Universal lead testing touches ideological nerve in Pa. House panel debate

A seemingly uncontroversial bill dealing with childhood testing for lead exposure sparked heated debate Wednesday about the balance between public safety and government overreach. 

The bill, sponsored by Rep. Mary Isaacson, D-Philadelphia, calls for doctors to make “reasonable efforts” to ensure  kids get their blood tested for lead, either by a finger prick or a vein, around the age one and two.

The House Children and Youth Committee voted 17-6 to advance the bill, amid concerns from some of the panel’s Republicans about the proper role of government. 

But the research they cited to buttress their points also appeared to indicate that there’s a larger place for government in lead mitigation beyond mandating blood tests.

Under Isaacson’s bill, the state would keep a confidential registry of the results, and the Department of Health would develop free literature on the dangers of lead — a known neurotoxin present in old paint, pipes and soil.

Lead exposure can lead to learning disabilities and other behavioral disorders in children that can carry over into adulthood, and the results are irreversible.

Isaacson’s legislation does not include penalties for doctors or parents who do not comply. Isaacson also argued that parents would still have the final say on conducting a test or not.

The first-year lawmaker said the bill comes from a 2019 report by  the Pennsylvania Joint State Government Commission, a bipartisan legislative group that studies issues and makes policy recommendations.

The report found that the age of Pennsylvania’s housing stock, among the nation’s oldest, “is the foundation for a ubiquitous risk of lead exposure Commonwealth-wide.”

Seventy-one percent of Pennsylvania’s homes were built before 1980, which was around when lead was banned in residential housing, the report reads.

Under current law, Children enrolled in the state’s  CHIP program or Medicaid already must be tested for lead exposure. 

Of the more than 843,000 children in the Commonwealth in 2017, 18 percent were tested for lead. Of those tested, 6 percent — or 9,325 kids — had more than 5 micrograms of lead per deciliter of blood.

The Centers for Disease Control and Prevention has found that no level of lead in a child’s blood is safe.

The report did recommend universal lead testing. But it noted some issues — such as removing physician discretion and the potential diversion of public health resources.

The report concluded that universal testing would be the best route, until the Department of Health had a chance to reevaluate the practicality of universal testing with better research.

Some committee Republicans, such as first-year Rep. David Rowe, R-Union, raised similar concerns. He argued that the plan would be expensive and could intrude upon individual liberty.

Rowe cited reports by the CDC and the American Academy of Pediatrics that found universal lead testing to not be cost effective, except for in “high prevalence areas with increased risk factors.”

“We should be very concerned as a society when we have reached the point where we expect government to be making medical decisions on our behalf,” Rowe said. He added the proposal was a “testament to how emboldened the nanny state has become.”

Despite some GOP opposition, and an attempt to table the bill, Issacson’s measure passed out of committee with the support of committee Chairwoman Karen Boback, R-Wyoming.

“As soon as we get into cost-benefit, I say, at what cost is a child’s health?” Boback told the Capital-Star. “This I see as preventive medicine.”

In an email, Annette G. Myarick, executive director of the chapter of the AAP, said the organization supported Isaacson’s bill.

The CDC has argued, most recently in a 2012 study, against universal lead testing — in favor of investing in preventive action.

Blood tests should be done, the report said, if some risk of lead exposure is uncovered in a home by inspectors or a doctor suspects exposure.

“Screening children for elevated [blood lead levels] and dealing with their housing only when their [level] is already elevated should no longer be acceptable practice,” the report said.

The study concludes that instead of testing, what is needed is a focus on creating zero lead environments. State investment in grants, tax credits or subsidized loans to remediate leads and “develop and enforce preventive lead-safe housing standards for rental and owner-occupied housing” could do the trick.

The report also noted that these actions should focus on decreasing disparities in blood lead levels because of racial and socioeconomic factors.

While Boback kept dissenters within her own caucus at bay, the passage was not without Democratic fireworks as well.

Rep. Summer Lee, D-Allegheny, assailed Rowe’s opposition to government meddling in medical matters by pointing to his vote for a recently passed fetal remains bill.

“To hear one of my colleagues talk about government overreach when we just voted on a bill that is going to mandate a woman who has a miscarriage go through a ritual funeral, when we put forth bills every week about abortion,” Lee said.

She was then interrupted by cries of “objection!” from Republican lawmakers.

Afterwards, Lee said that Rowe’s opposition was partisan, saying that “if a Republican had introduced that bill, they would have all fallen in line.”

“When we talk about the financial price tag on [lead testing], cannot be understated,” Lee said.

Rowe cited a 1998 study that estimated an annual nationwide cost of $352 to $432 million for universal lead testing annually — costs that “would be passed along to the consumers,” according to Rowe.

A 2009 study by the progressive Economic Policy Institute estimated savings of between $17 to $221 on each dollar invested in remediating lead paint, between health care, special education, criminal justice and other costs.

Boback said she expected more amendments before the bill could pass the full House.

*This story was updated with the position of the state chapter of the AAP.