Financial questions may doom a small Scotland County town

A small Scotland County town may become a spot on the map with no elected government or authority to collect taxes.

A state commission is recommending East Laurinburg be stripped of its charter after years of shaky finances.

The Local Government Commission, which operates within the state Treasurer’s Office, voted unanimously Tuesday on a resolution to recommend that the town of 300 lose its status as a municipality. Legislative action is required to revoke a charter, and state Treasurer Dale Folwell said he’d spoken to legislators who represent East Laurinburg.

The town has been on the Unit Assistance List for years, said Sharon Edmundson, director of the State and Local Finance Division in the Treasurer’s Office. The Unit Assistance List is a watch list the office keeps of towns, cities, and counties that don’t file audits on time or have other financial problems.

“They have not shown they are viable going forward,” she said. “We’ve struggled with them for years.” During one stretch of time,  state staff couldn’t figure out who the town’s finance officer was. “They wouldn’t return phone calls or anything.”

The commission also voted unanimously to take control over the finances of Pikeville, a Wayne County town of about 700 people.

The town spent more in 2019 from its general fund and utility funds than it had budgeted, according to information given the Local Government Commission. The town is facing debt payments in the coming months and “its financial position is impossible to determine,” said the resolution the commission approved.

NC legislators aim to reduce Black maternal deaths

Democrats in the NC legislature are sponsoring bills meant to improve Black maternal health that mirror parts of the federal Momnibus Act championed by U.S. Rep. Alma Adams, a Charlotte Democrat.

The United States has one of the worst records for maternal death in the developed world. Black women in the U.S. are three times more likely to die from pregnancy-related health problems as white women.

“The U.S. is one of only 13 countries where maternal mortality is on the rise, and racial disparities drive this crisis,” Sen. Natalie Murdock, a Durham Democrat, said at a news conference Monday.

According to the NC Maternal Mortality Review Committee, 63% of maternal deaths in North Carolina from 2014-15 were preventable.

Senate bill 632 and House bill 507 would set up a task force looking at maternity care and births in the COVID-19 pandemic; study cooperation between military veterans’ health care facilities and non-veteran facilities in delivery of maternal care; set up a task force that would recommend ways to address how  transportation, housing, environment, and other factors influence maternal health; and develop a grant program for community organizations focused on preventing Black maternal deaths and severe illnesses.

Dr. Narges Farahi, leader of the Maternal Child Health program at UNC Family Medicine, said she has seen how illnesses in mothers lead to illnesses in children “and lost opportunities for families.”

The pregnancy-related mortality rate does not improve for Black women with college degrees as it does for white women, she said. Black women with college degrees are five times more likely to die than white women with college degrees.

Studies have shown that “being pregnant while Black is more likely to be a fight for health, wellness and life for mothers and for their children. This shines a light on the tremendous impact racism has on the health of Black women before, during, and after pregnancy,” Farahi said.

The Senate bill was assigned to the chamber’s Rules Committee, an indication that it is unlikely to pass. Murdock said she’s talked to leading legislators about the importance of reducing Black maternal mortality, and wanted to go “big and bold” with the proposal.

She noted that Senate Republicans have filed a bill that would have women who use Medicaid while they are pregnant stay on the government insurance plan for 12 months postpartum rather than getting cut off after 60 days – a bill that supporters of the Black maternal health bill had considered putting in their package.

Rep. Julie von Haefen, an Apex Democrat and a sponsor of the House bill, said the hope is to get some of the provisions included in the state budget the legislature passes.

“We do have some support for some provisions across the aisle,” she said.

North Carolina’s leadership serves as a model other states can emulate, said Breana Lipscomb, senior manager of the U.S. Maternal Health & Rights Initiative at the Center for Reproductive Rights. Few other states are looking at the impact of COVID-19, addressing access for women in the military to pregnancy and postpartum care, and acknowledging the role of community organizations in reducing maternal deaths, she said.

“Research shows that for Black and white women with the same risk factors and the same pregnancy complications, Black women are still more likely to die,” Lipscomb said. “This indicates that there is some factor other than an individual’s health condition that influences mortality risk for Black women.”

Responses to COVID-19 offer the chance to address racism in healthcare, experts said

The COVID-19 pandemic has brought into stark relief how the health care system fails people with low incomes and people of color, panelists at a Duke University Margolis Center forum said last week.

Longstanding inequities in health care put people of color at greater risk of severe COVID-19 symptoms and death. The inequities continue with the COVID-19 vaccine roll-out, with white people getting disproportionate share of vaccines.

“Our health care system doesn’t work well for low income, low health literacy, undocumented – that didn’t start with COVID,” said Abner Mason, founder and CEO of ConsejoSano, a company that works with health care providers and insurers on patient engagement that is multicultural and multilingual.

“It shocked people out of their relative acceptance of a horrible system,” he said.

Building trusting relationships with communities and individuals is essential to  improving health, the panelists said.

Students in the Margolis Scholars Program at Duke  organized the event.

Kumbie Madondo is director of Community Partnerships & Policy Solutions at the New York Academy of Medicine, which works with the New York City Department of Health. She said the city’s health department is addressing disparities and racism in healthcare.

“We need to call things as they are,” she said. “If there is racism in health care, call it for what it is. In the communities we serve, health disparities are borne out of racism.”

In North Carolina, Latinx communities get confusing information about vaccines, said doctors and community health workers.

Dr. Edith Nieves Lopez, a pediatrician at Lincoln Community Health Center in Durham said CDC information about COVID-19 does not translate well into Spanish.

“Sadly, there are few things that you find online that are culturally sensitive that can relay information in a few sentences,” she said.

Lopez said it was her job to get people in the community to trust her.

Increasing access to care and making sustainable change is important, said Onyi Ohamidike, a third-year medical student.

“Community members need to see people who look like them” and share their experiences, she said. Often blame is put on communities for not being able to trust, she said, taking the focus off institutions that should become trustworthy,

“We might all look at ourselves at great, kind, empathetic people,” Ohamidike said. “We need to recognize that we are attached to an institution that has harmed a lot of people.”

Griselda Alonso, a community health worker, said it is important to get people in the Latinx community clear and accurate information.

It’s hard for the Latinx community to trust medicine when last year, they heard about a doctor sterilizing women held in an ICE detention center, Alonso said.

“Try to be empathetic with my community,” she said. “Leave your privilege to the side.”

Democrats in the NC legislature decry racial health disparities in their renewed push for Medicaid expansion

Democrats in the legislature renewed their press for Medicaid expansion, saying a Tuesday news conference that getting more people insured will reduce racial health disparities and help the economy.

Sen. Mike Woodard, a Durham Democrat, said there are signs that Republicans in the legislature who have long opposed Medicaid expansion are willing to talk about it.

“I think there are glimmers of hope,” he said.  “I think there are frameworks for us to move forward.”

North Carolina is one of a dozen states that has not adopted Medicaid expansion as allowed under the Affordable Care Act.  Last session, Senate Republicans said they did not like an expansion-like proposal called Carolina Cares that House Republicans crafted. The Carolina Cares bill never got out of the House.

Expansion is a top priority for Gov. Roy Cooper, and he once again has included it in his budget proposal.

Estimates for how many more people in the state would be insured with expansion start at 500,000. Many are childless adults younger than 65.

The most recent federal relief package includes financial incentives for more states to expand Medicaid. North Carolina would see a net gain of $1.2 billion, according to a Kaiser Family Foundation estimate.

Senate leader Phil Berger, an Eden Republican, told the Associated Press that the extra federal money is time limited and that coverage gaps could be addressed without “creating a whole new level of entitlement in the state of North Carolina.”

Senate Republicans this year have shown interest in allowing adults who use Medicaid to keep it under limited circumstances.

Three Republican senators, including Sen. Joyce Krawiec, one expansion’s fiercest opponents, are the main sponsors of a bill filed Monday that would allow women who use the government insurance program while they’re pregnant to keep the coverage for a year after giving birth rather than have it cut off after 60 days.

House Democrats, including Rep. Verla Insko of Chapel Hill, filed a similar bill last month.

The American Rescue Plan allows states to expand what’s called pregnancy Medicaid to 12 months postpartum.

Doctors, policy experts and others say that 60-day cut off doesn’t give some mothers time to have their postpartum medical visits or seek treatment for postpartum depression.

The American College of Obstetricians and Gynecologists has made extending postpartum Medicaid coverage a priority, saying it will help reduce the rate of maternal deaths. Medicaid pays for more than half the births in North Carolina.

At their press conference, Democrats highlighted  the racial disparities in maternal and infant deaths to make their case for Medicaid expansion.

The latest state data, from 2019, shows that Black and Native American babies in North Carolina are more than 2.5 times more likely to die before their first birthdays than white infants.

“The longer we wait to expand Medicaid, the more babies we will see die unnecessarily, particularly Native American and African American babies,” said Rep. Charles Graham, a Democrat from Robeson County who is Lumbee.  “This is not acceptable.”

At 6.8 deaths per 1,000 births, North Carolina has the 12th highest infant mortality rate in the nation, according the Centers for Disease Control and Prevention.

The CDC reports  wide racial disparities in maternal mortality.

Black and Hispanic adults are more likely to fall into what’s called the coverage gap, where they make too much to qualify for Medicaid and too little to qualify for subsidized premiums in the health insurance marketplace, according a 2020 report from The Commonwealth Fund.

The same report said that states that expanded Medicaid had helped reduced the racial disparities in health care coverage so that Black residents in  states that expanded Medicaid were more likely to have health insurance coverage than white residents of  non-expansion states.

The uninsured rate in North Carolina varies wildly by race and ethnicity, said Sen. Natalie Murdock, a Durham Democrat. Nine percent of Asian -American residents are in the coverage gap she said, while 12% of Black residents and 31% of the Latinx population are in the gap.

At the press conference Insko said military veterans are among those who would benefit from Medicaid expansion.

“We should look at the broad picture of what we’re doing and who we’re hurting by not expanding Medicaid,” she said. “We’re hurting the uninsured, we’re hurting their families, we’re hurting the state because it increases the cost for everyone.”

Expanding Medicaid ensures that essential workers can live free of medical debt and fear, said Rick Glazier, executive director of the NC Justice Center. (NC Policy Watch is a Justice Center project.)

”Medicaid expansion is one of the best policy interventions the General Assembly can take to reduce health care disparities, and make sure communities of color can get the care they need particularly during a time when communities of color have borne the brunt of the COVID epidemic,” he said.

Cooper proposes asking voters to approve $4.7 billion for school and state building projects.

Gov. Roy Cooper has again proposed that voters approve borrowing money for statewide construction and renovation projects.

But the idea of borrowing, no matter who comes up with it, has proven to be hard to get legislative approval recently. Senate Republicans prefer paying for buildings with direct appropriations.

As part of his budget this year, Cooper has proposed putting a $4.7 billion bond to a vote in November.

-$2.5 billion would go to K-12 school construction.  A report from the State Board of Education and the  Department of Public Instruction based on a 2015-16 survey found school districts needed $8 billion for buildings, additions, renovations, and other capital costs.

-$500 million would go to community colleges

-$783 million would go to UNC campuses. The largest project is a new Brody School of Medicine building at East Carolina University, at $187 million.

The recommendation includes money for renovations at two of the state’s development centers and two of its neuro-medical centers, the state alcohol and drug treatment center in Black Mountain, and money to expand TROSA, a residential addiction treatment center based in Durham, to the Triad.

The bond recommendation includes $229 million to move the state Department of Health and Human Services from the Dorothea Dix campus in Raleigh to Blue Ridge Road.

Assorted state attractions would get a total of $460 million, including $70 million for NC Zoo exhibits.

Cooper included a $3.9 billion general obligation bond as part of his 2019-20 recommended budget that the legislature did not consider.

The state House has been amenable to the idea of asking voters to approve borrowing for capital projects. In the last two years, House Republicans have put together their own bond proposals, and passed them with little opposition.

In 2019, House Speaker Tim Moore cosponsored a $1.9 billion school construction bond bill that moved swiftly through the House and died in the Senate.

approval.

The House tried again last year, passing a $3.1 billion bond bill with the money to go to school construction and transportation projects. That bill also died in the Senate.