Legislature neglects the health or rural NC

Editorial by News and Observer, August 23, 2014.

The General Assembly has adjourned, and its members have gone home, but the lawmakers leave behind a major problem that never made it onto the agenda – the crisis in rural North Carolina.

As lawmakers were preparing to go, a new report from the Task Force on Rural Health outlined the extent of the problem. The 2.2 million North Carolinians who live in the state’s 60 rural counties face a greater risk of illness and a shorter lifespan than people in the state’s urban areas. The task force was led by the N.C. Institute of Medicine and the state government’s Office of Rural Health and Community Care and funded by the Kate B. Reynolds Charitable Trust.

Rural areas in North Carolina and around the nation have long faced problems with access to health care, but what is striking in this report is how steps taken by the Republican-led General Assembly have exacerbated the problem. The task force noted that the health of an area’s people is tied to the health of the regional economy.

“The task force really saw education and economic activity as instrumental to the development of improved health in rural communities,” said Adam Zolotor, interim president of the Institute of Medicine, an independent, quasi-governmental group charged with giving state leaders advice on health issues.

Decisions by the General Assembly have hit rural residents on both health and economic fronts.

The biggest blow, of course, comes from the legislature’s refusal to expand Medicaid under the Affordable Care Act. That decision is straining rural hospitals, depriving low-income residents of preventative care or early care before a condition worsens and blocking billions in federal dollars from entering North Carolina’s economy.

The resistance to Medicaid expansion is a slow-motion disaster for poor rural areas. It deprives them of treatment and takes a toll in jobs forgone and lives lost. Perhaps the clearest expression of the urgency was the Republican mayor of Belhaven, Adam O’Neal, walking to Washington, D.C., to attract attention to the devastating closing of a local hospital and the strain being felt by rural health care.

The task force report did not address the Medicaid issue. Its members know Republican leaders won’t reverse course. But the report did recommend other actions that include boosting support for child care and education, bolstering economic development and better educating rural residents about insurance options under the ACA. In all these areas, the legislature has done nothing or made matters worse.

On child care, the General Assembly reduced eligibility for subsidies. The change will exclude about 12,000 children, most of them ages 6 to 12 who relied on the subsidies for after school care. Cindy Watkins, president of the N.C. Partnership for Children, says the worry now is, “Where will these children go and who will be watching them?”

On education, the legislature has failed to keep up with growth or directly cut funding for public education and the University of North Carolina.

On bolstering economic development, the legislature has all but eliminated the Rural Economic Development Center to consolidate its funds under the Department of Commerce. But the department’s effort to launch economic development projects has been hindered by the legislature’s resistance to incentives.

On better educating rural residents about insurance options, the legislature declined to let the state Department of Insurance help people make insurance choices under the ACA. That task has fallen to community groups supported by federal grants.

The task force report does more than describe the health of rural North Carolina. It makes the link between government support, economic development and wellness. It makes it clear that the actions taken by the General Assembly are not just matters of politics or policy. They’re matters of life and death.