now expanding to more beds.
— Taylor Knopf
The post What’s coming for 2025? NC Health News reporters look ahead into health policy for the new year. appeared first on North Carolina Health News.
