NC Rural Center John Coggin photo

John Coggin, director of advocacy at the North Carolina Rural Center,  shares his vision for a more prosperous rural North Carolina.

Editor’s note: This is the second in a three-part series on issues facing rural communities.

Representatives with the North Carolina Rural Center traveled to Morganton in mid-May to share how they are advocating for a better Burke County and improvements in rural areas across the state.

During the luncheon, John Coggin, director of advocacy at the NC Rural Center, and Miles Kirksey, Morganton native and engagement coordinator with the center, spoke to a group of local leaders in a variety of fields and shared their vision for more developed and prosperous rural communities, based on exhaustive research.

That research identified three areas of concern for rural areas such as Burke County, including expanding accessible, affordable high-speed broadband; stabilizing and transforming rural health; and investing in stronger entrepreneurship and small business development systems

Coggin said lack of access to affordable health care is a huge problem in the state.

“This issue is something that’s plaguing a lot of our communities, and it’s keeping hard-working folks from getting ahead,” he said.

The goals of the NC Rural Center’s heath care initiative are r ecruiting more health care providers to serve rural areas; closing the health insurance coverage gap; finding solutions to the opioid abuse crisis; and investing in telemedicine services.

Coggin noted that 74 of the state’s 80 rural counties are considered “medical deserts” because there are not enough primary care providers to serve those communities. A map he showed during the presentation indicated that Burke County is lacking sufficient primary medical, dental and mental/behavioral services.

He said local leaders should keep in mind the economic boost that recruiting health care providers and facilities would bring to the area in new jobs, wages, benefits and tax revenues, in addition to the fact they would be improving residents’ health.

“Look at all of these jobs that they (doctors) are bringing with them: nurses, techs, aides, but also non-health jobs, including office and admin staff, custodial, grounds support and food service preparation,” Coggin said. “It’s a bulwark. It’s helping to support the overall economy.”

He said closing the health insurance gap is the most urgent directive the center is pursuing.

“There are over 400,000 people (in North Carolina) who, out of some really weird ways that the American Affordable Care Act was designed and implemented, ironically, don’t make enough money to afford insurance subsidies on the federal marketplace,” Coggin said.

Some solutions that have been offered include expanding Medicaid or creating a state health insurance product available to non-state employees.

He highlighted the economic benefits of closing the coverage gap, including creating 43,314 jobs; adding $21.5 billion in business activity and $860 billion in state revenue; and saving $3.45 billion in uncompensated care.

He also outlined how the substance abuse crisis is “plaguing our children, our elders, our families and our friends.”

“There’s been an 800 percent increase in opioid drug deaths from 1999 to 2016 (in North Carolina),” Coggin said. “In 2017 alone, there were 1,683 deaths. This region is one of the hardest hit.”

He said in addition to opioids, other substances rural residents are abusing include alcohol, methamphetamine, heroin and cocaine.

“We need to figure out ways that we address the root causes of all of that, and new ways to help people go through recovery,” Coggin said. “We have not seen much on substance abuse going through the legislature this year. The past two years, they took some really great steps forward, but now we’ve got to get into some of those deeper, more complicated issues.”

One of the ways that problem might be addressed in the future is by the use of telemedicine, a growing field that allows health care professionals to use technology and internet access to treat patients remotely.

The main obstacle to implementing telemedicine in the communities most underserved health-wise is that they are the same communities that lack the broadband access needed to connect isolated residents with health care providers. People also have raised concerns about patient privacy and data security.

Keith Conover, a technical analyst with the Broadband Infrastructure Office at the North Carolina Department of Information Technology, shared information about funds his office is using to advance telemedicine in the state.

“The state received a $1 million grant from ARC (Appalachian Regional Commission) for telemedicine,” Conover said. “What that’s going to include is taking a look at all of the health care facilities, the smaller ones in rural areas, to make sure they have a fiber connection. I think we have 150 or so that we’re looking at right away. That’s not just important for the ability of telemedicine in those facilities, but the other good part about that is, to get that infrastructure to those buildings, they’re going to have to pass a lot of homes.”

The main bill the North Carolina General Assembly is considering that would increase health insurance coverage in the state is the NC Health Care for Working Families Act (HB655), which was crafted by a team that includes a doctor and a nurse.

The bill would create a state health insurance product for residents ages 19-64 who earn up to 133 percent of the federal poverty level through employment or the active pursuit of employment and who are committed to a healthy lifestyle. The premiums would be based on 2 percent of each person’s household income. Certain exemptions would apply to various health- and economic-related conditions.

“Reportedly, this will not cost a dime of state funding,” Coggin said. “Ninety percent of this will come from federal draw-down, and the remaining 10 percent will be made up from premiums and health-system assessments on hospitals and other health providers. Given the fact that 34 of our states have already found a solution to this problem, and it’s been working for them, and because I don’t see any big changes politically in the near future, I don’t see that 90 percent match going away.”

The insurance program would end if federal funds were withdrawn. The bill also would release grant funds to address state health care needs.

Other bills being considered would create a health insurance pool for small businesses, expand paramedic services, provide in-home health care for new mothers, pay health care professionals’ student loans if they serve in rural areas, and close the Medicaid coverage gap.

Coggin urged attendees to tell their state representatives that they “have their back” in exploring solutions to health care access.

For more information on the NC Rural Center, visit or contact 919-250-4314.

Staff writer Tammie Gercken can be reached at

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