Rural North Carolina’s Friend and Advocate: Part 2

Rural North Carolina’s Friend and Advocate: Part 2

It is always good to have an advocate, someone looking out for your best interests. For folks living in rural North Carolina, one advocate is the North Carolina Rural Center. In existence since 1987, part of the Center’s mission is policy, research, and advocacy with the goal of improving the quality of life of rural North Carolinians.

In part 1, Patrick Woodie, president of the N.C. Rural Center, talked about the Center’s role in advocating to expand accessible, affordable high-speed broadband and what that might mean to rural North Carolina in terms of small business growth, telehealth, educational opportunities, and agricultural applications. Here he shares about two other priorities identified by rural North Carolinians.

Stabilize and Transform Rural Health

The N.C. Rural Center is advocating that the state become one of the 39 states that expands Medicaid to close the health insurance coverage gap for working families. Patrick says there are only 11 states, including North Carolina, that have not done some form of Medicaid expansion and most are in the Southeast.

Current Situation

  • 63 of 80 rural counties are classified as medical deserts. They do not have the number of providers in virtually any category that they should have to support their population.
  • Rural hospitals and health systems in general are struggling mainly because of the volume of charitable care that they deliver each year.
  • 1.3 million North Carolinians are uninsured according to recent estimates.
  • About 600,000 citizens fall into the health insurance gap. They are working but they earn too much money to qualify for Medicaid but not enough money to afford insurance on the private marketplace, including the premiums on the Affordable Care Act (ACA) exchange. Despite working, because they are uninsured and uncovered, they are one medical incident away from bankruptcy.

 “It’s a major concern and one that has gotten worse with time in recent years,” explains Patrick.  According to the data that has tracked the states that expanded Medicaid with federal funds, there are numerous benefits. Among them:

  • Hundreds of thousands of citizens who weren’t covered receive coverage.
  • It stabilizes health systems and particularly rural hospitals because they now have more paying consumers and are delivering less in charitable care through emergency rooms.
  • The premiums for those with private insurance have gone down.

“It’s a win-win all the way around,” says Patrick. “With America’s Rescue Plan Act, the prospect for expanding coverage in North Carolina is an even more attractive deal. There was a 10 percent state match required for expanding Medicaid. That state match is going away and there actually is a net. In the first two or three years there is a net $300 million surplus in revenue to the state if the state expands coverage. We’re hopeful the General Assembly can get to consensus on this because nothing would help the rural economy more.”

Invest in Stronger Entrepreneurship and Small Business Development Systems

When it comes to economic development, the recruitment of large companies always gets lots of attention but it’s the small businesses where “the real bread and butter of job creation happens,” says Patrick.

Current Situation

  • 75 percent of businesses in rural counties have fewer than 10 employees.
  • Statewide 94 percent of all business establishments have fewer than 50 employees.
  • Small businesses make up about 40 percent (about 4 million people) of the state’s workforce.

The N.C. Rural Center formed the N.C. Small Business Policy Task Force to focus on the policy changes needed to support small businesses and entrepreneurs. A bipartisan slate of business owners, nonprofit leaders, entrepreneurship advocates, and local and state leaders from across the state weighed in through a series of focus groups and policy focused discussions. Based on this statewide input, the Center developed North Carolina’s New Small Business Plan, a 20-point policy agenda which is the guiding document in talking with the General Assembly about ways to support rural small business owners. Among them are greater access to capital and the adequate supports needed for those launching and expanding a business.

“Many of the items on that 20-point policy agenda found their way into the State Senate and House Budget proposals,” says Patrick. “We are optimistic that we are going to see some policy advancement that will bring stronger support to small businesses and entrepreneurs.”

In part 1 of this blog series, Patrick Woodie of the N.C. Rural Center, focuses on the Center’s advocacy work to expand accessible, affordable high-speed broadband. In part 3, he shares information about the state’s water and wastewater infrastructure, sustainable and affordable housing, and the importance of community leaders in every rural region of the state.

By Leah Chester-Davis