Category Archives: Blog

Wise County: Health care in a horse stall

Richmond Times-Dispatch | Guest Columnist | Allie Atkeson | Posted: Thursday, July 24, 2014 10:30 pm

In an effort to better understand how low-income, uninsured Virginians access health care, my co-worker and I drove to Wise County in Southwest Virginia last week to volunteer with Remote Area Medical. RAM was started by philanthropist Stan Brock to “prevent pain and alleviate suffering by providing free quality health care to those who cannot afford it.” RAM — in partnership with the Health Wagon — has a long history of organizing much-needed clinics in Southwest Virginia.

We were joined by more than 1,000 other volunteers, many of whom were from Richmond. The event was held at the Wise County fairgrounds, and volunteers arrived as early as a week in advance to clean barns and horse stalls and set up large tents where Virginians would receive their health care.

When I arrived on Thursday I was assigned the task of sorting needles for dental procedures.

That night, 1,200 people waited in line to receive medical, dental and vision care. The volunteers gathered at the grandstand where we sang “God Bless America” and the national anthem before eating dinner together.

When the clinic started the following day, it could only be described as a war zone.

Thousands rushed into the fairgrounds for their one-day-a-year opportunity to access care. I escorted patients from triage to the various services offered. The majority of patients needed dental care, and the dental operation, put on by the Virginia Dental Association Foundation’s Missions of Mercy clinic, was a machine.

Workers quickly triaged patients and assigned them to their care category: cleanings, fillings or extractions. I was surprised at the number of patients with an orange “extractions” band around their wrist — young adults (my own age) looking to have the majority of their teeth removed and replaced with dentures.

When your last resort is sitting under a tent in the rain, mouth wide open to have your teeth pulled, surely this cannot be the best health care system in the world.

The dental situation was the most shocking: 3.8 million Virginians do not have dental insurance, and unfortunately Virginia’s opportunity to expand coverage to up to 400,000 low-income adults will not provide dental coverage.

However, if the General Assembly chooses to accept federal funding to expand our Medicaid program, 2,300 individuals in Wise County and thousands more in Southwest Virginia could access high quality health care year-round outside of the fairgrounds.

I volunteered for several summers down in Louisiana and Mississippi repairing houses and schools after Hurricane Katrina and would also describe the RAM clinic as disaster relief. It’s a different kind of disaster — one that has occurred over a period of time in the form of job loss, high unemployment and now a public health crisis.

I am proud to be a Virginian and am in many ways a product of the state. I was born here, grew up here, attended public school and a public university in the commonwealth.

But while I was in the Wise County fairgrounds escorting my fellow Virginians to receive medical care in a horse stall, it was hard to feel proud.

Remote Area Medical fills a gap that the assembly could have prevented. Virginians deserve better.

VCV Heads to Wise County

Allie and Erin are about to set off on a trip to Wise County, VA to volunteer at the Remote Area Medical (RAM) clinic that is happening later this week. RAM was started to deliver health care and supplies to struggling nations around the world, “but now 90% of everything [they] do is here in the United States”, according to it’s founder, Stan Brock. Lately, RAM has been getting a lot of press, including a segment on 60 Minutes and The Daily Show. There is also a documentary about the RAM clinics touring the country right now, and you can see the preview here.


We are really excited that VCV staff will have the opportunity to get back to working with people face-to-face, rather than getting bogged down in policy at the General Assembly. While policy advocacy is a vital and interesting part of our work, frankly, we are tired after this marathon General Assembly session. So Allie and I are taking off to Southwest Virginia to help at the RAM clinic to reconnect with our purpose: ensuring that everyone has access to high quality health care. You can follow our journey on Twitter by following @vaconsumervoice and by checking our Facebook page. We are going to be updating with pictures and information as we go along. Also, please check out to learn more about the great work they do across the country.

Lawmakers turned their backs on young adults

Richmond Times-Dispatch

Saturday, June 21, 2014 10:30 pm

I am ashamed of — and outraged by — our General Assembly. It has passed a budget that specifically leaves out any way to close the health insurance coverage gap in Virginia. What lawmakers might have forgotten is how young adults are affected by their decision.

A popular provision of the Affordable Care Act allows young adults to stay on their parent’s insurance plan until age 26. In today’s economy, this provision keeps many high school and college graduates insured while they struggle to find jobs.

But what about the young adults whose parents don’t have health insurance? What about those who turn 26 and still don’t have a job with health insurance? In 27 states and the District of Columbia, these young adults can sign up for Medicaid if they make below a certain income, but not in Virginia. Our legislators made sure of that.

Because of them, 400,000 people continue to worry about making ends meet while paying their health care bills. Because of them, three of my closest friends will remain uninsured for who knows how long. I have changed their names to protect their privacy, but I believe their stories need to be told.

David is severely affected by an undiagnosed illness. His illness is so debilitating that he cannot even work a part-time job, though he worked for as long as he could. His 26th birthday is coming up, and I am afraid of what will happen when he loses his coverage through his parents’ insurance.

Michael is working a part-time job because, even though he is college-educated, even though he has been applying, he doesn’t have a full-time job. He turned 26 and is now without health insurance, despite his employment and educational attainment.

Anna has a seizure disorder and has been uninsured for years. She is paid by the state to care for her mother, who has kidney failure and other health issues. Anna gets some assistance with her health care through VCU Medical Center, but it isn’t health insurance, and it isn’t enough to keep the bills from piling up.

My friends aren’t alone. There are hundreds of thousands of people like them across Virginia, and they are all suffering because of our legislature’s poor decision. David, Michael and Anna are all represented by a senator and delegates who had the opportunity to vote for a budget that closed the coverage gap, but their representatives squandered it.

Closing the coverage gap brings money into Virginia from the federal government, helps to support hospitals and obviously helps the uninsured by giving them the ability to better take care of their health. When the legislators in both the House and the Senate voted for a budget that did not close the coverage gap, they voted against the interests of Virginia.

The stories of my friends, and the other Virginians in the coverage gap, can still have a happy ending. Our state government can still decide to do the right thing for Virginians and accept the offered federal money to close the coverage gap. So to our elected representatives, I say: The lives of my friends, and of hundreds of thousands of Virginians, depend on you.


Gov. McAuliffe Closing the Gap


On Friday, June 20, Governor Terry McAuliffe announced several vetoes to the budget that was presented to him by the General Assembly last week. Most important to health care advocates was his decision to line-item veto the amendment that prohibits the expansion of Medicaid without the approval of the General Assembly. He also took action that essentially abolished the Medicaid Innovation and Reform Commission (MIRC) and announced that he has authorized Secretary of Health and Human Resources, William Hazel, MD, to work with stakeholders to create a plan that will expand Medicaid benefits to over 400,000 uninsured Virginians. The plan is due September 1.

While this was definitely not the preferred way to go to get Medicaid expansion in Virginia the Governor showed leadership and his flexibility in finding a solution that works for all Virginians, especially the 400,000 low-income Virginians who will be directly affected by expansion.


For more about the Governor’s actions, click here.

Budget Without Medicaid

Legislators in Richmond have said for months that they wanted to have a budget first and then have a conversation and move forward with Medicaid expansion. They got what they wanted when lawmakers passed a budget that strips out the additional health-care coverage for low-income Virginians.

The budget that was sent to Governor Terry McAuliffe includes cuts to increased spending that had been proposed in earlier versions of the budget, essentially keeping funding for most programs at or near current levels. Planned new spending for higher education was cut by $184 million. Public schools took a $166 million hit, although the budget retains additional funding linked to enrollment growth.

Health and human resources spending was trimmed by $80 million though legislators retained $50 million in additional spending for mental health, which became a priority after state Sen. Creigh Deeds was wounded by a son who then committed suicide hours after being released from an emergency custody order. Hospitals and nursing homes were hit with cuts to reimbursement rates that were supposed to increase for inflation, and the state cut $15 million for indigent care at Virginia Commonwealth University and University of Virginia medical centers, which bear the biggest burden of serving uninsured people and Medicaid recipients.

Advocacy organizations are focused on our next steps in fighting to close the coverage gap.Turning down the almost one billion dollars that Medicaid Expansion would have brought to the state to date may result in more hospitals closing and will actually increase the burden on Virginia taxpayers.

During a passionate debate on the amendment, Senator McEachin told the story of his diagnosis of rectal cancer last fall and his return to health thanks to the coverage he received through his part-time status as a state lawmaker. “Oh it's fine for us,” McEachin said of the health care coverage. “But we would deny that to people who work every day… How dare we?”

Sen. John Watkins, one of the Republicans who supported expansion through the Marketplace Virginia private option, said he was not happy or proud of his decision to support the floor amendment that blocked funding of health care expansion but he was concerned about what would have happened if a budget had not been adopted.

Advocates will continue to follow the developments and work to convince legislators of the importance of closing the coverage gap in Virginia.