A “willingness to work together” is a stated top priority of AppHealthCare Jennifer Greene in referencing funding needs and a service budget gap of the tri-county agency.

That willingness must be a top priority of Watauga, Ashe and Alleghany counties’ leadership, too. The alternative — inferior or nonexistent county health services — is not an option, especially in our rural counties.

In identifying an almost $1.2 million funding gap to maintain sustainability — and in real numbers, sustainability means serving nearly 6,000 patients across the three counties last year — Greene is right to now address the situation with county commissioners and the communities at large serving individual boards of health.

Continually operating from the health agency’s fund balance, currently at 29 percent of expenditures, is similarly not an option — a fund balance dipping below 8 percent will trigger an investigation by North Carolina’s Local Government Commission.

Because of two essential factors — the high cost of public health and a lack of state subsidization for that cost — the burden is on our three High County counties to figure out the financial challenges. Admittedly, this is not an easy equation to work with. Disproportionate tax bases and patient loads mean that there is no apples to apples answer in deciding what is an “equal” share of the cost per county. Should Watauga, with a greater tax revenue than its counterparts, subsidize the agency to a greater extent, even though Ashe County uses the agency’s services by more than a third? Should Ashe be tasked for those services because it boasts significantly fewer doctor offices than its neighbor? What about Alleghany County — a county that is populated by fewer than half of the number of residents in Ashe but has nearly as many health agency patients as Watauga, and only about 500 fewer than Ashe?

Obviously, the answer is not going to be found by simply carving the debt into equal thirds. County leaders and health board members of AppHealthCare’s regional footprint must come together to work out a solution, and they must do so willingly and quickly to secure the public health. This is Greene’s call today, and she must be heard.

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