Fertile ground for Medicaid pitch


Virginia Gov. Terry McAuliffe chats with Stan Brock, the founder of Remote Area Medical, during a tour of the fairgrounds Friday. (Michael S. Williamson/The Washington Post)

Gov. Terry McAuliffe renewed his pitch for expanding health care to the poor Friday by touring a field hospital set up at a county fairgrounds, where people had camped out for days for the chance to see a dentist or doctor.

McAuliffe flew to the Remote Area Medical expedition in far southwest Virginia, where the line for free dental and medical care was 1,500 long by 4 a.m. Friday, when organizers started turning people away.

“That just breaks your heart,” said McAuliffe (D), standing in a horse barn that served as a makeshift doctor’s office, with bedsheets strung up between examination tables to provide a measure of privacy.

McAuliffe chatted there with a single mother who comes to the clinic every year to get treatment for asthma and to see the dentist. The woman told him that she can get insurance through her job as a foodservice worker but that the premium would consume half her paycheck. He told her that he was “working hard so we can get health care for everyone when they want it, not just once a year.”

The free clinic springs up at the Wise County Fairgrounds every year. Stan Brock, founder of Remote Area Medical Volunteer Corps, began offering medical services in Third World countries 30 years ago but today focuses on poor parts of America, including this scenic but economically depressed swath of Appalachian coal country.


Virginia Gov. Terry McAuliffe chats with coal miner Sam Chandler who came to the Remote Area Medical event to get some dental work done. At right is Chuck Flandry who was also there for dental work. (Michael S. Williamson/The Washington Post)

The event took on added political significance this year, as McAuliffe continues his push to expand Medicaid under the Affordable Care Act.

Since taking office in January, McAuliffe has pushed to expand Medicaid coverage to 400,000 uninsured Virginians. The federal government has offered to pay most of the $2 billion-a-year cost under the health care law known informally as Obamacare. But the Republican House of Delegates, skeptical that Washington can afford to keep that promise, has blocked expansion.

McAuliffe said in June that he would find a way around the legislature and expand health-care access unilaterally. He reiterated that intention Friday, accompanied by Attorney General Mark R. Herring (D) and Health and Human Resources Secretary William A. Hazel Jr. “There are different vehicles and avenues that we can [use to] provide health care,” he said. “We’re doing an analysis. We have teams working around the clock on this.”

At the same time, he appeared to be trying to lower expectations that he will come up with something as far-reaching as enrolling 400,000 people in Medicaid, saying whatever he announces in September will be “only a step.”

He also renewed efforts to drum up public pressure on Republicans who oppose expansion, urging patients to lobby local legislators for it and calling on Republican delegates to visit the clinic.

“I would go back and remind everybody to call their members of the House of Delegates,” he said.

Republicans, who question McAuliffe’s legal authority to expand Medicaid without legislative approval, dismissed his visit as a photo op. “It is going to take more than a few photo opportunities to explain to the people of Virginia why he’s ignoring the legislature, the law and the Constitution,” Matthew Moran, spokesman for House Speaker William J. Howell (R-Stafford), said via e-mail.

In remarks to reporters, McAuliffe noted that any effort to enact expansion on his own will be “within the confines of what we’re allowed to do.”

The three-day clinic, which relies on more than 1,000 volunteers, will serve as many as 3,000 people before it ends Sunday. The vast majority of patients — more than 70 percent — come for dental care, Brock said.

Every year, hundreds of people have every one of their teeth pulled there. Then they put their names into a denture lottery, with the hope of being picked to get a set of false teeth made for them at the next year’s event. Forty-six people were picked from a list of 700 to get dentures this year.

“They pull thousands of teeth here. At the end, they’ll have buckets of teeth,” said volunteer Jennifer Lee, Virginia’s deputy secretary of health and human resources and an emergency room doctor.

Medicaid expansion would not fully alleviate the dental situation. Medicaid does not cover routine dental care for adults or dentures. But Medicaid does pay for emergency tooth extractions, so patients would not have to wait a year to have a bad one pulled.

“I just had an 18-year-old have a full mouth extraction because she’s never had dental care,” said Beth Bortz, who runs the Virginia Center for Health Innovation. “It’s not unusual.”

She said patients often want their good teeth removed, too, because they associate teeth with pain. She said health-care providers counsel them to keep them.

In a tent where people waited for a vision exam, McAuliffe knelt beside Martha Deel, whose only job is caring for her brain-injured son. Fifty-one years old, she looked decades older. After her exam, she said she would line up to see a doctor for “the girl stuff.”

“We’re fighting hard for health care,” he told her.

As McAuliffe moved on, Deel — amazed that she had just had a talk with the governor — high-fived the health-care workers. “That was just awesome!” she said.

McAuliffe spoke to about 100 people in a tent waiting to see a dentist. Gilda Mountcastle, who’d been waiting for care since 5:30 a.m. Thursday, called out from the back of the crowd to say she would not have access to a dentist or eye doctor without the clinic.

But she told a reporter afterward that she did not support Medicaid expansion, which she saw as a government handout.

“We’re hardworking, hillbilly mountain people,” she said. “We’re too proud to beg and bum.”

Laura Vozzella covers Virginia politics for The Washington Post.
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