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Gaping, painful holes remain in U.S. health care despite coverage gains

November 4, 2016 at 6:30 PM EST
Dire dental problems and other health issues keep the nonprofit Remote Area Medical busy running free clinics, particularly in states that didn't expand Medicaid. Even after Obamacare, large coverage gaps still exist in the nation's health care system. Special correspondent Sarah Varney reports from southwestern Virginia, an impoverished region where many still turn to charity for basic needs.
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JUDY WOODRUFF: The fate of the Affordable Care Act is at stake in Tuesday’s election. More than 20 million people have gained coverage through the health insurance reform law.

But, as special correspondent Sarah Varney reports, large gaps still exist.

Our story, produced in collaboration with our partner Kaiser Health News, begins in Grundy, Virginia, at a clinic run by a nonprofit called Remote Area Medical. It’s a program that is still surprisingly necessary in 2016.

SARAH VARNEY: Sandra Cook got in line midday on a recent Friday for dental care that she wouldn’t receive until the next morning. Hundreds more like her showed up at Riverview Elementary and Middle School in Grundy, Virginia, just as volunteers were arriving by the hundreds to turn the school into a makeshift clinic.

Many people here in this southwestern corner of Virginia struggle to pay for everyday needs. And that includes basic health care.

SANDRA COOK: There’s a lot of poverty in this area, and the coal mines, they went down, and the jobs have gotten really bad.

MATT KEENE: A lot of people ain’t got no insurance or no income, and this is the only place they can come to.

SARAH VARNEY: Just next to the line, Trey Justice and his girlfriend set up a tent, after walking for five hours to get here.

TREY JUSTICE: My teeth and my eyes are really bad. I got ran over about four year ago. Don’t have no doctors, no insurance.

SARAH VARNEY: Six years after the passage of the Affordable Care Act, and despite 20 million more Americans gaining health insurance, considerable gaps in health care remain. The decision by states like Virginia not to expand Medicaid and the lack of dental and vision coverage even for those with insurance has meant that scenes like this are still playing out.

STAN BROCK, Founder, Remote Area Medical: If you’re here to see the dentist, please raise your hand.

SARAH VARNEY: The next morning, the sun had yet to rise when Stan Brock called out the first numbers.

STAN BROCK: We’re going to bring you in 20 at a time and there’s no reason to rush, OK? Plenty of time.

SARAH VARNEY: Brock founded Remote Area Medical in 1985 to bring health care to people in developing countries. But he expanded the project to the U.S. when he realized the depth of the need here.

Over the weekend, nearly 1,000 teeth will be pulled, some 400 pairs of eyeglasses made, and more than one million dollars in health care services delivered.

Gary Owens was one of those workers laid off from the coal mines. At 55, he’s uninsured. He tells the volunteer doctor that his hands feel numb, his feet burn and old job injuries plague him.

GARY OWENS: I hurt. I mean, I hurt. It’s like something to do with my body that don’t feel right, or is not right.

SARAH VARNEY: Owens has paid out of pocket in the past for health care, but he’s been unable to afford the blood tests to figure out what’s wrong with him.

The doctors here worry the reason he recently lost 25 pounds is that he might have cancer. If Owens lived just 15 miles away, in Kentucky or West Virginia, he’d be covered.

State lines are now often the difference between poor adults having health insurance or not. After Kentucky expanded Medicaid under the Affordable Care Act, the percentage of uninsured poor adults dropped from 40 percent to 23 percent in one year.

But, in Virginia, which hasn’t expanded Medicaid, many low-income adults are still left to rely on charity care, with Remote Area Medical being the most visible and dramatic.

Studies have found that people in Medicaid expansion states are more likely to have a regular doctor, get vaccinated and receive treatment for chronic diseases. But in states like Virginia, uninsured poor adults often must turn to the emergency room when they need help.

Back at the school, volunteer nurse Doreen Facey-Biggs says the choices people face seem at odds with America’s standing in the world.

DOREEN FACEY-BIGGS, Volunteer Nurse: I’m from Jamaica. I have been in this country a long time, but I’m still amazed at the differences and the disparities in health care services, that, in this rich country, this First World country, so many people have no insurance.

SARAH VARNEY: That’s the case for James Love. He lives along a mountain road with his wife, tending to his animals and working multiple jobs to pay the bills. No one in the family has health coverage. And they rely on the Remote Area Medical events each year for nearly all of their dental and vision care.

Love has to make tough choices when it comes to paying for medications.

JAMES LOVE: You choose what you can afford. And you not only have to do it for you, your wife, your children, sometimes your grandparents, your parents.

SARAH VARNEY: The dismal health conditions here are widespread. Diabetes, heart disease and stroke are endemic and smoking and cancer deaths far exceed national levels.

But the most common complaint is painful, rotting teeth. Matt Keene had six teeth pulled at last year’s free clinic, and he’s back to have another dozen removed. At 24 years old, he feels a sharp pain when he eats or drinks.

Stan Brock says his pop-up clinics around the country continue to overflow because the Affordable Care Act and public insurance programs don’t cover dentistry.

STAN BROCK: They need to fix that. It was a step in the right direction, but it missed out on the thing that really leads to a lot of problems. Heart disease, diabetes, and so on all emanate from things like bad teeth.

SARAH VARNEY: But it’s not just insurance. Poor health habits and poverty are big factors, too, says Dr. Terry Dickinson, head of the Virginia Dental Association and a longtime volunteer.

DR. TERRY DICKINSON, Executive Director, Virginia Dental Association: The most product that they can buy is usually the worst for you. It’s the highly processed foods, the highly sugared drinks. All of those things are not good for you either health-wise or dental-wise.

So it’s this kind of conglomeration of things that are going around in their lives, that it makes it very difficult to break into that cycle, because it’s economic, it’s culture, it’s everything.

SARAH VARNEY: Young people like Jesse Charles are an example of why that cycle is hard to break. He has no job, no health insurance. He went to elementary school here and started smoking when he was 11. He’s 21 now and fairly healthy, but he’s taking part in a rite of passage: getting his tooth pulled at a Remote Area Medical event.

The dentist warned him that smoking after dental surgery is dangerous, but, on the way home, he quickly reaches for a cigarette.

JESSE CHARLES: Yes, it’s starting to hurt a little bit.

SARAH VARNEY: Back at his aunt’s house, Charles is worn down after the long day. His family has been roiled by the recent deaths of his mother and uncle, and he wishes he had followed their advice.

JESSE CHARLES: They told me to take care of my teeth. And it’s one thing I didn’t take care of. I never did listen.

SARAH VARNEY: With few jobs available in Grundy, he’s thought about moving to a larger town 60 miles away, where he might have more control over his future.

Terry Dickinson says stories like this haunt him — that somehow the whole weekend is just a stop gap.

DR. TERRY DICKINSON: I think about that a lot on the way home. I’m thinking, ‘So what did we do?’ Because our goal is to stop the cycle, is to do something that’s sustainable. But we’re the Band-Aid. We’re the safety net until that happens.

SARAH VARNEY: When the volunteers leave town on Sunday, it’s up to free clinics like the Health Wagon in nearby Wise, Virginia, to try to scrape together follow-up care.

DR. PAULA HILL MEADE, Clinical Director, The Health Wagon: Now, if you will take a deep breath every time I touch you.

PATIENT: OK.

SARAH VARNEY: Paula Hill Meade, a nurse practitioner, is the Health Wagon’s clinical director.

DR. PAULA HILL MEADE: No one cares that people like me are here begging and saying, ‘I need somebody to see this patient. Will you please see her? She needs a breast biopsy. Can I get her seen?’ A lot of times, it’s just, ‘No. Can she pay this much up front?’ ‘Well, no, she can’t.’

SARAH VARNEY: She’s angry that health care has become so political.

DR. PAULA HILL MEADE: It really makes you mad and it makes you infuriated to see that they’re up here using this as a political game. It’s sickening to think that you’re dealing with people’s lives like that.

SARAH VARNEY: But the bleak truth in central Appalachia is that many people here are used to waiting, and they expect little to change before the Remote Area Medical event comes back to town next year, once again bringing its caravan of volunteers and promises of momentary relief.

For the “PBS NewsHour” and Kaiser Health News, I’m Sarah Varney in Grundy, Virginia.

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