September 2017

Fall is almost officially here, and there is a great deal going on at the Rural Center in the policy and advocacy worlds. Because we like to keep you on your toes, we have decided to shake things up with this month's newsletter. First, you'll find federal and state policy updates grouped by our Rural Counts strategies, along with opportunities for you to get involved. Then, you can find updates on Rural Center programs, such as our Rural Road Trip and upcoming Rural Assembly. 

Like what you see? Looking for something different? Let us know what you think!


Affordable Care Act (ACA)
ACA Open Enrollment for 2018 is being held from November 1 - December 15. According to a recent announcement from the federal Centers for Medicare and Medicaid Services, the NC Navigator Consortium led by Legal Aid of North Carolina has been notified they will receive the same funding level as last year to enroll participants. North Carolina has about 150 navigators who have completed a 40-hour training program to help enrollees sign up on the federal website. There is still concern whether there will be federal funds for education and advertising for ACA insurance plans.
Repealing & Replacing the ACA: Graham-Cassidy Plan
Senators Lindsey Graham (R-SC) and Bill Cassidy (R-LA) have introduced a bill that would fundamentally change the Medicaid program by capping it on a per-capita basis and provide block grant ACA funds to states to deliver health care to low-income people. The formula change would result in a major redistribution of federal funds among the states, which would only have two years to create a new health care infrastructure. While keeping some of the ACA provisions, the bill would abolish the requirements that individuals purchase health insurance and that employers with 50+ employees sponsor a medical coverage plan. The bill grants so much flexibility to states that they could set up markets where individuals with pre-existing conditions could be charged more for insurance or could ignore the essential health benefits requirements of ACA such as hospitalization, prescription drugs, mental health and substance abuse, and maternity care. The bill is designed to go into effect over the 2020-2026 period.    
The Center for Budget and Policy estimated the measure would cut health care spending by providing $239 billion less over 10 years in subsidies and expanded Medicaid and reduce the existing Medicaid program by $175 billion. North Carolina alone would see more than $1 billion fewer dollars in health care funding by 2026. The authors have asked the Congressional Budget Office for a scoring.
The Senate Finance Committee will hold a hearing on the Graham-Cassidy proposal on September 25, and the Senate Homeland Security and Government Affairs Committee will hold a hearing on September 26 titled "Block Grants: How States Can Reduce Health Care Costs."
T he Senate Parliamentarian has ruled that in order to use the fast-track procedure, requiring 51 votes for passage rather than 60, the legislation must be approved by  September 30 . So, the window is closing quickly for repealing and replacing the ACA.

Fixing the ACA: Alexander & Murray Plan
Senators Lamar Alexander (R-TN) and Patty Murray (D-WA) are drafting a bill to stabilize the individual health insurance marketplace under the Affordable Care Act. The measure will likely include the cost-sharing reduction payments for the insurance companies, expanded state flexibility for innovation waivers, and reauthorization of the federal reinsurance program that expired in 2016. 
Of particular concern is whether the essential benefits package requirement will be altered, whether the prohibition on lifetime spending caps or discrimination based on pre-existing conditions will be changed, and whether the Navigator program will be continued and funded. If there are an increasing number of counties with no ACA exchange insurance provider, then committee members warned they would have no choice but to consider a public option such as allowing people to buy into Medicare.
Children's Health insurance
The Children's Health Insurance Program authorization expires 
September 30 and this must-pass bill may give lawmakers the legislative vehicle they need to make changes to the Affordable Care Act. 

Senators Orrin Hatch (R-UT) and Ron Wyden (D-OR) have introduced the Keeping Kids' Insurance Dependable and Secure (KIDS) Act, S. 1827, a bipartisan bill to ensure stability for vulnerable children by extending funding for the Children's Health Insurance Program (CHIP) through FY 2022.

Carolina Cares

Governor Roy Cooper this month announced his support for Carolina Cares (HB 662), a bill offered by a group of Republican legislators to help close the health care coverage gap in North Carolina. An alternative to Medicaid expansion, the GOP proposal would help working North Carolinians making up to 138% of the federal poverty level qualify for affordable health insurance. The Rural Center has publicly supported using the Carolina Cares model as a starting point for a statewide effort to close the coverage gap. We are encouraged by the bipartisan support for the bill and will continue to work toward the passage of smart legislation. 

Action Alert:
We encourage our advocates to communicate with their legislators at both the state and federal level how important affordable health insurance is to rural people and economies. For information on how closing the insurance gap could help your county, check out our interactive county-level database

Homework Gap Convening

The NC Broadband Office and the Friday Institute at NC State University recently hosted the 2017 Homework Gap Convening, bringing over 70 stakeholders together to discuss a recent statewide survey of parents about internet access and how it affects homework completion.

Speakers included FCC Commissioner Jessica Rosenworcel, Governor Roy Cooper's Senior Education Advisor Geoff Coltrane, and North Carolina's Chief Information Officer Eric Boyette.

Results from the survey show that the digital divide in our state has particular impact on students with online homework assignments. Affordability is a key barrier - 67 percent  of survey respondents without internet access identified the cost of internet as their primary reason for not subscribing.

Two rural school districts - Lee County Schools and Montgomery County Schools - were celebrated for pilot projects extending access to students. Lee County offers a mobile hot spot program to give students access to the internet for homework assignments, and Montgomery County has equipped buses with mobile WiFi to allow students, some of whom ride the bus for four hours each day, the opportunity to complete assignments on their way to and from school.


Action Alert:
NCDOT Strategic Plan - Community Workshops

This October, stakeholders and the public are invited to provide input at community workshops across the state as part of the NC Department of Transportation Statewide Strategic Plan. The workshops are free and open to the public. No registration is necessary to attend.

The NC DOT is developing the Public Transportation Statewide Strategic Plan to improve bus, rail, and paratransit services across the state by better matching transit services to the needs of North Carolinians.

For more information on the Public Transportation Statewide Strategic Plan, please visit:

NC Public Transportation Strategic Plan
Community Workshop Schedule, October 2017
Northeastern North Carolina
October 2, 2017
12:30 p.m.-3:30 p.m.
Pitt County Agricultural Extension Auditorium
403 Government Circle, Suite 2
Greenville, NC 27834
Southeastern North Carolina
October 4, 2017
12:30 p.m.-3:30 p.m.
Bladen Community College Auditorium
7418 Highway 41 West
Dublin, NC 28320
October 5, 2017
8:30 a.m.-11:30 a.m.
Research Triangle Foundation
Meeting Rooms A&B
12 Davis Drive
Durham, NC 27709
October 5, 2017
12:30 p.m.-3:30 p.m.
Research Triangle Foundation
Meeting Rooms A&B
12 Davis Drive
Durham, NC 27709
Charlotte / Gastonia / Kannapolis
October 16, 2017
12:30 p.m.-3:30 p.m.
Rowan-Cabarrus Community College - South Campus
Building 1000 (Main Building), Room 106
1531 Trinity Church Road
Concord, NC 28027
Northern Mountains
October 17, 2017
12:30 p.m.-3:30 p.m.
Blue Ridge Energy
Meeting Room
2491 US Hwy 421 S
Boone, NC  28607
Land Use
October 18, 2017
8:30 a.m.-11:30 a.m.
Piedmont Authority for Regional Transportation (PART)
Board Room
107 Arrow Road
Greensboro, NC 27409
October 18, 2017
12:30 p.m.-3:30 p.m.
Piedmont Authority for Regional Transportation (PART)
Board Room
107 Arrow Road
Greensboro, NC 27409
Southern Mountains
October 19, 2017
12:30 p.m.-3:30 p.m.
Asheville-Buncombe Technical Community College
Conference Center, Room B
340 Victoria Road
Asheville, NC 28801
NCDOT will provide auxiliary aids and services under the Americans with Disabilities Act for disabled persons who wish to participate in this meeting. Anyone requiring special services should contact Jamille Robbins, Human Environment Section, via e-mail at or by phone  (919) 707-6085 as early as possible so that arrangements can be made. 

Federal Package

Congress combined key pieces of legislation and approved the measure in record speed to suspend the debt limit, approve a short-term Continuing Resolution to provide funding to federal programs until December 8, and approve emergency supplemental appropriations for FEMA, SBA, and HUD-CDBG for hurricane response and recovery (H.R. 601, Public Law 115-56).    

The CR contains a $15.25 billion package for hurricane response and recovery. The legislation allows the FEMA Disaster Relief Fund (Public Assistance, Individual Assistance and Hazard Mitigation Grant Programs) spending flexibility to accommodate Hurricane Harvey, Hurricane Irma, and other ongoing 2017 disaster responses. The FEMA fund will receive $7.4 billion; $450 million is provided to the SBA Disaster Loans Program, with the ability to transfer funds for administrative expenses; $7.4 billion for CDBG disaster relief, long-term recovery, restoration for infrastructure and housing, and economic revitalization in the most impacted and distressed areas resulting from major disasters declared in 2017; and continues authority of USDA and the Department of Interior to transfer necessary funds for wildfire suppression. Like previous natural disaster response and recovery funding bills, the hurricane recovery package did not contain offsets to pay for the disaster assistance, but is designated as emergency funding that doesn't count against the non-defense discretionary spending cap under the Budget Control Act (P.L. 112-25).

National Flood Insurance Program

Authorization is extended through December 8. It was due to expire September 30. The program offers insurance policies to property owners in areas with significant flood risks. 

Continuing Appropriations

Congress combined key pieces of legislation and approved a measure in record speed to suspend the debt limit and approve a short-term Continuing Resolution to provide funding to federal programs until  December 8 , (H.R. 601, Public Law 115-56).   

Congress combined key pieces of legislation and approved a measure in record speed to suspend the debt limit, approve a short-term Continuing Resolution to provide funding to federal programs until December 8, and approve emergency supplemental appropriations for FEMA, SBA, and HUD-CDBG for hurricane response and recovery (H.R. 601, Public Law 115-56).    

Debt Limit Increase: Suspended the debt limit through December 8, which appeased the markets that there would be no default. 

No Shutdown: To avoid a federal government shutdown October 1, Congress enacted a three month Continuing Resolution (CR) to December 8 to fund programs at the FY 2017 appropriated level, reduced by 0.6791 percent across-the-board to keep the measure within the discretionary spending caps, which total $1.06 trillion. The measure also provides for up to 30 days after the expiration of the CR authority to make payments for appropriated entitlements and other mandatory spending such as Medicare and Social Security.

2018 Federal Appropriations

The House of Representatives packaged their 12 appropriations bills into two mini-packages and approved the measures, (H.R. 3219, H.R. 3354). Because of various policy riders, these measures were approved by mostly partisan vote margins. The Senate is moving forward with markups of the 12 individual bills and have begun negotiations with the House Appropriations Committee to finalize the bills before the December 8 deadline.    

We are very pleased that House and Senate Appropriations Committees have rejected deep cuts proposed by the White House, although specific program funding levels are recommended by each respective subcommittee.  

Tax Reform

White House and Congressional leadership are expected to release their proposal the week of September 25, with final action planned by the end of the year. North Carolina members of Congress on the committees of jurisdiction over tax reform include Senator Richard Burr serving on the Senate Finance Committee and Representative George Holding serving on the House Ways & Means Committee.

Taxable wage data tells mixed story for rural NC economies

The growth or decline of jobs, often benchmarked by the unemployment rate, is the default measurement of economic wellbeing. However, income from jobs is another excellent way to assess economic change. The source of this data is the Quarterly Census of Employment and Wages from the Bureau of Labor Statistics, and accessed from the D4 data portal of the NC Department of Commerce.

The Tableau visualization below measures percentage change in taxable wages with 2000 as the benchmark year. Every subsequent year up to 2016 is measured as percentage change from 2000. All years are in current 2016 dollars.

The top graph summarizes the change for (from top to bottom) the six urban counties, the state average, the 14 suburban/regional city counties, and the 80 counties the center defines as rural. In 2016, rural counties collectively were still six percent below the taxable wage level of 2000. However, the trend has improved from the 16 percent decline in 2011. This six percent decline is a total of $350.5 million.

Rural North Carolina is diverse. The bottom visualization is designed to select an individual county and compare its trend line for the average for the county classification - that is comparing urban to urban, regional city/suburban counties to one another, and rural to rural. Therefore, if you select Richmond County you will see its trend as compared to the total of all rural counties. Some rural counties close to growing metro regions are doing well, Johnston and Franklin for example. 

Generally, urban counties have higher growth rates than rural counties, but if you look on the map below at Forsyth County, for example, you will see that its taxable wage growth rates are significantly lower than the average for all six urban counties.
Taxable wage levels are improving in rural counties, but if you look at change from just before the Great Recession we see a very mixed picture. Thirty-three counties had positive wage growth between 2007 and 2016, but 47 rural counties had an aggregate decline of $289.7 million. Jobs alone are not an adequate measure for determining the long road to economic recovery. 

Register now to help us celebrate 30 years!

Join us  November 16-17  for the 2017 Rural Assembly at the  Raleigh Marriott Crabtree Valley  as we take a deep dive into the topic of rural leadership and the importance of local leaders in helping rural communities chart their own course for the future.

Our keynote speaker this year is bestselling author, renowned chef, and television host Vivian Howard. Vivian will share a personal story of her return home to rural North Carolina and her journey from a budding rural entrepreneur to television star.

Be sure to register early! Confirm your seat at the Assembly by October 16 and receive a signed copy of Vivian's critically acclaimed book of recipes and reflections, Deep Run Roots
Halfway there! 40 down, 40 to go

This March, Patrick Woodie and John Coggin set out on a quest: visit each of the 80 counties served by the Rural Center and meet with community leaders - elected officials, business leaders, health care workers, educators, and civic champions - to hear what was going well, and what major issues need to be tackled by a statewide network of rural advocates.

We are now officially halfway through this ambitious tour. We have visited 40 of the state's 80 rural counties, and have hosted meetings from Murphy to Nags Head. What have we learned? North Carolina's rural communities are vibrant places, brimming with entrepreneurs creating opportunity, teachers helping launch the next generation, and leaders passionate about making their communities better places.

We've also found that while every county is distinct, there are many unifying struggles. Access to affordable high-speed internet is a hindrance to development in almost every county we've visited. The need for qualified teachers, capable health care professionals, and workforce housing touches most every community.

Our goal by the end of this journey is to have a deeper sense of the county-level nuances of the issues facing rural North Carolina, as well as to have identified areas in which the Rural Center can be most effective at gathering rural citizens to speak up for statewide solutions.

But first, we have to finish the tour! If we have not yet visited your county, please let us know! We are taking a bit of a hiatus as we prepare for the Rural Assembly, but we can still fit in some visits this fall, and hope to be back on the road this winter.  Contact  John Coggin  to schedule a community forum in your town.

Director of Advocacy
The Rural Center