map shows economic rankings of all NC counties, with rural counties less prosperous than urban ones
The North Carolina Department of Commerce annually ranks the state’s 100 counties based on economic well-being and assigns each a Tier designation. The 40 most distressed counties are designated as Tier 1, the next 40 as Tier 2 and the 20 least distressed as Tier 3. Most rural counties are Tiers 1 and 2. Credit: The North Carolina Department of Commerce

By Jared Weber

Medicaid expansion and health challenges for North Carolina’s rural population took center stage Tuesday afternoon in Raleigh at the second annual legislative rural advocacy day.

Many of the attendees were still processing the legislature’s state budget proposal, which was released late Monday night. Republican legislators, who hold veto-proof supermajorities in the House and the Senate, plan to approve the proposal with no changes by the end of the week.

shows a man sitting in a spotlight, gesturing as he speaks
Rep. Robert Reives, II (D-Chatham) speaks during Tuesday’s panel on expanding access the rural broadband. Reives advocated for closing the homework gap — a problem facing rural students who don’t have reliable internet access at home, and as a result, struggle to complete assignments. He said that he’s seen the gap become an issue in Chatham County. Reives also expressed frustration several times with the lack of input his party enjoyed in crafting the legislative budget proposal. Photo credit: Jared Weber

Nonetheless, advocates pressed for legislative action all day.

The event, held across the street from the General Assembly building at the N.C. Museum of History, was hosted by the NC Rural Center, a Raleigh-based nonprofit that “aims to improve the quality of life for the state’s rural people and places.”

Rural Day is the center’s annual opportunity to shine a light on the issues facing rural communities, said Director of Advocacy John Coggin.

He said 450 people, hailing from 83 of the state’s 100 counties, made their way to Raleigh.

“We feel that the story of rural America is being told wrong a lot these days,” Coggin said. “It’s wonderful to have an event where people can come, have their voices be heard and then talk, in productive ways, with their legislators and policymakers about the issues that really matter.”

Expanding Medicaid debated … again

The hot-button issue of the afternoon was the debate over Medicaid expansion.

Medicaid is the state and federally funded health care program that covers low-income children, some of their parents, pregnant women and people with disabilities. Under the Affordable Care Act, states were given an indefinite option to expand the program. So far, 32 states and the District of Columbia have chosen to do so.

But a lot of people — who make too much to qualify for Medicaid and too little to receive ACA subsidies toward their own private insurance plan — are unable to afford health insurance.

These people fall into what’s become known as the Medicaid coverage gap.

According to estimates from the North Carolina Community Health Center Association, 244,000 people live in the coverage gap, and as many as 400,000 North Carolinians could benefit from expanding the program.

Proponents of Medicaid expansion also tout its the positive effects on the state economy.

“You create about 40,000 new, good-paying health care jobs over the next five years — many of them going to your counties,” said Gov. Roy Cooper, who gave the day’s opening remarks.

Carla Obiol spoke on behalf of Care4Carolina, a coalition that’s working to close the coverage gap. The coalition backs Carolina Cares, a Medicaid expansion bill proposed by House Republicans in 2017.

shows a man standing on a stage in the spotlight, gesturing.
Wilkes Communications CEO Eric Cramer gives a speech about expanding access to broadband internet Tuesday morning at Rural Day. The legislature’s state budget proposal, which was released late Monday night, allocates $10 million toward funding a grant program for expanding rural broadband. Photo credit: Jared Weber

Despite the accelerated pace of the short session, Obiol hopes Carolina Cares will be on the table during the legislative short session, which is slated to run through the end of June.

“One might think that issues like ours wouldn’t be heard in the short session … that things would be said and done,” she said. “We don’t feel discouraged at all. We’re going to keep talking about it.”

Sparks fly over Medicaid

The afternoon health panel brought together Attorney General Josh Stein, DHHS Secretary Mandy Cohen, Novant Health Brunswick Medical Center head Shelbourn Stevens and Rep. David Lewis (R-Dunn).

Lewis, who recently co-chaired a legislative study committee on rural health care access, said rural hospitals need more support before they’re in “severe financial strain.”

“[It’s] changing the way we think about how we can best utilize our money to keep people well, and how hospitals fit into that model,” Lewis said.

Cohen and Stein insisted that Medicaid expansion is the only viable option that would both close the coverage gap and provide relief for rural hospitals.

“[People in the coverage gap] are working, struggling folks who are disproportionately in rural areas,” Stein said. “If they had an ability to pay for the health care services they receive, the rural health care system would be stabilized and strengthened immeasurably.”

shows man standing at a podium on the stage, a sign behind him reads: Rural Day
Gov. Roy Cooper addresses the media shortly after giving the opening remarks at Tuesday’s second annual Rural Day in Raleigh. Cooper also fielded questions about legislature’s budget proposal, which had been released the night before. Republican leaders made clear that they planned to pass the proposal as is by the end of the week. Photo credit: Jared Weber

When uninsured people need medical care, they often resort to visiting an emergency room at the last minute. Cohen said the resulting medical fees are rarely paid back, leaving others to cover the costs.

“When folks don’t have insurance, it raises the price for all of us,” she said. “All of the employers out there who buy insurance for us? Costs are going up for them because we, in North Carolina, have a higher uninsured rate.”

Telehealth could be a solution

Some also advocated for the expansion of telehealth.

Telehealth is a method of enhancing health care by allowing patients to seek long-distance medical care from different physicians using telecommunications technologies, such as video chat.

Steve North, co-founder of the Center for Rural Health Innovation, said North Carolina is behind the curve, particularly on breaking down institutional barriers that prevent patients from using telehealth to do things like get second opinions or connect with physicians in other parts of the state who have more expertise than their local doctors.

“Our colleagues in Virginia are 10 years ahead of us in terms of developing statewide networks and collaborative care,” North said.

“We need an organized statewide effort,” he continued. “We need to find a common ground that allows for innovation and allows for us to reach beyond just our little neck of the woods and provide care across the state.”

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Jared Weber

Jared Weber is NC Health News' 2018 legislative intern. He is a rising junior at UNC Chapel Hill where he's majoring in journalism and global studies with a minor in Spanish.