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What Virginia’s poorest citizens want from health care reform

July 10, 2017 at 6:30 PM EDT
As Republicans on Capitol Hill try to repeal and replace the Affordable Care Act, we visit patients and health care providers at a free clinic in rural southwest Virginia -- a region that strongly supported President Trump, in a state that did not expand Medicaid under the Affordable Care Act -- to listen to the extreme health care challenges they face and what they think should be done.
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JUDY WOODRUFF: But first: As Republicans on Capitol Hill try to repeal and replace the Affordable Care Act, we’re going to spend the next couple of nights hearing what patients and health care providers think should be done.

Our team visited West Virginia and Virginia, which made very different decisions about Medicaid. West Virginia did commit to expanding Medicaid through Obamacare. But Virginia is one of 19 states that didn’t. The state’s Republican-controlled legislature voted against expanding the program to 400,000 more citizens because of concerns over costs.

Tonight, we visit a clinic providing free care in the western corner of Virginia, a region that strongly supported the election of President Trump.

WATCH: What Medicaid patients in West Virginia want from health care reform

PAULA HILL, Clinical Director, The Health Wagon: My name is Dr. Paula Hill. I’m a family nurse practitioner and clinical director here at the Health Wagon. We are at the Smiddy Clinic in Wise, Virginia. We actually say that we’re the forgotten Virginia, because we’re down in the corner with Tennessee and Kentucky borders.

And we’re very rural, very mountainous and very isolated from the rest of Virginia and a lot of ways the rest of the country. We have a high rate of heart disease, diabetes. And it’s because of the economics here.

JOYCE CAMPBELL, Patient, The Health Wagon: All the mines and stuff have just about closed down. And there really isn’t any jobs around here.

My name is Joyce Campbell. I’m from Wise, Virginia.

You know, I get $800 a month. And I am fortunate I do have an income coming in, with my Social Security. But by the time you pay your rent, your electric, your water, your gas, you either have a choice of whether you want to buy your medicine or whether you want to eat.

PAULA HILL: The Affordable Care Act, when it was enacted, it did help a lot of Virginians. But down here in this part of the state, in far southwestern Virginia, we didn’t benefit as much because there are such dire economic constraints here. Our patients couldn’t afford the Affordable Care Act. They couldn’t afford $400 a month for a family plan.

And when Virginia didn’t expand Medicaid, we actually didn’t benefit any. It would have helped if we had expanded Medicaid. It would have helped some of our residents anyway. Because there’s a dire amount of poverty. There’s people dying every day, and dying senseless deaths, because they don’t have equal right to health care.

TINA BEAN, Patient, The Health Wagon: My name is Tina Bean. I’m 59, and I’m from Haysi, Virginia.

I had congestive heart failure twice. I didn’t have insurance. And that’s when I started coming to Paula, or coming to the Health Wagon. Without the medicines and stuff, I probably wouldn’t be here.

When I heard about the Obamacare a few years ago and checked it and stuff, you could tell then that it wasn’t going to work. People can’t afford it.

JOYCE CAMPBELL: They call it Affordable Care Act. But it’s not. And they said you could keep your doctors. You couldn’t because your doctors wouldn’t take the thing. And they said you could go to the same hospital. But a lot of it was built on lies, if you really want to know the truth. I think — and I think somebody one of these days is going to give an account for it.

JEFF TILLER, Patient, The Health Wagon: My name is Jeff Tiller. I’m 47 years old. And I have worked in the coal mines for 29 years.

They diagnosed me for black lung. They done a chest X-ray. They also have found some nodules in my lung.

PAULA HILL: We are overwhelmed here at the Health Wagon. We have went to over almost 9,000 patients, and we have a staff of less than 20.

Every year, we have an outreach clinic event called Remote Area Medical. You will see them standing in line for dental care, for medical care, for vision. We have found people with dissecting aortic aneurysms that’s had to be flown out. We have had patients have a stroke right there in front of us at these Remote Area Medical events. We have had brain tumors that have been discovered, lung cancers that have been discovered.

And every year, it’s like this. We keep thinking, ‘Well, is it ever going to get better? Is anybody going to help these forgotten people?’ It’s like something you would see in a third-world country.

JOYCE CAMPBELL: The Obamacare could have helped some people. I say it needs to be replaced.

TINA BEAN: I hope that they can replace it. I know it’s not going to be something they can do overnight, because the mess didn’t come overnight.

JEFF TILLER: When I first started hearing that Obama getting ready for health care, Obamacare, I thought that was great. We tried it. We got it. Does it have faults? Yes, it does. Is it working? Yes, it is.

And I know right there in my hometown of people that’s got insurance through the Affordable Care Act. And you reverse it, they lose their insurance.

PATIENT: If all of this goes through, I probably won’t have anything. I don’t know how I’m going to get covered.

PAULA HILL: Because of the pre-existing conditions?

PATIENT: Yes, right. And I have had it for years.

PAULA HILL: If the Senate plan actually passes, there will be deep cuts to Medicaid. Even though Virginians didn’t expand, what they are paying out is going to be even — subjected to even more cuts.

Then you have the preventive care that’s being discussed that they’re not going to be paying for anymore.

Just because it wasn’t a perfect plan, it doesn’t mean do away with the whole thing. Why can’t we build on it and repair it, not take it away and then start over with another plan that’s not perfect and not ideal?

JOYCE CAMPBELL: It helped the insurance company, because they made all kind of money off of it. But, as far as helping a lot of poor people, it didn’t, and it still isn’t.

Now, we cannot afford the high cost like Obama had there. There’s no way that people in Southwest Virginia can handle it. Now, maybe up Washington, or way up where there’s money and jobs, you could. But there’s neither money nor jobs here.

TINA BEAN: They need to do something to help it. And, hopefully, the administration now, maybe they will do something.

JOYCE CAMPBELL: Washington, come to Southwest Virginia.

PAULA HILL: Come down here and look in their eyes. And don’t forget where you came from. Don’t forget who put you in the position that you’re in.

JOYCE CAMPBELL: Check the people. Look at them. Go sit on the streets. Go bring your car and park it and look at the people that are hurting. And then, if you have got a heart, you will know what it needs.

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