Return to Healthcare Never-Never Land

A man sleeps in front of his car in the parking lot at the Wise County Fairgrounds, where people hope to receive free medical care the next day at the 16th annual Remote Area Medical (RAM), clinic in Wise, Virginia, U.S., in the early morning on Friday, July 17, 2015. Photo: Pete Marovich/Bloomberg

A man sleeps in front of his car in the parking lot at the Wise County Fairgrounds, where people hope to receive free medical care the next day at the 16th annual Remote Area Medical (RAM), clinic in Wise, Virginia, U.S., in the early morning on Friday, July 17, 2015. Photo: Pete Marovich/Bloomberg

Six years ago I made a trip to Wise County, Virginia, in rural Appalachia, to photograph Remote Area Medical (RAM) for the first time. A nonprofit volunteer medical relief corps based in Knoxville, Tennessee, RAM provides free health, dental and vision care to people in remote areas of the United States and around the world. Stan Brock, who once assisted Marlin Perkins on Mutual of Omaha’s Wild Kingdom, founded RAM in 1985.

RAM reports that, with the help of 36,675 volunteers, it has provided more than $33 million in free healthcare to more than 350,000 patients during the past 30 years. It has conducted two-thirds of this work in the United States.

In recent years, RAM has treated 2,500 to 3,000 people annually at the Wise County Fairgrounds. People who can’t afford health insurance or cover high medical bills wait all year to receive free care at the three-day clinic.

This year, on assignment for Bloomberg News, I returned to see whether demand for RAM’s services had decreased since the Affordable Care Act (ACA) was signed into law five years ago to help people obtain health insurance.

I discovered that little had changed.

I had forgotten that although Virginia Governor Terry McAuliffe had tried to push through Medicaid expansion, as outlined in the ACA, the Republican-controlled state legislature blocked his efforts.

The ACA called for expanding Medicaid to all Americans under age 65 whose family income is at or below 133 percent of the federal poverty line. But a 2012 Supreme Court ruling allowed states to forego the expansion, as Virginia chose to do, leaving many people in the so-called gap without healthcare coverage.

As a result, this year’s turnout for RAM’s Wise County clinic rivaled years past. In fact, the clinic set an opening-day record, taking in more than 1,600 patients. By noon on Saturday, the clinic saw an additional 1,000 patients.

One woman’s life may have been saved on Friday, after physicians determined she had a dangerous ectopic (tubal) pregnancy, and she was taken to an local hospital for further care.

Images and story from my last visit in 2009 can be found on American-Journal.org.

Here are some images from this year’s RAM expedition in Wise County, Virginia.

People wait for the gates to open at the Wise County Fairgrounds where they hope to receive free medical care at the 16th annual Remote Area Medical (RAM), clinic in Wise, Virginia, U.S., on Thursday, July 16, 2015. Photo: Pete Marovich/Bloomberg

People wait for the gates to open at the Wise County Fairgrounds where they hope to receive free medical care at the 16th annual Remote Area Medical (RAM), clinic in Wise, Virginia, U.S., on Thursday, July 16, 2015. Photo: Pete Marovich/Bloomberg

Tempers flare as people drive in from two different directions to the gates of the Wise County Fairgrounds. Photo: Pete Marovich/Bloomberg

Tempers flare as people drive in from two different directions to the gates of the Wise County Fairgrounds. Photo: Pete Marovich/Bloomberg

Volunteers direct traffic as people drive in from two different directions to gates of the Wise County Fairgrounds where people hope to receive free medical care at the 16th annual Remote Area Medical (RAM), clinic in Wise, Virginia. Photo: Pete Marovich/Bloomberg

Volunteers direct traffic as people drive in from two different directions to gates of the Wise County Fairgrounds where people hope to receive free medical care at the 16th annual Remote Area Medical (RAM), clinic in Wise, Virginia. Photo: Pete Marovich/Bloomberg

Tempers flare at the Wise County Fairgrounds, where people hope to receive free medical care the next day at the 16th annual Remote Area Medical (RAM), clinic in Wise, Virginia. In previous years they could receive their ticket for the next day and then leave to return in the early morning. This year they were told if they left, they would give up their ticket and order in line. Photo: Pete Marovich/Bloomberg

Tempers flare at the Wise County Fairgrounds, where people hope to receive free medical care the next day at the 16th annual Remote Area Medical (RAM), clinic in Wise, Virginia. In previous years they could receive their ticket for the next day and then leave to return in the early morning. This year they were told if they left, they would give up their ticket and order in line. Photo: Pete Marovich/Bloomberg

Proceedure changes cause concern at the Wise County Fairgrounds, where people hope to receive free medical care the next day at the 16th annual Remote Area Medical (RAM), clinic in Wise, Virginia. In previous years they could receive their ticket for the next day and then leave to return in the early morning. This year they were told if they left, they would give up their ticket and order in line. Photo: Pete Marovich/Bloomberg

Proceedure changes cause concern at the Wise County Fairgrounds, where people hope to receive free medical care the next day at the 16th annual Remote Area Medical (RAM), clinic in Wise, Virginia. In previous years they could receive their ticket for the next day and then leave to return in the early morning. This year they were told if they left, they would give up their ticket and order in line. Photo: Pete Marovich/Bloomberg

Tempers flare at the Wise County Fairgrounds, where people hope to receive free medical care the next day at the 16th annual Remote Area Medical (RAM), clinic in Wise, Virginia. In previous years they could receive their ticket for the next day and then leave to return in the early morning. This year they were told if they left, they would give up their ticket and order in line. Photo: Pete Marovich/Bloomberg

Tempers flare at the Wise County Fairgrounds, where people hope to receive free medical care the next day at the 16th annual Remote Area Medical (RAM), clinic in Wise, Virginia. In previous years they could receive their ticket for the next day and then leave to return in the early morning. This year they were told if they left, they would give up their ticket and order in line. Photo: Pete Marovich/Bloomberg

Wayne Moore, 55, of Clinchco. Virginia., waits in the parking lot at the Wise County Fairgrounds, where people hope to receive free medical care the next day at the 16th annual Remote Area Medical (RAM), clinic in Wise, Virginia. Photo: Pete Marovich/Bloomberg

Wayne Moore, 55, of Clinchco. Virginia., waits in the parking lot at the Wise County Fairgrounds, where people hope to receive free medical care the next day at the 16th annual Remote Area Medical (RAM), clinic in Wise, Virginia. Photo: Pete Marovich/Bloomberg

Wayne Moore, 55, of Clinchco. Virginia., waits in the parking lot at the Wise County Fairgrounds, where people hope to receive free medical care the next day at the 16th annual Remote Area Medical (RAM), clinic in Wise, Virginia. Photo: Pete Marovich/Bloomberg

Wayne Moore, 55, of Clinchco. Virginia., waits in the parking lot at the Wise County Fairgrounds, where people hope to receive free medical care the next day at the 16th annual Remote Area Medical (RAM), clinic in Wise, Virginia. Photo: Pete Marovich/Bloomberg

People spend the night in the parking lot at the Wise County Fairgrounds, where they hope to receive free medical care the next day at the 116th annual Remote Area Medical (RAM), clinic in Wise, Virginia.  Photo: Pete Marovich/Bloomberg

People spend the night in the parking lot at the Wise County Fairgrounds, where they hope to receive free medical care the next day at the 116th annual Remote Area Medical (RAM), clinic in Wise, Virginia. Photo: Pete Marovich/Bloomberg

People spend the night in the parking lot at the Wise County Fairgrounds, where they hope to receive free medical care the next day at the 116th annual Remote Area Medical (RAM), clinic in Wise, Virginia.  Photo: Pete Marovich/Bloomberg

People spend the night in the parking lot at the Wise County Fairgrounds, where they hope to receive free medical care the next day at the 116th annual Remote Area Medical (RAM), clinic in Wise, Virginia. Photo: Pete Marovich/Bloomberg

A man sleeps in front of his car in the parking lot at the Wise County Fairgrounds, where people hope to receive free medical care the next day at the 16th annual Remote Area Medical (RAM), clinic in Wise, Virginia, U.S., in the early morning on Friday, July 17, 2015. Photo: Pete Marovich/Bloomberg

A man sleeps in front of his car in the parking lot at the Wise County Fairgrounds, where people hope to receive free medical care the next day at the 16th annual Remote Area Medical (RAM), clinic in Wise, Virginia, U.S., in the early morning on Friday, July 17, 2015. Photo: Pete Marovich/Bloomberg

Roy Pickett, 48, of Wise, Va. spends the night in the parking lot at the Wise County Fairgrounds, where he hopes.  to receive free medical care the next day at the 16th annual Remote Area Medical (RAM), clinic in Wise, Virginia. Photo: Pete Marovich/Bloomberg

Roy Pickett, 48, of Wise, Va. spends the night in the parking lot at the Wise County Fairgrounds, where he hopes. to receive free medical care the next day at the 16th annual Remote Area Medical (RAM), clinic in Wise, Virginia. Photo: Pete Marovich/Bloomberg

People spend the night in the parking lot at the Wise County Fairgrounds, where they hope to receive free medical care the next day at the 116th annual Remote Area Medical (RAM), clinic in Wise, Virginia. Photo: Pete Marovich/Bloomberg

People spend the night in the parking lot at the Wise County Fairgrounds, where they hope to receive free medical care the next day at the 116th annual Remote Area Medical (RAM), clinic in Wise, Virginia. Photo: Pete Marovich/Bloomberg

People wait in the parking lot in the early morning at the Wise County Fairgrounds where they hope to receive free medical care at the 16th annual Remote Area Medical (RAM), clinic in Wise, Virginia. Photo: Pete Marovich/Bloomberg

People wait in the parking lot in the early morning at the Wise County Fairgrounds where they hope to receive free medical care at the 16th annual Remote Area Medical (RAM), clinic in Wise, Virginia. Photo: Pete Marovich/Bloomberg

People wait in the parking lot in the early morning at the Wise County Fairgrounds where they hope to receive free medical care at the 16th annual Remote Area Medical (RAM), clinic in Wise, Virginia. Photo: Pete Marovich/Bloomberg

People wait in the parking lot in the early morning at the Wise County Fairgrounds where they hope to receive free medical care at the 16th annual Remote Area Medical (RAM), clinic in Wise, Virginia. Photo: Pete Marovich/Bloomberg

People wait in the parking lot in the early morning at the Wise County Fairgrounds where they hope to receive free medical care at the 16th annual Remote Area Medical (RAM), clinic in Wise, Virginia. Photo: Pete Marovich/Bloomberg

People wait in the parking lot in the early morning at the Wise County Fairgrounds where they hope to receive free medical care at the 16th annual Remote Area Medical (RAM), clinic in Wise, Virginia. Photo: Pete Marovich/Bloomberg

Dorinda Brightwell hugs her daughter, Kristin Overman, 24, both from Johnson City, Virginia, as they wait to see if Overman will be given a spot to have denture work finished at the16th annual Remote Area Medical (RAM), clinic at the Wise County Fairgrounds in Wise, Virginia. Overman had work started at a previous RAM event in Bristol, Tennessee, and was told to come to Wise to see if she could get in to have the work completed. Photo: Pete Marovich/Bloomberg

Dorinda Brightwell hugs her daughter, Kristin Overman, 24, both from Johnson City, Virginia, as they wait to see if Overman will be given a spot to have denture work finished at the16th annual Remote Area Medical (RAM), clinic at the Wise County Fairgrounds in Wise, Virginia. Overman had work started at a previous RAM event in Bristol, Tennessee, and was told to come to Wise to see if she could get in to have the work completed. Photo: Pete Marovich/Bloomberg

A woman listens to volunteers at the 16th annual Remote Area Medical (RAM), clinic in Wise, Virginia. Photo: Pete Marovich/Bloomberg

A woman listens to volunteers at the 16th annual Remote Area Medical (RAM), clinic in Wise, Virginia. Photo: Pete Marovich/Bloomberg

Patients wait to see a dentist at the 16th annual Remote Area Medical (RAM), clinic in Wise, Virginia. Photo: Pete Marovich/Bloomberg

Patients wait to see a dentist at the 16th annual Remote Area Medical (RAM), clinic in Wise, Virginia. Photo: Pete Marovich/Bloomberg

A dentist walks past waiting patients at the 16th annual Remote Area Medical (RAM), clinic in Wise, Virginia, U.S., on Friday, July 17, 2015. Photo: Pete Marovich/Bloomberg

A dentist walks past waiting patients at the 16th annual Remote Area Medical (RAM), clinic in Wise, Virginia, U.S., on Friday, July 17, 2015. Photo: Pete Marovich/Bloomberg

A young woman stares upward as a dentist works on removing all of her teeth at the 16th annual Remote Area Medical (RAM), clinic in Wise, Virginia. Photo: Pete Marovich/Bloomberg

A young woman stares upward as a dentist works on removing all of her teeth at the 16th annual Remote Area Medical (RAM), clinic in Wise, Virginia. Photo: Pete Marovich/Bloomberg

A tray of pulled teeth at the 16th annual Remote Area Medical (RAM), clinic in Wise, Virginia, U.S., on Friday, July 17, 2015. Photo: Pete Marovich/Bloomberg

A tray of pulled teeth at the 16th annual Remote Area Medical (RAM), clinic in Wise, Virginia, U.S., on Friday, July 17, 2015. Photo: Pete Marovich/Bloomberg

Patients wait to see a dentist at the 16th annual Remote Area Medical (RAM), clinic in Wise, Virginia. Photo: Pete Marovich/Bloomberg

Patients wait to see a dentist at the 16th annual Remote Area Medical (RAM), clinic in Wise, Virginia. Photo: Pete Marovich/Bloomberg

People stand in line to be processed in the triage tent at the 16th annual Remote Area Medical (RAM), clinic in Wise, Virginia, U.S., on Friday, July 17, 2015. Photo: Pete Marovich/Bloomberg

People stand in line to be processed in the triage tent at the 16th annual Remote Area Medical (RAM), clinic in Wise, Virginia, U.S., on Friday, July 17, 2015. Photo: Pete Marovich/Bloomberg

A woman looks for frames she likes after seeing an optometrist  at the 16th annual Remote Area Medical (RAM), clinic in Wise, Virginia. Photo: Pete Marovich/Bloomberg

A woman looks for frames she likes after seeing an optometrist at the 16th annual Remote Area Medical (RAM), clinic in Wise, Virginia. Photo: Pete Marovich/Bloomberg

RAM Founder Stan Brock, left, gives Virginia Governor Terry McAuliffe, left, a tour at the16th annual Remote Area Medical (RAM), clinic in Wise, Virginia, U.S., on Friday, July 17, 2015. Photo: Pete Marovich/Bloomberg

RAM Founder Stan Brock, left, gives Virginia Governor Terry McAuliffe, left, a tour at the16th annual Remote Area Medical (RAM), clinic in Wise, Virginia, U.S., on Friday, July 17, 2015. Photo: Pete Marovich/Bloomberg

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