The Pennsylvania House voted Monday to send the Senate legislation mandating lead testing for all children by age 2 at no cost to their parents.

Currently, doctors are instructed to consider whether there are known risks that justify testing a child for lead exposure and consulting with the child’s parents to determine whether they want the test done. The state updated the lead testing law through Act 150 of 2022 but only after watering down language that would have called for the sort of universal testing lawmakers are now seeking in House Bill 916.

Federal law already dictates that all children enrolled in Medicaid must receive universal lead testing at ages 12 months and 24 months. House Bill 916 would require private insurers to pick up the cost of lead testing. The measure was approved by the House in a 157-44 vote.

“Lead poisoning is a significant health risk for children and for pregnant mothers,” Rep. Jose Giral, D-Philadelphia, said in a statement after the vote. “We do a disservice to these vulnerable groups if we only recommend a course of action. This bill would require healthcare practitioners to perform blood lead testing at least once during a woman’s pregnancy, and twice before a child’s second birthday, unless there is express written refusal by the woman or the child’s parent.”

Lead poisoning in children can lead to significant health issues, including developmental delays, seizures and nervous system damage. During pregnancy, lead poisoning raises the risk of miscarriage or exposes the developing baby to lead, which can cause premature birth, underdeveloped organs, low birth weight and learning and developmental issues.

Universal screening, like that mandated by House Bill 916, is required in 10 states — Connecticut, Delaware, Iowa, Louisiana, Maryland, Massachusetts, New Jersey, New York, Rhode Island and Vermont, according to Toxic-Free Future.

Ohio and West Virginia are among eight states that have broader testing requirements than the federal government but stop short of universal testing. These states require blood lead testing for children with a risk factor for lead exposure, including such factors as living in housing built before 1950, living near a lead smelter or receiving benefits from the Special Supplemental Nutrition Program for Women, Infants, and Children.

Philadelphia and Allegheny County already have local blood testing requirements. Allegheny County began requiring lead tests for children 9-12 months and at 24 months in 2018. The next year, the Philadelphia City Council passed an ordinance requiring physicians to test children for lead exposure twice before age 2.

Blood tests revealed that 621 children in Philadelphia had been exposed to elevated levels of lead after almost 17,000 children were tested. Allegheny County had 278 children test positive for elevated lead levels out of more than 10,000 tested.

Berks County had far fewer children tested, 2,865, than Allegheny County but almost as many children who tested positive for elevated lead exposure.

Pennsylvania’s housing stock is almost twice as likely to have been built prior to 1978 when lead paint was outlawed. Twenty-eight percent of dwellings in Pennsylvania are old enough for lead exposure to be a concern. The national average is 16.4%.

In 2023, about 35% of children were tested for lead exposure in Pennsylvania. Almost 3,200 children statewide were found to have elevated levels of lead in their blood.

By the numbers

Counties with most cases of elevated lead levels in children:

Philadelphia County — 621 cases in 2023; down 7.7% from 673 in 2022

Allegheny County — 278 cases in 2023; up 5.7% from 263 cases in 2022

Berks County — 217 cases in 2023; down 14.5% from 254 cases in 2022

Lancaster County — 189 cases in 2023; up 48.8% from 127 cases in 2022

Montgomery County — 149 cases in 2023; up 16.8% from 124 cases in 2022