- The Washington Times - Wednesday, March 12, 2014

BUENA VISTA, Va. — Many of the hundreds of people gathered on a recent Saturday for a free clinic are exactly the types of people Obamacare is trying to reach — generally poor in pocketbook and in health, who either lack insurance or whose bare-bones policies don’t cover vision or dental care.

Despite an intensive effort by the Obama administration and heavy spending on outreach by the president’s political allies and the health care industry, the 500-plus patients at the massive traveling clinic in Buena Vista are either unaware or unswayed by the law.

“Everybody here shouldn’t be here,” said Rich Bsullak, 51, a patient from nearby Fairfield. “Why are people in the United States in a place like this in the freezing cold?”

The law’s complexity and penalties have perplexed and discouraged many of the people, some who slept in cars to get into the clinic at daybreak.

“I haven’t looked into it. I just keep hearing all the hubbub about it,” said Carla Bible, a 27-year-old uninsured resident of Bedford who was waiting outside. “Usually it’s anti-[Obamacare] — a lot of anti.”

Some of the patients thought the law could be promising. But just weeks before the March 31 deadline for having coverage, they still hadn’t signed up for plans on the federal Obamacare website, HealthCare.gov.

Others said they are among the 400,000 or so Virginians who could benefit if Gov. Terry McAuliffe, a Democrat, succeeds in his plan to expand Medicaid benefits. He is battling Republicans in the legislature who cite concerns about the cost and doubt the program’s efficacy.

Get a number, get it early

The first cars arrived before midnight on a Friday. Some stayed overnight, parked in a paved lot across from the student activities center at Southern Virginia University. Others gravitated to a heated tent set up nearby.

At 3 a.m., patients warmed by camouflaged hunter jackets, Washington Redskins gear and blankets gathered near the clinic building to take a number from a deli-style dispenser. Tickets in hand, they waited for the doors to open at 6 a.m.

The school’s gymnasium served as an eye clinic, where patients peered at letters 20 feet away and then picked out frames for new eyeglasses. Down the hall, drills whirred as rows of dentists repaired fillings and yanked out hundreds of teeth. In between, patients waited near a small stairway to see the medical doctor, some with mouths full of gauze after their visits at the dental station.

This is how it works at clinics hosted by Remote Area Medical, an organization founded by British-born Stan Brock in 1985 to deliver free health care to those who cannot afford it or access it where they live.

Mr. Brock was inspired to form the organization after he had a medical emergency in a remote part of the South American nation of Guyana. Since then, he has been a “24/7” volunteer at the helm of the nonprofit.

The organization relies on $5 and $10 donations and the generosity of medical professionals who volunteer their time and expertise at free clinics in underserved areas from Appalachia to the Pacific Northwest.

The university in Buena Vista hosts a Remote Area Medical clinic every two years. Events in 2010 and 2012 each doled out the equivalent of more than $200,000 in care, said Ryan Sloan, the head student coordinator.

But this year’s event posed a new question: Obamacare launched months ago, so can it take hold in a place like this?

A clear view gets murky

Buena Vista means “good view” in Spanish. Though the way locals say it, “Buena” rhymes with “tuna” and “i” in “Vista” is a short sound. However it sounds, the name is fitting for a town nestled in majestic mountains.

A house along the town’s main drag flew a Confederate flag and the “Don’t Tread on Me” banner of the tea party. Although President Obama won Virginia in 2012, voters in Rockbridge County supported Republican nominee Mitt Romney by an 18-percentage-point margin.

Even so, many of the clinic’s patients said they liked the spirit of Mr. Obama’s law, formally known as the Affordable Care Act, which attempts to cover millions more Americans by offering subsidized health care plans and expanding Medicaid in states. After all, they might benefit from the law.

But it was hard to find anyone at the clinic who had logged onto HealthCare.gov, browsed through plans and ended up a happy customer.

“Nobody knows what it’s about,” Erica Fitzgerald, 26, said as she waited in the women’s health care section. “That’s why I’ve waited for so long [to apply for coverage]. I’m a little nervous about not knowing what I’m really getting into.”

Deborah Oswalt, director of the Virginia Health Care Foundation, said that besides the law’s complexity and mixed messages from the political class, the word might not be getting out because state leaders left federal grant money on the table instead of spending it on state-run exchanges and marketing.

“I certainly think that one of the problems is that since Virginia opted for using the federal marketplace, there is very little money available to pay for navigators and other ways of educating folks,” she said, referring to in-person assisters who guide people through the enrollment process.

Some clinic patients brushed off Obamacare or bristled at the idea that government could siphon off a penalty from their tax refunds for flouting the individual mandate, a part of the law that requires almost all Americans to hold insurance.

A 27-year-old man from Harrisonburg referred to the law by coupling the president’s name with an expletive. He said he checked out plans on HealthCare.gov and couldn’t find anything affordable.

Others said the nation’s health care problems run too deep to see instant results.

“Obama did what he could do,” Mr. Bsullak said as he waited to see a medical doctor. “There’s a good chance all he did so far is help the insurance companies.”

The dentist(s) will see you now

David McCormick, 36, hoped to get 14 teeth pulled by one of the clinic’s dentists. He was off by one.

By the time he was finished, Dr. Francis G. Serio, dean of the dental medicine school at Bluefield College in Virginia, had extracted 15 teeth from Mr. McCormick’s mouth.

As he worked, Dr. Serio spoke at length about the dental problems in Appalachia, including “smoking and Mountain Dew” and high-deductible plans that are practically worthless.

“They get a new plan, then they find out it doesn’t pay anything,” he said as he stood on a tarp put down to protect the gym floor from blood spatter. Each dentist’s station had a waste basket — for the teeth.

Mr. Brock said that whenever representatives of Remote Area Medical ask who needs dental or vision care at the start of their clinics, almost all the hands go up. Few hands go up for general medical care, either because the patients have some form of health care benefits or use the emergency room when they fall ill.

Both of those are issues for Obamacare.

The law requires plans to cover dental care for children but not for adults. HealthCare.gov advises adults to buy standalone dental plans or find health care plans on the exchanges that include dental coverage.

Some people can afford that, but “for a lot of people, they won’t be able to,” Karen Pollitz, a senior fellow at the Kaiser Family Foundation, said in a phone interview.

She said an Obamacare subsidy might help consumers pay for dental plans, but the assistance is applied to underlying medical plans first. Health care plans at the bronze level may save money for dental coverage but likely carry high deductibles, she said.

As Dr. Serio put it, “None of this is simple.”

Emergency room use also is a major problem — one Obamacare was designed to fix. The administration argues that relying on emergency rooms is more expensive and less healthy in the long run. Because emergency rooms cannot deny care, those without insurance end up freeloading on everyone else.

“Those that can afford it, those who’ve got the insurance, the system works,” Mr. Brock said. “But you’ve got to do something for the 40-odd million Americans for which the system does not work, and it sure as hell doesn’t work in dentistry and vision.”

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