East Carolina University (ECU) aims to reopen Martin General Hospital in Eastern North Carolina as a Rural Emergency Hospital (REH), which handles outpatient and emergency cases only. This plan requires $220 million and stable Medicaid funding, both uncertain amid recent federal Medicaid cuts and North Carolina’s $319 million Medicaid shortfall. Over 40% of Martin County residents rely on Medicaid, making funding critical. Despite mixed signals—ECU’s COO doubts reopening chances—local officials remain committed. The scaled-down hospital would improve emergency access but still require residents to travel 30 minutes for inpatient care. If successful, it could serve as a model for reviving rural hospitals statewide.
by Jane Winik Sartwell, Carolina Public Press August 25, 2025
East Carolina University is officially pursuing the idea of reopening Martin General Hospital, the shuttered hospital in Eastern North Carolina. But first, it needs $220 million — and for cuts to Medicaid to stop coming.
That’s starting to seem increasingly unlikely.
The uncertainty around the plan for Martin General shows just how vulnerable rural health care access is to the headwinds of policy decisions coming out of Washington and Raleigh.
ECU filed a letter of intent in July to reopen the hospital as a Rural Emergency Hospital, a new type of hospital for the state: one that sees only outpatient, emergent cases. The designation, created in 2021 by the Centers for Medicare and Medicaid, is a new tool to save struggling hospitals or revive closed ones.
But the cuts to Medicaid in Donald Trump’s Big Beautiful Bill, now law, are a serious curveball. More than 40% of Martin County residents are enrolled in Medicaid. The program would be a critical funding source for the hospital.
Meanwhile, at the state level, North Carolina’s recently passed minibudget falls $319 million short of fully funding Medicaid. It’s likely that the state will have to reduce what it pays hospitals for services provided to Medicaid beneficiaries.
Hospital and county officials say that as long as the legislature provides the $220 million they need, and a permanent solution to the Medicaid problem is determined, the plan is a go. Those are some big ifs.
“ECU Health and Martin County are committed to partnering together to build a sustainable model for health care in the community,” ECU Health spokesperson Brian Wudkwych told Carolina Public Press.
“While the nonbinding letter of intent represents an important milestone, there are many complex rural health care challenges that must be solved to make the proposed rural health care model a reality in Martin County. These challenges include navigating new federal health care legislation as well as securing vital public funding needed to build a long-term, sustainable regional system of care.”
In a break from the official line, ECU’s chief operating officer Brian Floyd told the New York Times that “the chances of reopening the hospital are low” due to the loss of Medicaid expansion. But Wudkwych and Dawn Carter, a health care consultant with the county, maintain that both parties fully intend to move forward with the plan.
The signals are mixed, to say the least. For Martin County, however, the confusion hasn’t crushed its dream of restoring the hospital.
“Martin County has, for the last two years, faced obstacles one after another, and worked tirelessly to get around and through all these different issues,” Martin County attorney Ben Eisner told CPP.
“Now we’ve got these Medicaid issues and federal headwinds. This little county is one of the smallest, most rural, poorest in the state. It has risen to the occasion anytime something’s been thrown its way. This is the little engine that could.”
ECU’s proposal would create a scaled-down version of the hospital. Rural Emergency Hospitals, or REHs, are not designed to provide inpatient services that would require overnight stays — think hip replacements, C-sections or appendectomies. For that kind of care, Martin County residents would still need to travel 30 minutes to the nearest full-service hospital, ECU Health Beaufort in “Little” Washington. Part of the $220 million ECU is asking for would go towards expanding capacity there.
CMS doles out $3 million to each REH each year in order to keep their doors open. They also receive higher reimbursement rates for each patient visit.
Due to the age and condition of the building, the new REH will be relegated to a corner of the old hospital. For residents of Martin County, the reopening of the hospital in any capacity would be a major boon.
“The closure has been a huge hit to the county in terms of lack of emergency care and transport times and strain on our EMS,” Eisner said.
“There’s the medical part of it, then there’s the economic part of it. ECU Health is a major economic engine in the eastern part of the state. This would have downstream effects of hiring new providers and staff. It could be really big for the region.”
If all goes well, Martin General would become North Carolina’s first Rural Emergency Hospital, clearing a path forward for other struggling hospitals across the state.
Note: The following A.I. based commentary is not part of the original article, reproduced above, but is offered in the hopes that it will promote greater media literacy and critical thinking, by making any potential bias more visible to the reader –Staff Editor.
Political Bias Rating: Center-Left
The content focuses on the challenges of rural healthcare access, emphasizing the negative impact of Medicaid cuts and the importance of public funding to support vulnerable communities. It highlights concerns about policy decisions at both federal and state levels, particularly those associated with conservative-led initiatives, while advocating for sustained government support. This perspective aligns with a center-left viewpoint that prioritizes social welfare and government intervention to address healthcare disparities.
www.thecentersquare.com – By Alan Wooten | The Center Square – (The Center Square – ) 2025-08-25 09:11:00
North Carolina motorists are paying about 30 cents less per gallon for gasoline than the national average, with the state average at $2.86 for unleaded gas and $3.45 for diesel. Prices are slightly lower in the mountains and higher along the coast. Compared to last year, gas and diesel prices have decreased. The state follows EPA rules requiring summer blend fuel until September 15, adding 10-15 cents per gallon. North Carolina has over 8 million combustion engine vehicles and more than 100,000 electric vehicles, with EV charging rates below the national average. Motor fuel taxes fund state transportation projects.
(The Center Square) – As they often have throughout the summer, motorists in North Carolina are paying about 30 cents less than the nation on average for gasoline.
Summer’s unofficial closing of Labor Day weekend arrives this week, with many families already in the state’s tourism meccas. The state average for a gallon of unleaded gasoline is $2.86, with prices a little lower in the mountains and a tick higher along the 320 miles of ocean shoreline.
A year ago, the state average was $3.11, according to the American Automobile Association. The average for diesel is $3.45, down from $3.64 a year ago.
Nationally, the unleaded gas average is $3.16, down from $3.35 last year, and diesel is $3.68, down slightly from $3.70, respectively.
Per Environmental Protection Agency rules in place from June 1 to Sept. 15, the less volatile summer blend fuel must be sold. Price impact is generally considered 10 cents to 15 cents higher per gallon.
Combustion engine consumers make up more than 8 million vehicle registrations in the nation’s ninth-largest state.
North Carolina’s electric vehicle charging rate average, according to AAA, is 33.2 cents per kilowatt-hour. The national average is 36.3 cents per kWh. More than 100,000 zero-emission vehicles are registered in the state. At the start of the calendar year, the state norm was 33.5 cents per kWh and the national was 34.7 cents per kWh.
Among 14 major metro areas, the least expensive average for unleaded gas is in Fayetteville at $2.76. The most expensive area is the Durham-Chapel Hill metro area at $2.92.
Diesel is the most consumer-friendly ($3.29) in the Hickory-Lenoir-Morganton market.
North Carolina’s 40.3 cents per gallon tax rate for 2025 is topped by California (59.6), Pennsylvania (57.6), Washington (49.4), Illinois (47), Maryland (46.1), and New Jersey (44.9).
Motor fuel taxes in the state fund the Department of Transportation’s highway and multi-modal projects, accounting for more than half of the state transportation resources. The revenues go into the Highway Fund and the Highway Trust Fund.
Note: The following A.I. based commentary is not part of the original article, reproduced above, but is offered in the hopes that it will promote greater media literacy and critical thinking, by making any potential bias more visible to the reader –Staff Editor.
Political Bias Rating: Centrist
This article provides a straightforward report on gasoline and diesel prices in North Carolina compared to national averages, along with information about electric vehicle charging rates and state fuel taxes. The language is neutral and factual, focusing on data, statistics, and relevant state policies without endorsing or criticizing any political ideology or party. The content neither advances a particular political perspective nor uses charged language, making it a clear example of neutral, factual reporting rather than an article with discernible political bias.
John Boyle reflects on flood risks in Asheville, prompted by Buncombe County’s planning director Nathan Pennington’s warnings about increasing floods due to climate change and development in risky areas. After Tropical Storm Helene caused severe flooding, Boyle considered flood insurance but was shocked by high premiums—even outside floodplains—due to updated federal risk assessments. Experts explain that outdated FEMA maps and climate change have increased flood risks beyond traditional floodplain boundaries. While flood insurance is costly and limited, relying solely on FEMA aid is risky. Boyle remains torn between financial caution and the prudent advice to secure flood coverage amid growing climate threats.
Man, I would like to get Nathan Pennington’s voice out of my head.
Last year, before Tropical Storm Helene hit, I interviewed Pennington, Buncombe County’s planning director and floodplain manager, for a story about how our area’s flood risk will only grow, a result of climate change, more impermeable surfaces — and our penchant for building in risky places.
Ten days before Helene pummeled us, Asheville Watchdog published the story, which memorably featured Pennington saying, “We are the United States of Amnesia when it comes to flooding.”
We also talked about the 100-year and 500-year flood plains, and how those really are just statistical estimates of the likelihood of a flood — a 1 percent chance in the 100-year area, .2 percent in the 500-year zone. Pennington noted that 500-year zones are unregulated as far as building restrictions.
“However, what we’re advising people nowadays is, ‘Please get flood insurance if you’re in the 500-year [zone],” he said. “Please get flood insurance if you’re outside it.”
On Sept. 27, when Helene dumped a biblical amount of rain on our area, just two days after a previous deluge, our region flooded. Badly.
In my Fletcher neighborhood, about two dozen homes took on water from the normally placid Cane Creek, which expanded from about its normal 25-foot width to a swift-moving monster about a half-mile wide. My house is not in the flood plain, but the water came up our street to my next door neighbor’s driveway before receding.
It certainly made me think about flood insurance, as just about every neighbor I talked to didn’t have any, and most had tens of thousands of dollars in damage. Helping a couple of neighbors rip out soaked drywall, insulation and flooring only amplified Pennington’s voice in my head.
Debris and damaged furniture sit outside a flooded home, which ultimately had to be gutted down to the studs, in John Boyle’s Southchase neighborhood in Fletcher. About a dozen homes flooded in the neighborhood. leading Boyle to consider buying flood insurance. // Watchdog photo by John Boyle
But then we had about two months of crisp, clear weather, followed by a mild, hurricane-free winter. So I put off checking on insurance.
Yes, I embraced the amnesia, at least until Hurricane Erin took a good run at the Carolina coast last week. And there was Pennington again, whispering about flood insurance.
So I checked with two companies, including our current home insurance carrier, Travelers. As both front for federally backed National Flood Insurance Program (NFIP) policies, both came back with the same numbers: Right at $2,400 annually for $250,000 in coverage on the structure and $100,000 on the contents.
Ouch!
This made my cheapskate DNA rearrange itself deep in the core of my brain’s money vault. Hey, we already pay close to three grand a year in home insurance, and another couple thousand in taxes, so our house that is technically paid off continues to cost us more than $5,000 every year.
And every time I go to the grocery store my eyes involuntarily bug out of my head when the grand total appears on the screen. My wife Grace and I are both 61, and we’re trying to slam away as much money for retirement as we can, so the prospect of dropping $200 a month on more insurance isn’t appealing.
And did I mention that our house is not in the floodplain?
Floodplain designation doesn’t mean what it used to
The problem, of course, is the flood plain designation doesn’t mean what it used to. Thanks to climate change, lots of folks outside that designation keep getting flooded. As climate scientists will tell you, we’re seeing more and more heavy rainstorms, and when tropical storms come up from the Gulf of Mexico, they pass over those warmed waters, which makes the storms pick up even more moisture.
So we’re likely to see more floods. As my neighbor who did his own restoration work told me, a FEMA inspector told him they’ve been going to a lot of allegedly 500-year floods over the past couple of years.
Don Hornstein, a law professor at the University of North Carolina Chapel Hill and director of the school’s Center on Climate, Energy, Environment and Economics, explained why I got sticker shock on my flood insurance quote.
In a nutshell, as my colleague Dan DeWitt explained in his excellent July 30 story about hopelessly outdated FEMA flood maps, government-backed flood insurance premiums had been kept artificially low, which in turn encouraged building in riskier areas.
Now, Hornstein told me in a phone interview, the federal government has made adjustments.
“You have to pay a relative high amount, even though you’re not in a floodplain, in part because they’re using this new approach called ‘Risk Rating 2.0,’” Hornstein said. “That doesn’t make whether you’re in or out of one of these 100-year floodplains the be all and end all, because they realize these maps are hopelessly out of date.”
He noted that more than 40 percent of all flooding takes place “out of the so-called ‘100-year floodplains.’”
That’s because of the changing climate and more rain-laden storms, and because of, well, human nature.
“Once they looked at the 100-year flood plain, people started building like one inch outside of the 100-year flood plain,” Hornstein said. “So all of a sudden you get a lot of construction that’s just over the theoretical line, and because the line between us is theoretical, a huge amount of flooding is taking place outside of the flood plains.”
Hornstein pointed out that if you’re in a 100-year floodplain and you have a federally backed mortgage, you’ll likely be required to get flood insurance to keep your lender happy.
But now the feds are also looking at your proximity to water and the elevation of your home.
This is all smart, because the NFIP program has taken a beating over the past decade or so, and Congress has had to bail it out at least once to the tune of $16 billion. They needed to bump those flood insurance rates up, even those for folks like me who aren’t in the floodplain but are close to it. (Regular homeowners insurance does not cover flooding from exterior sources, by the way.)
In talking last week with a couple of my neighbors who got flooded, I was not surprised to learn they still haven’t bought flood insurance. Both said it’s just too expensive, and one said she’d heard about people having difficulty getting a payout.
Most neighbors, including these two, got emergency funds from FEMA for their flooding, with amounts ranging from $16,000 to more than $30,000. One neighbor told me he got about $32,000, and his damages cost about $40,000 to fix, so he had to pony up $8,000 out of pocket. (He did a lot of the work himself, though.)
So this also fired up my cheapskate mitochondria. I mean, why not just roll the dice, use the $48,000 over 20 years I’d have to pay the NFIP in flood insurance toward a brand new Toyota Tacoma that I’ve always dreamed of, and just wait for FEMA to pony up cash if my house floods, hoping it’ll mostly cover the rebuild cost?
Hornstein offered some wisdom on that scenario, too. It seems I could end up living in that Tacoma.
“Helene came at a particularly potent political time — (FEMA) was absolutely at its most generous,” Hornstein said.
The presidential campaign was in full swing last September when Helene hit, and President Joe Biden and Vice President Kamala Harris, the Democratic presidential nominee, wanted to look like their administration was ultra-responsive to North Carolina, a key swing state. After President Donald Trump won the election, he came to Asheville four days after his inauguration, vowing to rebuild North Carolina like it’s never been rebuilt before.
Later, of course, he talked about getting rid of FEMA like it’s never been gotten rid of, but in the interim, money was flowing to many flooded homeowners. The money flowed quicker than usual, and in the form of grants, too, not loans, Hornstein noted.
Trump has also pushed for shifting more of the financial burden of emergency response to the states. That is yet to be worked out.
FEMA might not be so generous in the future, Hornstein said. Or it might not even be there.
But on the other hand, Hornstein pointed out that NFIP flood insurance is very limited, expensive and it typically doesn’t cover substitute housing if your home is flooded. Also, our home is paid for, so we’re not going to have a bank foreclose on us and give us the boot from our house.
I’ll note too that for good or bad, I apparently have a lot of company in not being wild about shelling out for flood insurance. As we reported last October, “Fewer than one percent of Buncombe structures, including homes and businesses, are covered by flood insurance.”
DeWitt noted in his story that the number of NFIP policies in Buncombe has risen by nearly 500 since Helene, to 1,424. So a few more folks are heeding nature’s warnings.
Good angel, bad angel
The upshot of all this is I’m still kind of on the fence, and that makes me a little nervous.
I feel like I have the good angel, which looks a lot like the dastardly, probably correct Nathan Pennington, sitting on one shoulder, whispering into my ear, “You know you need the flood coverage, John. It’s the responsible thing to do.”
Nathan Pennington is director of the Buncombe County planning department and iJohn Boyle’s “good angel” when the reporter and columnist weighs buying flood insurance or a brand new Toyota Tacoma that he’s always dreamed of owning. // Watchdog photo by John Boyle
On the other shoulder, the bad angel, which looks surprisingly like me after a couple (or four) weekend IPAs, is waving his hand and saying, “Get the Tacoma! Live a little, man! What are the chances of another thousand-year storm hitting right here again? I like the red metallic color and king cab, by the way.”
Then the Pennington angel shouts out, “Enjoy living in your truck, doofus! Hope you can afford a camper top!”
Man, that guy gets annoying in my imagination.
After hearing me whine about my potential flooding plight and my miserly ways for 20 minutes, Hornstein tossed out another idea: a less expensive insurance option offered in North Carolina by a company called Munich Re (for “Reinsurance”). The company doesn’t sell direct to consumers but rather through insurance carriers, and it provides lower coverage amounts to lower-risk homeowners that also have lower payouts.
In a news release, a Munich Re senior vice president said, “Average homeowners in a lower flood hazard area seek basic protection for their home and personal property at a competitive price. Our new Inland Flood Coverage Endorsement is designed to solve that need; it can be offered at lower limits and tailored to the underlying homeowners policy, thus eliminating the cost and administrative burden of a separate, stand-alone flood policy.”
That sounds like it might be right up my skinflint alley. I’ll have to check it out.
Or maybe just skip it altogether. My penuriousness knows no bounds, you know.
In my efforts to have someone tell me what I wanted to hear, I reached out to David Easterling, chief scientist at Future Climate LLC, in Hendersonville. Easterling spent three decades working for the National Oceanic and Atmospheric Administration, retiring earlier this year as director of the National Climate Assessment Technical Support Unit, part of NOAA’s National Centers for Environmental Information in Asheville.
In full disclosure, he’s also a friend of mine who knows I can be stingy. So I asked him if I should shell out the $2,400 a year or gamble on another whopper storm missing us in the future.
In John Boyle’s quest to have someone tell him what he wanted to hear, he reached out to David Easterling, former director of the National Climate Assessment Technical Support Unit, part of NOAA’s National Centers for Environmental Information in Asheville. It didn’t go as Boyle had hoped it would. // Watchdog photo by Dan DeWitt
“Hmm…assuming I am not going to get sued, my opinion is that if you didn’t get flooded with Helene you are OK without it,” Easterling told me.
Yes!
But just as I was heading out to the Toyota dealership, I read the rest of Easterling’s message.
“But always remember that that kind of flooding or worse can happen,” he said. “The French Broad valley is flat for a reason.”
Damn it, man! Can’t a man just be cheap, buy a nice pickup truck and not worry about the consequences, which may include setting up camp in said pickup truck?
I’ll also note that going back to the pre-Helene news story last year, I quoted Easterling saying he expects that we will see more heavy rainfall events in the future, as warmer air holds more moisture.
Global temperatures have gone up about 1.8 degrees Fahrenheit since 1901, he said then.
“As it warms up, we’re seeing more moisture in the air,” Easterling said. “We already see that in the observations. There’s more moisture in the air than 60 years ago, and that’s just going to continue.”
The surface temperatures in the Gulf of Mexico, where most tropical storms or their remnants arrive from, ”have gone up considerably,” Easterling said.
That doesn’t bode well for us in general, or me in particular.
Pennington’s angel just got real loud on my shoulder again. “Get the insurance, dipwad,” he said.
Kind of a sassy angel. But, damn it again, he’s probably right.
I’ll sleep on it. And pray for a light hurricane season.
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Asheville Watchdog is a nonprofit news team producing stories that matter to Asheville and Buncombe County. John Boyle has been covering Asheville and surrounding communities since the 20th century. You can reach him at (828) 337-0941, or via email at jboyle@avlwatchdog.org. To show your support for this vital public service go to avlwatchdog.org/support-our-publication/.
Note: The following A.I. based commentary is not part of the original article, reproduced above, but is offered in the hopes that it will promote greater media literacy and critical thinking, by making any potential bias more visible to the reader –Staff Editor.
Political Bias Rating: Center-Left
This content reflects a center-left political bias primarily due to its acknowledgment of climate change impacts and the emphasis on responsible community planning and insurance measures to cope with increased natural disaster risks. The article highlights the role of government programs like FEMA and the National Flood Insurance Program and discusses their challenges in managing flood risk fairly, which aligns with a pragmatic approach often found in center-left discourse. The narrative is focused on personal responsibility balanced with recognition of environmental and economic realities, without strong ideological leanings to either extreme.
SUMMARY: North Carolina’s Wake County Public School System (WCPSS) is prepared for the 2025-26 school year with 605 bus drivers and ongoing recruitment efforts, including bonuses up to $4,000 to retain and attract drivers amid past shortages. The district manages 564 routes serving nearly 90,000 students, with buses averaging six runs daily and 21-minute ride times. Safety remains a priority, with buses averaging 135,000 miles between accidents. Maintenance challenges persist due to a 25% mechanic vacancy rate. WCPSS emphasizes reliable transportation to support consistent student attendance, a key goal for academic success, as highlighted by Superintendent Dr. Robert P. Taylor.
