Part two of WNCW's three-part series on rural healthcare access in western North Carolina
By Dylan Henson, WNCW
SPINDALE, N.C. — In rural western North Carolina, an ambulance can get you to a hospital two counties away. Getting home is another matter.
"We see people regularly who might be transported by an ambulance to another hospital, and they don't have the money to get back," said Maggie Sauer, director of the Office of Rural Health at the North Carolina Department of Health and Human Services — the first office of its kind in the nation. "People are having to take off work. There may be childcare, there may be eldercare. That's a huge, huge burden."
That gap between care and the people who need it is the focus of part two of "More to the Story," WNCW's three-part series on rural healthcare access, featuring Sauer and Dr. Susan Mims, CEO of Dogwood Health Trust, the foundation created from the sale of Mission Health.
Both leaders push back on the idea that health starts at the doctor's office. Mims said medical care accounts for about 20% of what determines how long and how well people live — the rest comes from housing, education, jobs and environment.
"All of these things really contribute much more to our overall health and well-being than the actual healthcare that we receive," Mims said.
North Carolina's expansion of Medicaid brought coverage to people who had never had it — and Sauer said it exposed a new problem.
"When Medicaid expansion first came out, they didn't even know how to use insurance, because they never had it," she said. "People are just trying to go to the emergency department. They're sicker, they don't feel well."
The financial picture for the hospitals serving those patients is darkening. Sauer said rural hospitals in North Carolina face at least a $3.7 billion loss over the next 10 years — a figure that does not include rural health clinics. Many hospitals, she said, are "right-sizing" — shrinking services to fit communities smaller than the ones they were built for.
Distance compounds the strain. In Graham County, Sauer said, taking a single patient to Asheville ties up a transit vehicle for an entire day. And in the state's smallest communities, her office found some patients skip the local clinic altogether — out of privacy concerns — or seek care where it fits their lives.
"Why do you think people are going to Walmart sometimes for their healthcare?" Sauer said. "Because I can shop. It's open past 5. I have some ability to schedule things in a way that's convenient because of my work hours."
One partial answer is broadband. Sauer called specialty care "a real conundrum" and said telehealth can stand in for some specialist visits — if the connection exists. Since its founding in 2019, Dogwood Health Trust has invested more than $700 million in over 850 organizations across the region, including a $10.5 million initiative with the Primary Care Development Corporation to strengthen community health centers serving nearly 200,000 people, and put more than $80 million into Hurricane Helene relief in the four months after the storm.
Nearly two years later, Mims said, the recovery is unfinished: "We still see people living in trailers that have mold and mildew. We see people who have not been able to get their lives back."
Asked what holds the region together, Mims pointed past the budget lines.
"Rural communities come together and support each other," she said. "We saw it especially in Hurricane Helene — neighbors helping neighbors."
Tune in next week for the series finale on the healthcare workforce.
