In 2017, when the U.S. Department of Homeland Security declared the electoral system “critical infrastructure,” state and local election officials around the country were forced to take cybersecurity much more seriously. And it wasn’t long before physical threats and misinformation also became a greater concern. 

In North Carolina, state board of elections director Karen Brinson Bell said the DHS’s designation “didn’t take anything off her plate.” Instead, the responsibilities of election officials like her only grew, especially in battleground states like North Carolina.

In the lead up to this year’s election, Brinson Bell said “everything is a concern” when it comes to election security. Like her counterparts across the region, she’s especially focused on cybersecurity, preventing physical threats and battling misinformation around the elections process, while communicating to voters that the electoral system in North Carolina is actually safe and secure. 

“We had to become much more adept at telling our story, being accessible to the public, helping them understand what is really a complex, methodical, multilayer process in all that we do,” Brinson Bell said. “And it’s not soundbite friendly.”

Other states in the region like Pennsylvania, which was at the center of the 2020 election denial campaign and is considered a “must-win” for both former President Donald Trump and Vice President Kamala Harris in this year’s presidential race, are also confronting the same concerns as North Carolina. 

Earlier this year, Pennsylvania launched a task force focused on election threats like misinformation related to the adoption of new voting systems and no-excuse mail-in voting.  

“In recent years, we’ve seen bad-faith actors attempt to exploit these changes by spreading lies and baseless conspiracy theories, and attempting to delegitimize our safe, secure and accurate elections,” said Pennsylvania Secretary of the Commonwealth Al Schmidt in a February news release. “This task force has been working together to develop and coordinate plans to combat this dangerous misinformation and continue providing all eligible voters with accurate, trusted election information.”

2020 Hindsight

Many election officials didn’t have a plan for handling the 2020 presidential election fallout, Brinson Bell said. From protests fueled by misinformation and lawsuits seeking to overturn the results, states like Georgia and Pennsylvania were mired in controversy, and North Carolina was “just on the bubble” of facing the same issues. 

“For North Carolina, we have to think about, what can we learn from those states?” Brinson Bell said. “It’s unfortunate what they went through, but it’s unfortunate if we don’t learn from it.” 

In North Carolina, according to one recent poll, nearly 50% of those who responded said they won’t believe the results of the election.  

One major focus for Brinson Bell is making sure that voters understand the election process and how it actually operates — even promoting physical transparency at the county level, like urging election staff to use clear plastic tubs with labels to store ballots instead of recycled cardboard boxes. 

“That’s not election jargon,” Brinson Bell said, “but it’s something clear to the public.” 

Now, Georgia, another battleground state in the region, is mired in controversy surrounding its state election board, which recently approved new rules that critics believe will “sow confusion, compromise ballot security and potentially enable rogue county boards to block certification of election results in November,” according to reporting by the Washington Post.  

Later this month, the board is scheduled to vote on whether to require counties to count ballots by hand at each precinct, which critics believe could produce inaccurate results and be less secure. 

Georgia Secretary of State Brad Raffensperger described the election board as “a mess,” and told the Washington Post, “Legal precedent is pretty clear. You shouldn’t change rules in the middle of an election.” 

Physical Security, New Rules and Turnover

Elections officials are also working to boost physical security in the lead-up to the election. 

In North Carolina, Brinson Bell said workers are securing doors and installing panic buttons at county elections offices. Staff are also being trained in de-escalation techniques to counter voter intimidation and other physical threats. Earlier this year, Georgia passed an election security law requiring police to take a one-hour class on election laws, which also included training in de-escalation, though the new law doesn’t go into effect until 2025. 

In North Carolina, a 2023 voter identification law will be in effect for this year’s election and photo ID will be required. Mississippi, Georgia, Tennessee and Ohio also have strict photo ID requirements for voting.

Staff turnover, specifically county election directors, has been another concern of Brinson Bell, who earlier this summer said more than 60% of county election directors have left their post since 2019. For many of the replacements, she said, this will be their first presidential election. 

“While there’s much that’s the same processes and routines, the volume, the intense scrutiny and being a battleground state with so many high profile contests on our ballot this year, it’s just a different environment to be a new director,” Brinson Bell said.  

Urban-Rural Divide

It’s not just Appalachia’s battleground states taking election security seriously. Other states in the region are also working to combat misinformation and thwart physical and cybersecurity threats.

Deak Kersey, chief deputy and chief of staff for the West Virginia Secretary of State’s Office, said the state has focused on cybersecurity since DHS’s critical infrastructure designation went into effect. 

“West Virginia was not in a great spot eight years ago,” Kersey said. “Nobody knew what cybersecurity really was, as far as the Feds really considered it.” 

Since then, the state has pushed to disperse Help America Vote Act, or HAVA, funds to counties, which have used the funds to update voting equipment, like purchasing new ballot-marking equipment that’s ADA accessible and electronic poll books. In August, the state election commission approved sending nearly $1 million in HAVA funds to 24 counties. 

DHS also awarded $1 million to North Carolina this year, but the money can’t be spent until the state’s General Assembly authorizes it. If and when it does, then the state elections office will have to decide whether to disperse it between counties or keep some of it at the state level to continue funding a statewide cybersecurity expert to monitor for doxing, denial-of-service attacks, phishing schemes and other online threats.  

“I don’t mean to make light of a million dollars, but that doesn’t go far in a state with 100 counties,” Brinson Bell said.

The funding issues hit especially hard in the state’s rural counties.

“I think some of the concerns in Western North Carolina really are reflective of sort of that rural-urban divide in North Carolina — the economically distressed counties versus those that are prospering more,” Brinson Bell said. 

It’s a concern across Appalachia, where most of the region is rural. And while federal funding will help, elections officials have less than two months left before the election to see how far it will go to update equipment, implement new security measures and hire new people to replace outgoing directors.

The post In Appalachia’s Battleground States, Election Officials Worry About Cyber Security, Physical Threats and Misinformation appeared first on 100 Days in Appalachia.

HARRISBURG — Pennsylvania lawmakers hope a new commission created to encourage people to live in rural areas can stem the population decline happening in those parts of the state, which federal data show is outpacing predictions.
The Center for Rural Pennsylvania, an agency overseen by the state legislature, released 30-year population projections last fall that forecast a 5.8% decline in rural counties. But after reviewing new data from the U.S. Census Bureau, the state’s experts said last week that the decline is happening more rapidly.

FERGUSON TOWNSHIP — Linnet Brooks wasn’t surprised when she went to brush her teeth one night in early March and the faucet ran dry.
She texted her neighbors in a group chat to discuss these kinds of outages and left messages on the emergency and general lines for Rock Spring Water Company, which is privately owned and serves about 500 properties in rural Centre County.
About an hour later, Brooks’ water came back on with no explanation for the interruption.

This story was produced by the State College regional bureau of Spotlight PA, an independent, nonpartisan newsroom dedicated to investigative and public-service journalism for Pennsylvania. Sign up for our north-central Pa. newsletter, Talk of the Town, at spotlightpa.org/newsletters/talkofthetown.
BELLEFONTE — As part of his administration’s efforts to bolster the agriculture industry through state spending, Democratic Gov. Josh Shapiro wants to use millions of dollars to connect more Pennsylvania farmers to a federal dairy program.

This story was produced by the State College regional bureau of Spotlight PA, an independent, nonpartisan newsroom dedicated to investigative and public-service journalism for Pennsylvania. Sign up for our north-central Pa. newsletter, Talk of the Town, at spotlightpa.org/newsletters/talkofthetown.
BELLEFONTE — When their longtime police chief stepped down, Sweden Township supervisors disbanded the municipal department and joined a growing list of rural Pennsylvania municipalities that rely on State Police for law enforcement.

Bucktail Medical Center, an independent hospital in western Clinton County, Pennsylvania, is asking for nearly $1.5 million on the crowdfunding platform to help it stay open.

Tim Reeves, the hospital’s administrator, said in an interview with the Daily Yonder that the 16-hospital bed and adjacent 43-bed nursing home are the only hospital with in-patient facilities for nearly 40 miles. While the hospital has struggled for years, he said, it had just come out of bankruptcy reorganization and plans were being made to attract more patients and increase revenue.

But some unexpected financial news hit the hospital hard.

Over the course of less than two weeks, the hospital saw a series of financial setbacks. First, one of its employee retention credit applications, worth up to $400,000, was delayed. That filing became mired in a bureaucratic chain of events that meant a delay of up to 14 months. Next, the Pennsylvania Department of Human Services sent a notice that it had overpaid the hospital in 2018, and they needed to pay back $255,000.

“They want to recoup that and the way they do it is they just stop paying us our medical assistance payments until they make it up,” Reeves said.

Following that, the hospital was informed by one of its commercial insurers that the hospital needed to pay back $82,000 because of documentation problems over physical therapy charges, and then the company that provided physical, occupational, and speech therapy announced they were pulling their services out of the hospital, eliminating that potential revenue stream.

“Could we weather one of those? Probably,” Reeves said. “But the four of those together? It’s just made it impossible to have the cash that we need to operate.”

Without some short-term funding, Reeves said, the hospital may be forced to close.

The idea to put a fundraising call out on GoFundMe came from one of the hospital’s board members, he said. So far, the campaign has raised just over $15,500.

Still, the hospital is working with its state legislators and Congressmembers to get some help.

“We’re in contact with all of them pretty much on a weekly basis, and they’ve been able to come up with some things to help in the long term, but not a lot so far for short-term assistance,” he said. “We’re trying to reach out in every direction that we can, it just seems very difficult to find any readily available funding.”

Bucktail’s situation is not far off from that of other rural hospitals. According to the Chartis Center for Rural Health, 141 rural hospitals have closed since 2010. Of the rural hospitals in the U.S. nearly half (43%) are operating in the red, the center said.

“There are 453 rural hospitals that are considered vulnerable to closure, over 215 of them at high risk,” Brock Slabach, COO of the National Rural Health Association, told The Daily Yonder. “I’m hearing about more financial distress in rural hospitals, due to lower volumes and increased expenses, especially due to higher labor costs.”

Slabach said the situation at Bucktail is one that the NRHA is monitoring.

Reeves said when he took over Bucktail Medical a little over nine years ago, the hospital was struggling. After filing for Chapter 11 organization in 2015, it seemed like there was a light at the end of the tunnel when the hospital came out of bankruptcy in 2018. But when the Covid-19 pandemic hit, financial stresses came with it.

Once the pandemic subsided, the hospital decided to change the facility in order to better meet the needs of the community, he said, and to increase patient volume.

“We’d come up with a master plan,” Reeves said in an interview with the Daily Yonder. “We’d started to implement the first two steps of that, which was to start up our ambulance service, which we did on June 15, and to increase our diagnostic testing ability.”

In October, the hospital will have a CT facility in its parking lot to add to the hospital’s diagnostic abilities. Previously, he said, patients might be transported to other facilities with better diagnostic capabilities but would never return for treatment.

“We were hoping that these two improvements would generate greater patient volume,” he said. “Increased patient volumes in our emergency room will also increase patient volumes in our acute care hospital, but also generate revenue through other services like our laboratory, physical therapy, and other things.”

Kyle C. Kopko, executive director for the Center for Rural Pennsylvania, said in an email interview with the Daily Yonder there are 18 hospitals in that state that are at risk for closure. There is pending legislation in the state that would help struggling rural hospitals, but nothing has been enacted yet, he said.

The nature of rural hospitals makes them financially vulnerable, Kopko said. Rural hospitals tend to have higher percentages of patients on Medicare and Medicaid, but reimbursement rates for those patients are inadequate. Additionally, declining populations in rural areas lead to less demand for services, while staffing shortages lead to hospitals relying on more expensive contract workers.

NRHA’s Slabach said that as the federal government reduces the number of people on Medicare and Medicaid, it’s an issue that will face many more struggling rural hospitals.

“We’re now at over seven million people having been disenrolled from Medicaid coverage,” Slabach said. “This won’t help troubled rural hospitals, that’s for sure, since rural communities have higher percentages of older, sicker, and poorer populations than their urban counterparts.”

Still, Reeves said, the hospital is working with its vendors and trying to meet its payroll every week. At 85 employees, it is the largest employer in western Clinton County, he said. The impact of the hospital closing would be devastating for the county, he said.

As he works on a short-term solution, there are long-term decisions America has to make about healthcare in rural areas, he said.

“I think as a society we need to make a choice – do all Americans deserve the same level of health care?” he said. “Are we okay with the disparity where you may receive a lesser quality of health care because of where you decide to live?”

In the meantime, Reeves said he will continue fighting for Bucktail and the community it serves.

“We are still providing services, we’re still billing, we’re still collecting some money, but it just has not been enough,” he said. “We’re going to keep pushing as long as we can. And we’re going to keep looking for solutions until we find something that works.”

The post Rural Hospital Turns to Crowdfunding for Help appeared first on The Daily Yonder.