The Affordable Care Act is intended to provide insurance for America’s poorest. It was supposed to control healthcare costs by getting people to doctors for routine visits. But for many low-income -- and especially rural -- Americans, healthcare needs are still not being met.
At a fairground just outside downtown Knoxville, Tennessee, hundreds of people wait in line. They come from nearby cities and small towns with names like "Coalfield" and "Deer Lodge". Inside a giant auditorium converted to a mobile clinic for the day, dozens of dentists clean teeth. The two-day clinic, called Remote Area Medical, offers free medical services -- from dental to vision to yearly checkups.
James Barlow is 47-years-old. He received his first pair of glasses two years ago at the clinic. Today he is waiting in line for a new pair of reading glasses from a volunteer student studying optometry.
“I was struggling and running out of reading glasses. It was just getting too weak,” he says.
Barlow says he needs health insurance. In 2008, he was hospitalized for a heart attack. He says as soon as he walked into the emergency room, they knew he couldn't afford care, but they made him stay in the hospital anyway. Now, he's grateful -- he says would have "probably died."
Barlow had another heart attack this past year. His medical bills have cost tens of thousands of dollars. But like a lot of people at the clinic, he still can’t afford to buy his own insurance, even with subsidies. And Barlow lives in Tennessee, a state that opted out of Medicaid expansion through the Affordable Care Act.
A number of people came the night before -- sleeping in their cars for the services offered today.
“I don’t know a whole lot of people who would stand in a line for 24 hours if they had a better plan, if they had an easier way to get what they needed,” says Amy Smith, a nurse and volunteer here.
That’s the case with Britanny and Dustin Scalf, both in their mid-20s.
“When I was in high school, I was going to the dentist all the time. After that, it just stopped. It literally stopped right in its tracks. Lost insurance,” says Dustin Scalf. His wife Brittany Scalf finished his thought: “When I turned 18, I got pregnant. And I don’t know, I just quit going.”
Brittany hasn’t gone to the dentist in six or seven years. A lot of people here are used to not having health insurance in their family.
“His mom’s on disability; my dad’s on disability,” says Brittany. “She never really tried to get it until she got sick and had to go the doctor...and then it was too late. She already owed thousands and thousands of dollars.”
A few hours later, Brittany’s finally in the dental chair. The dentist removes four teeth from the back of her mouth. The couple hopes procedures like this one are a thing of the past, because Dustin has a new job that comes with health insurance.
Finally, the two head to their camper to make the two-hour trip back to Hawkins County, Tennessee. As for so many people here, this trip is a painful reminder of the past few years without health insurance.
“I’m just ready to get home,” says Brittany.
“I know...It’s been a long day,” says Dustin.