A sweeping set of bipartisan bills aiming to reduce childhood lead exposure are making their way through the Michigan Legislature, with provisions that would strengthen intervention and monitoring across state programs, the medical profession and the real estate industry.
The state House Committee on Health Policy discussed a package of bills to reform Michigan’s lead laws Thursday, hearing testimony from advocates and critics. Several Republican members questioned the scope of the bill and asked for further data to support its measures. The committee took no action on the package, and Committee Chair Bronna Kahle (R-Adrian) pledged to continue discussions.
“When I look at this package and see the number of bills and the breadth that they touch on, I start to wonder if we’re really being as precise and therefore effective as we could be,” Rep. Andrew Beeler (R-Port Huron) commented.
The bipartisan package, led by Rep. Rachel Hood (D-Grand Rapids), would lower the definition of an elevated blood lead level (EBLL), strengthen the healthcare system to deal with lead exposure, and strengthen home inspection requirements.
“I’m excited, especially because it’s bipartisan, and it’s almost an even split of bills,” Tina Wahl, an environmental health program director with Michigan Environmental Council, told Planet Detroit. “These bills are sponsored by individuals from all over the state, from rural areas and urban areas.”
Wahl and Hood provided committee members with a list of the highest risk zip codes for lead exposure in children that scatter across the state.
“We’re trying to adjust the perception that this is just an urban issue — this is an urban and rural issue,” Wahl testified.
HB 5415 would reduce the threshold under which Michigan considers a child’s blood lead level elevated. State law currently defines a test showing a blood lead level above 20 micrograms per deciliter as elevated, triggering intervention and case management by the local health department or Michigan Department of Health & Human Services (although some local health departments use a threshold of 10 micrograms per deciliter).
“Our public health code is just not up to federal standards,” Hood told Planet Detroit. “Of course, no level of lead in children’s blood is appropriate, and we want to try and remediate it and get to zero.”
As currently written, the bill would reduce the threshold to 5 micrograms per deciliter. However, in late October, the Centers for Disease Control and Prevention released guidance that recommends decreasing the number to 3.5 micrograms per deciliter. Hood said the legislators are developing a substitute bill that would index the state threshold level in the future to the CDC’s evolving rules. “Michigan’s laws will just kind of seamlessly move along with CDC guidelines moving forward,” she said.
Lead is a potent neurotoxin. Children who are exposed to lead may have reduced IQ and problems with attention, learning, behavior, hearing, and speech that can impact them throughout their lives. Although exposure from lead-based water service lines in places like Flint and Benton Harbor has directed national attention to the health issue in recent years, the most prevalent source of lead exposure in children is lead-based paint. A recent analysis of national clinical data found that 78% of blood samples from Michigan children had a detectable lead level. No level of lead is safe.
Other bills in the package discussed Thursday would reorganize and redefine terms to better align with federal standards (HB 5413), strengthen the state’s lead prevention program and bolster reporting requirements (HB 5417), and simplify the process for a child referred to the state with an elevated blood lead level to receive early intervention services through the Early On program (HB 5418). HB 5423 would require state officials to refer such children to other support services inside or outside the department.
These referrals would be available to all children, whether enrolled in Medicaid or not, Rep. Julie M. Rogers (D-Kalamazoo), the lead sponsor of HB 5318, said at the hearing. “[Lead exposure] shows no socio-economic barriers or boundaries,” added Rogers, a physician. “This is why my bill, in particular, is crucial to ensuring that Michigan’s children are connected with the resources that they need and as soon as possible after the lead exposure.”
Another bill, HB 5416, aims to expand the number of children tested for lead. Under current policy, the only children required to be tested for lead are those enrolled in Medicaid, who get tested at 12 and 24 months of age. The new bill would expand testing requirements to all Medicaid-enrolled children enrolled under age six and would require testing of children enrolled in MIChild, the federal-state children’s health insurance program (SCHIP).
Wahl estimated that lowering the standard to 3.5 micrograms per deciliter and testing these additional children will likely mean an additional 1,200 Michigan children will be identified as lead impacted and therefore eligible for services each year.
“We know that we are not testing enough kids,” Hood said. “There’s a whole population of kids who may be getting exposed who we have not yet identified.”
But the bill stops short of requiring universal testing for all children, something advocates have long lobbied for and which Hood said is “coming in a future bill,” though she stopped short of giving specifics.
“We’re much more in favor of universal testing,” Wahl said. “We don’t want kids to fall through the cracks.”
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Among the more controversial bills in the package is HB 5414, which would require lead education for all practicing physicians in the state of Michigan as part of medical board licensing. According to Dr. Kanta Bhambhani, a pediatric oncologist and director of the lead poisoning program at Children’s Hospital of Michigan, such a requirement would be too onerous because it would not apply to most physicians’ practice.
Rep. Beeler and Rep. Mike Mueller (R-Linden) both questioned the need for continuing education. Beeler called on Hood, the lead sponsor of that bill, to provide data evidence that increasing physician awareness and treatment would be more effective than patient and parent awareness and training.
“Physicians who take care of children should be aware of this — pediatricians and family practitioners, even physicians who take care of both children and adults,” Bhambhani said. “But I’m not so sure about if a plastic surgeon should be aware of this.”
Wahl and Hood noted a willingness to soften those requirements, likely narrowing the number of practice areas that may be required to receive education under the bill. But Wahl underscored the importance of physician education in her testimony.
“We do get stories very often of parents bringing their children and saying ‘hey, you know I live in an old home, does my child needs to be tested?’ and physicians will say no and not order the test,” Wahl said in her testimony. “Parents can’t just get a lead blood test on their own. And so having education for physicians is really important.”
Another subset of the bills would deal with lead inspections and mitigation in housing. “As we strengthen standards around lead for the public sector, we need to start requiring best practices in real estate and home inspection,” Hood said.
Two bills (HB 5420 and 5421) would reorganize and refine terms and definitions regarding construction and lead abatement requirements. Another more controversial bill, HB 5419, would require sellers of residential structures constructed before 1978 (when Congress banned lead-based paint) to obtain a lead-based paint inspection of the property and provide it to the purchaser before the sale.
Randolph Barker, president of the Detroit Association of Realtors, opposes the bill, saying it would create a “hindrance” and interfere with property rights. Under federal law, owners of homes constructed before 1978 must furnish buyers with a pamphlet communicating lead-based paint risks.
“The process already accommodates prospective buyers who want to conduct those inspections. This particular statute would require those that report being provided before even having someone sign a purchase agreement or a lease,” Barker told Planet Detroit. “The traditional routine has proven effective for the last 40 years, which is to let the buyer conduct those inspections, and if they’re not satisfied with the inspections, then they walk away from the transaction.”
Wahl supports the bill, although she sees a challenge in getting the real estate industry to adopt anything that might delay a sale or put it at risk. “I’m very supportive of the concept,” she said. “It’s the best way to protect kids and to make sure that they don’t get impacted in the first place.”
Meanwhile, bills to address lead contamination in water in schools and daycare centers (Senate Bills 184 and 185) passed out of the Senate Committee on Environmental Quality with 5-0-1 votes on Nov. 30 and are headed to the Senate Floor. Sponsored by Sens. Curtis VanderWall (R-Ludington) and Jim Ananich (D-Flint), the bills would require schools in Michigan to install lead filters on taps and water bottle stations. They also require all childcare centers to provide only filtered water to children.
According to Wahl, moving these changes forward is essential for parents and kids.
“We often hear from parents that there was a lot of regret, a lot of remorse, a lot of guilt,” she said. “Parents said ‘if I only knew my child was at risk, I would not have put them in harm’s way.’ There’s a number of bills in the package that empower parents with information.”
Planet Detroit’s Solving Lead & Asthma in Detroit series is underwritten, in part, by the Erb Family Foundation.