November 2017
Help the Rural Center Shape Our 2018 Policy Agenda

Rural Counts: 10 Strategies for Rural North Carolina's Future is a guide map that outlines the rural economic development imperatives that should guide our action today and be the measure of our success going forward.

We kicked off the Rural Counts program by spending the past six months on the road, visiting rural communities from Murphy to Nags Head, to hear from you what within these strategies should be top priorities for the Rural Center going forward.

We are only 40 counties into our 80 county tour, but in all of the counties we have visited, three issues consistently rise to the top:

1) Broadband
2) Health Care
3) Entrepreneurship

We are now focusing on identifying where we, together with you, can make some real progress in each of these areas. And we want to hear where you think we should start.

Please fill out this survey to tell us areas you care about, and what's happening in your local community that you think could be addressed by collaborative statewide efforts.

We'll use your feedback to identify key policy opportunities that could be taken up at the state or federal level.

And, don't worry! We'll make sure to loop back to you with what we're thinking, so you can let us know if the ideas we're exploring will actually work for you.

Complete the survey by Friday, November 10, and forward this email to others you know who care about our rural communities. We want to gather as many voices as possible to guide us in finding solutions for the biggest challenges facing rural NC.

 John Coggin
 Director of Advocacy

Registration closes Friday for our 30th anniversary celebration

On  November 16-17, more than 400 rural citizens and supporters will gather at the Raleigh Marriott Crabtree Valley to 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.

Claiming our Future: Inspiring Leadership, Driving Change  is two days full of content and conversations focused on how communities can engage the next generation of rural leadership to build the foundation for a better and brighter tomorrow. 
Bestselling author, renowned chef, and television host  Vivian Howard  will deliver the keynote address at this year's Rural Assembly. Howard will share a personal story of her return home to rural North Carolina and her journey from a budding rural entrepreneur to television star. 
Visit the  2017 Rural Assembly website to learn more and register by Friday, November 10!

The 80-county tour resumes after Thanksgiving

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.

We have taken a short break to plan the best Rural Assembly yet, but we will be hitting the road again after Thanksgiving!

If we have not yet visited your county, please let us know! Contact  John Coggin
to schedule a community forum in your town.


Tax Reform
On November 2, the House Ways & Means Committee released its tax reform bill. Among various provisions, the initial draft bill eliminates the Historic Preservation Tax Credit, the New Market Tax Credit and Private Activity Bonds, makes small business reforms, includes major changes regarding education expenses, repeals medical expense deductions, modifies the energy investment tax credit, and gradually eliminates the federal estate tax. The Committee is scheduled to consider the bill the week of November 6 and the full House of Representatives to vote on the measure before Thanksgiving. The Senate Finance tax reform bill also is expected to be introduced the week of November 6. Congressional Republican leaders and the White House hope a final bill will be approved before the end of the year.  
Health Care
Affordable Care Act (ACA)
ACA Open Enrollment for 2018 is from November 1 - December 15, 2017. The signup season has been reduced to 45 days from three months in previous years. To add to the challenges of registering, the Department of Health and Human Services is taking the system down every other Sunday to update. Premiums have increased in response to the October 12 announcement by the White House that they would not make the cost-sharing reduction (CSR) payments to the insurance companies to offset the cost of reducing out-of-pocket expenses like deductibles and co-payments for low-income customers, not qualifying for Medicaid. Legislation to stabilize the insurance marketplace sponsored by Senators Lamar Alexander (R-TN) and Patty Murray (D-WA) has not yet been brought to the floor for consideration.
Home Health Care
The Centers for Medicare & Medicaid Services is expected to release a final rule regarding how and when Medicare would pay for home health services. Medicare currently pays for up to 60-day episodes of care, but this summer CMS proposed using a 30-day unit in 2019. The change could result in $950 million in cuts to home health services for 2019. The National Association for Home Care and Hospice strongly opposes this effort. 
Children's Health Insurance and DSH Payments
The Children's Health Insurance Program (CHIP) authorization expired September 30 and this must-pass bill may give lawmakers the legislative vehicle they need to make some changes to the Affordable Care Act (ACA) and approve other health care program reauthorizations that also have expired. Some states will start exhausting existing funds by early December, so the reauthorization needs to happen soon.
On November 3, the House of Representatives approved H.R. 3922, the Community Health and Medical Professionals Improve Our Nation (CHAMPION) Act, which reauthorizes CHIP and delays for two years the proposed cuts in Medicaid payments to disproportionate share hospitals (DSH) with large numbers of low-income patients. To pay for the bill, House Republican leadership included language to increase Medicare premiums for high-earning seniors (means-testing), and takes more funding from the ACA Prevention and Public Health Fund.
The measure provides $1 billion to support Puerto Rico and U.S. Virgin Island Medicaid programs, but requires the local match, and extends for two years the federal Community Health Centers program and the National Health Service Corps, which supports primary-care providers in underserved communities through scholarships and loan repayments. The bill also reauthorizes the Teaching Health Center Graduate Medical Education Program, the Special Diabetes Program at the National Institutes of Health, the Family-to-Family Health Information Centers program for children who have special health care needs, and the State Abstinence Education Grant Program, renamed the Youth Empowerment Program, and the Personal Responsibility Education Program to prevent teen pregnancy at the Administration for Children and Families. Despite Democrats objecting to the proposed offsets to pay for the programs, House Republican leaders took the bill to the floor and it passed 242-174.
The Senate Finance Committee has approved 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 through FY 2022. Sponsored by Senators Orrin Hatch (R-UT) and Ron Wyden (D-OR), the bill also includes state flexibility and will move the program's funding closer to its original federal-state partnership. It does not include the House offsets to fund the extension.

President Trump officially declared the opioid crisis a Public Health Emergency. The 90-day declaration directs federal agencies to better use their funding to fight the opioid problem, but no new funds were provided at this time. The executive action allows for expanded access to telemedicine, including services involving remote prescribing of medicine commonly used for substance abuse or mental health treatment; allows the Department of Health and Human Services to quickly make temporary appointments of specialists to respond to the crisis; allows the Department of Labor to issue dislocated worker grants for those impacted by abuse; and allows for the shifting of resources within HIV/AIDS programs to help people eligible for substance abuse treatment. Last year, Congress passed the Comprehensive Addiction Recovery Act to improve prevention, treatment, recovery, overdose reversal, and our law enforcement efforts.       
FY 2018 Federal Appropriations
Hurricane Recovery

Congress enacted a bill providing $36.5 billion for hurricane disaster recovery and wildfire relief. The bill provides funding for FEMA's Disaster Relief Fund, support for the wildfire-fighting efforts and debt relief for the National Flood Insurance Program so it could continue to pay insurance claims to owners of property damaged by the hurricanes and other flooding. President Trump signed the measure on October 26. Another disaster supplemental funding proposal, expected to cost more than $75 billion, to address hurricane damage and wildfires in western states is expected before the end of the year.
FY 2018 Annual Appropriations

The House and Senate appropriations leadership are in bipartisan discussions on how to complete the FY 2018 appropriations process before the December 8 deadline. Efforts are ongoing to raise the discretionary spending totals and remove the threat of deep cuts caused by sequestration.   

Director of Advocacy
The Rural Center