The Pikesville RAM clinic in 2011. Photo by Scott Elmquist
The Pikesville RAM clinic in 2011. Photo by Scott Elmquist

By Peter Galuszka

Sure it’s a photo op but more power to him.

Gov. Terry McAuliffe is freshly arrived from the cocktail and canape circuit in Europe on a trade mission and is quickly heading out to the rugged and impoverished coal country of Wise County.

There, he, Attorney General Mark Herring and Health and Human Resources Secretary William A. Hazel will participate in a free clinic to help the mountain poor get free health care. The political opportunity is simple: Many of the 1,000 or more who will be attending the Remote Area Medical clinic are exactly the kind of people getting screwed over by the General Assembly’s failure to expand Medicaid to 400,000 low income Virginians.

RAM makes its Wise run every summer and people line up often in the wee morning hours to get a free medical and dental checkup. For many, it’s the only health care they get all year unless it’s an emergency. Another problem: Distances are great in the remote mountains and hospitals can be an hour away.

Mind you, this is Coal Country, the supposedly rich area upon which Barack Obama is waging war and harming local people by not going along with coal executives’ demands on environmental disasters such as mountaintop removal, keeping deep mine safety standards light and avoiding carbon dioxide rules.

The big question, of course,  is why if the land is so rich in fossil fuel, are the people so poor and in need of free medical care? It’s been this way for 150 years. And now, coal’s demise got underway in Southwest Virginia in 1991 when employment peaked at about 11,000. It is now at 4,000 or less. It’s getting worse, not better.

In June 2011, by coincidence, I happened along a RAM free clinic in Pikesville, Ky., not that far from Wise when I was researching my book, “Thunder on the Mountain: Death at Massey and the Dirty Secrets Behind Big Coal.” My photographer Scott Elmquist and I spotted the clinic at a high school. There must have been hundreds of people there —  some of whom told me they had been waiting since 1:30 a.m. It was about 8:30 a.m.

Attending them were 120 medical and dental personnel from the U.S. Public Health Service. They were dressed in U.S. Navy black, grey and blue colored fatigues. The University of Louisville had sent in about 80 dental chairs.

Poverty in Pike County had been running about 27 percent, despite the much-touted riches of coal. Pike is Kentucky’s biggest coal producer.

One man I spoke with said he had a job as a security guard, but he doesn’t qualify for regular Medicaid and can’t afford a commercial plan. In other words, had I interviewed him more recently and had he been a Virginian, he would have been lost through the cracks of Medicaid expansion. Alas, he’s in luck. In 2013, Kentucky opted for a “marketplace” expansion system where federal funds would be used to help lower income buy health plans through private carriers.

Lucky the man isn’t from here. The marketplace plan is exactly the kind that McAuliffe has proposed and exactly the one that stubborn Republicans such as Bill Howell in the General Assembly are throttling. The feds would pick up the bill for expanding Medicaid to 400,000 needy Virginians, at least initially.

Yet another irony. Expanded medical benefits are available just across an invisible border in two states whose coalfield residents somehow never got the great benefits of King Coal.

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2 responses to “RAM, Coal and Massive Hypocrisy”

  1. I’m surprised McAuliffe didn’t go for this photo op a long time ago. If you want to sell Medicaid expansion, you highlight the people who will benefit from it. No one disputes that hundreds of thousands of Virginians aren’t getting the health care they need. If there’s no obvious alternative, people will tend to support the Medicaid expansion, especially considering that Virginians have already paid for their share of that expansion through numerous taxes that came with Obamacare.

    I understand the humanitarian impulse for expanding Medicaid. I just don’t trust the federal government to live up its promises to pay 90% of the expanded program over the long run. Given the fiscal condition of the federal government (see the graph on Virginia’s aging population in the next blog post), cost shifting back to the states is inevitable.

  2. larryg Avatar

    re: “I just don’t trust the federal government to live up its promises to pay 90% of the expanded program over the long run.”

    Jim – do you KNOW what actually funds the expansion?

    do you know if it is from the general fund or from earmarked funds?

    the argument about the 90% is rank hypocrisy unless you want to stop trusting the feds for roads and decide to no longer take the road money either.

    so your argument is essentially that we trust the Feds to fund the roads and the existing Medicaid but not the expansion even though the expansion is funded like roads are – with earmarked taxes?

    but there’s more – the expansion is for people who work

    further if we had an ounce of true humanitarianism scruples – why do we wait for the Feds to do anything at all and then blame the Feds for potentially not funding it?

    this is hypocrisy at it’s worst!

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