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Remote Area Clinics: Treating Patients in a Horse Barn

Jo Rozycki | July 21, 2018

Topics: healthcare, Healthcare in Virginia, healthcare reform, medical insurance, underinsured, Wise

The tents begin to pop up in the parking lot of a rural fairgrounds on Wednesday evening, the night before the largest free medical clinic in Virginia opens. It would be 10 hours before the gates would open to the 2,000 or so people, many sleeping in their cars, some from as far away as West Virginia and North Carolina, to obtain the only medical attention they might receive this year.

The fairgrounds of Wise, a small town in deep southwestern Virginia, was home to a three-day long free medical clinic provided by non-profit Remote Area Medical. Founded in 1985 by Stan Brock, who hosted Wild Kingdom, the organization has offered nearly $120 million in free medical, dental, and optical services to patients all over the world. Beginning as an international organization, like Doctors Without Borders, the group quickly shifted to a domestic focus, and now nearly 90 percent of their operations occur in the United States.

Triage. Photo Sarah Kerndt

At Remote Area Medical, insurance coverage–or the lack thereof–does not matter. Citizenship does not matter. Children, disabilities, pre-existing conditions; none of these are a factor. The only consideration is the pain a patient suffers.

For almost 20 years, Wise has been home to one of the largest of these remote clinics operated in the Commonwealth of Virginia. And as a region with one of the largest number of uninsured individuals who work, situated between Dickenson and Lee Counties, Virginia’s largest free clinic is providing vital medical care to a population that has no other options.

Doctors, nurses, dentists, and medical professionals and general support staff alike all volunteer their time, working from 5:30 a.m. until 4 or even 6 p.m.. Some come out of retirement, others use vacation or personal time, and they come from all over the country, drawn by the great need and a desire to help.

While the clinic was held in the Wise fairgrounds this year, Remote Area Medical has operated clinics in a variety of locations, ranging from airplane hangers and NASCAR race tracks to schools on summer break. At the fairgrounds, patients sat in bandstands, and an array of services–including donated clothes, shoes, school supplies and books–were located in tents, RVs, and even a horse barn throughout the site.

Dental clinic. Photo Sarah Kerndt

The horse barn offered triage and intake before patients were sorted out to the service providers. Cardiovascular, audiology, and women’s health were all on offer; in an enclosed, air-conditioned tent, the group also operated radiology, urology, plastic, and dermatology clinics.

Some 40 percent of Americans lack dental insurance, according to the National Association of Dental Plans, and dental care is one of the most requested services at the free clinic. The tent housing the dental clinic had space for nearly 30 patients at a time.

Despite the range of professional services and the quality of care, portions of the clinic were shockingly improvised. Livestock stalls were separated by gates and bed sheets, all clipped together with clothespins. Duct tape was a mainstay, and plastic buckets held biohazardous waste. Although the surroundings were humble, patients flowed through comfortably, thanks to a high-degree of coordination and professional support.

The pharmacy. Photo Sarah Kerndt

People come to the clinics for many reasons. Although some of the 2,000 participants are unemployed, many have jobs that earn below the federal poverty line. Both groups lack insurance, placing them in a group that includes nearly 13 percent of Americans. Others lack dental insurance, or have health insurance coverage which doesn’t cover necessary specialists. All of them live precariously, balancing their health against their bank accounts, as they await the annual clinic that may be their only chance for free, necessary medical care each year.

Sandra Schwaner, a nurse practitioner from Charlottesville, praised the attendees and the community of Wise. “People are always very grateful. They’re very happy to be here. You’ll see a lot of people who literally dress up to come to RAM,” she said, using a common acronym for the organization.

Patient intake. Photo Sarah Kerndt

People drive as many as four hours just to get a skin check or a dental cleaning. Ms. Tiller, a single mother from West Virginia, drove two hours for a full skin check. About the clinic, she said, “It is beneficial. It truly does help the people in the community.”

Even some people born in Wise who have moved, like Autumn, who came from North Carolina, return for the clinic. “We don’t have insurance, and it helps tremendously. It helps everybody. I’m so grateful for the things that they do,” she said.

“We don’t have insurance, and it helps tremendously. It helps everybody. I’m so grateful.”

Even for people with insurance, the region lacks medical facilities. Schwaner described it as a healthcare desert that specifically lacked specialists. “They have to drive to Kingsport [Tennessee], and some of these people don’t have cars, or they can’t take time off of work, or there’s one car for the whole family,” she said. And for those who are uninsured or not making enough money to take time off for a drive to Tennessee or further, the lack of care has a significant impact on their health outcomes.

The resilience of the people who come to the clinic is extraordinary and almost uplifting, but the reasons these folks have to wait a year for basic and life-preserving medical care are staggering. Despite living in the same state as those of us in metropolitan Richmond, they are often described as alien or unworthy of baseline medical services. Despite the stereotypes and the lack of attention, though, these are the very same people of our beloved Virginia, subjected to a system that feels cruel and unfair.

Patient room. Photo Sarah Kerndt

The crumbling coal and factory industries have left them without jobs or opportunities, and government services have failed them. They struggle to survive in rural communities that once promised opportunity for hard-working, independent people like themselves, a way of life that seems to have been completely erased.

Despite their struggles, Autumn said that community spirit still thrives, saying, “Everybody here would give you the shirt off their back if you needed it, willing to help each other.”

Although it can’t replace the year-round care the people of Wise need, Remote Area Medical provides at least one beacon of hope, by bringing in caring, compassionate medical providers to a group of people who deserve so much more than they’ve gotten out of life.

All photos credit Sarah Kerndt, who contributed to this report.

The 6 Virginia congressmen who voted in favor of Trump and Ryan’s healthcare bill

Brad Kutner | May 5, 2017

Topics: ACHA, community, Don McEachin, healthcare reform, Virginia congressmen

A chorus of rage has spewed fourth after yesterday’s House vote on Trump’s proposed “repeal and replace” plan for Obama’s legacy healthcare policy and Congressmen from Virginia are among those who helped it pass.

The six Virginia members of the House who supported the bill are:

Dave Brat, Va.
Thomas Garrett, Va.
Bob Goodlatte, Va.
H. Morgan Griffith, Va.
Scott W. Taylor, Va.
Rob Wittman, Va.

All six are Republicans. Brat and Garrett have both stood out in recent weeks for antagonistic town hall events or pushes for changes to marijuana laws.

Tom Garrett, who pushed for pot reform, took to cable news in the hours leading up to the ACHA vote to defend his “yes” vote by saying he didn’t read the bill and constituents* who protested at his local office and were concerned they would lose their healthcare “didn’t vote for him.”

http://shareblue.com/wp-content/uploads/2017/05/5.mp4

Garrett (and Bratt) were among the 40 House Freedom Caucus members who opposed the original Trump/Ryan plan back in March saying it didn’t go far enough to curb the national debt.

But it appears a part of the new plan that allows states to opt out of parts of the law, as well as an alternative to guaranteed coverage that “mirrors the main concept for funding for care for folks with pre-existing conditions,” helped seal the deal this time around.

“You’ve got three to five percent of the population driving 40 to 60 percent of health care costs,” he told Bearing Drift in an interview ahead of Thursday’s vote.

As for Brat, it seems he was directly involved with Freedom Caucus and the Trump Admin’s negotiations – He told the Washington Times late last month that VP Pence came to the group to figure out specifics of a bill that the group could agree with.

Brat said Pence came with a “great compromise” and it included Garrett’s favorite part as well, allowing “the states to opt out of some of the regs.”

“This approach turns over control and decision-making authority to the states, rather than leaving Americans’ health care decisions to federal government bureaucrats in Washington, D.C.,” said Brat in a statement released late last week. “This improved bill also includes a key provision to ensure Members of Congress will have the same health care options as everyone else, with no preferential treatment.”

So what’s in the bill? We’re gonna go with the NPR folks for details on this because there is no bi-partisan Congressional Budget Office review of the document yet.

VIA NPR:

The bill would no longer require people to buy insurance through the marketplaces created by the Affordable Care Act, also known as Obamacare, if they want to use federal tax credits to buy coverage. It also would eliminate the tax penalty for failing to have health insurance coverage, effectively doing away with that requirement altogether.

…

The House Republican plan would eliminate the income-based tax credits and subsidies available under the Affordable Care Act, replacing them with age-based tax credits ranging from $2,000 a year for people in their 20s to $4,000 a year for those older than 60.

…

The bill eliminates nearly all the taxes that were included in the Affordable Care Act to pay for the subsidies that help people buy insurance. Those cuts, which add up to about $592 billion, include a tax on incomes over $200,000 (or $250,000 for a married couple); a tax on health insurers and a limit on how much insurance companies can deduct for executive pay; and a tax on medical-device manufacturers.

…

The Republican plan would gradually roll back [Medicaid] expansion starting in 2019 by cutting the federal reimbursement to states for anyone who leaves the Medicaid rolls. People often cycle in and out of the program as their income fluctuates, so the result would likely be an ever-dwindling number of people covered.

…

The AHCA maintains protections for people with pre-existing conditions, with some important exceptions (see waivers, below). That means that someone with high medical expenses pays the same premium for the same policy as anyone else his age in his area.

…

[Editor’s note: The part below is what Garrett and Brat were really into]

States could apply for waivers that would allow insurance companies in their states to do three things: 1. Charge older people more than five times what they charge young people for the same policy; 2. Eliminate required coverage, called essential health benefits, including maternity care, mental health and prescription drugs, that were required under the Affordable Care Act; and 3. Charge more for or deny coverage to people who have pre-existing health conditions, such as cancer, diabetes or arthritis.

You really should listen to the NPR story here for more of a breakdown of the bill as we continue to wait for numbers from the CBO.

There were five Virginia Congress(wo)men who didn’t vote in support of the bill. They are seen below:

Barbara Comstock
Don Beyer
Gerald E. Connolly
Donald McEachin
Robert C. “Bobby” Scott

The Comstock vote is interesting because her district has remained Republican for some time, but she continues to oppose the bill.

And while she’s voted in support of Trump’s measures 96% of the time, she’s also played the foil to some of his more drastic plans.

“I did not support the AHCA today because of the many uncertainties in achieving those goals,” wrote Comstock after yesterday’s vote. “We have seen over the past year more bad news of skyrocketing premiums, rising deductibles, and fewer choices for millions of American families. The status quo is unsustainable and we need to find real solutions for the American people.”

As for Virginia Democrats who voted against the bill, they were upset in line with the rest of the party. Congressman Don McEachin (who reps parts of Richmond) pointed to the bill slashing as much as 30% of Planned Parenthood’s federal funding and no longer requiring contraceptive coverage and called it an “Attach on women’s rights and health.”

“By beginning the process of rolling back the Affordable Care Act’s contraceptive coverage policy and passing legislation to defund Planned Parenthood, the Republican leadership has shown a reckless and dangerous disregard for women’s health, and for their right to make deeply personal decisions free from government interference,” he said in a statement after yesterday’s vote. “Worse yet, eliminating these protections will have a disproportionate impact on vulnerable people who already face barriers to health care like low-income, rural, LGBTQ, and communities of color.”

*Editors note: this sentence could have been misinterpreted and has been updated for clarity.

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