The Health Crisis In Joe Manchin’s Backyard

In early June, Charles Combs traveled 50 miles to attend a free pop-up health clinic in Charleston, West Virginia, to have some teeth extracted.

He pulled down his facemask, revealing a patchwork of missing teeth, and pointed to a damaged tooth in the center that needed to be removed.

A resident of Lincoln County, Combs said he’s disabled from a head injury he sustained years ago as a laborer and does not have health or dental insurance. He told The Lever he has resorted to extracting his own teeth because dental care is too expensive.

“I’ve been doing them myself,” Combs said. “I’ve been offing them out with a hammer and a knotter.”

Combs was sitting on bleachers in a school gymnasium that had been temporarily converted into a COVID-safe dental clinic. A maze of white tents, connected to one another by snaking air ducts, spread across the tarp-covered floor, looking like something out of the film E.T. Some volunteers nearby checked patients in and brought them to their appointments, while others emptied out buckets of blood and hazardous materials.

Combs was one of hundreds of patients who had congregated here, at Charleston’s Bible Center School, to attend a Remote Area Medical (RAM) clinic designed to offer free medical, dental, and vision services to people in need. The operation was taking place just a few miles away from the riverfront home of Sen. Joe Manchin (D-W.Va.).

Manchin last year blocked Democrats’ plan to expand Medicare to provide all seniors with dental and vision benefits, arguing it would be too expensive. Manchin’s opposition was a victory for the health insurance industry, which ran TV ads praising him for protecting their lucrative privatized Medicare plans.

But the Charleston clinic made clear just how badly people need such care — and not just seniors, and not just West Virginians. Combs, for instance, is still in his 50s, while the clinic saw patients of all ages driving hours from Ohio, Kentucky, and Virginia.

The RAM clinic hinted at the kind of universal health care system America could have, if not for senators like Manchin and their health care industry donors. The organization doesn’t ask patients about what its team calls the “three I’s”: identification, income, or insurance. Patients are treated with kindness, compassion, and professionalism — and fairly quickly. All services are free.

But instead of being replicated from coast to coast, this vital work is relegated to a small operation that many don’t know about. RAM, which has been operating for more than three decades, reported just $6.4 million in revenue in 2020, and only has roughly three dozen clinics planned for this year. The organization relies in large part on volunteers, especially volunteer physicians, nurses, dentists, and hygienists.

The problems RAM is working to address are staggering. Some patients at the Charleston clinic were living in constant pain, due to a lack of professional dental care. Their ailments would have been easier to manage or less severe had they received care sooner — if only they had been able to afford it.

Combs, and his self-directed dental surgery, illustrates the issue. “When I had this last one pulled, it cost me $400,” he said. “That’s too much.”

“All We Ask Of The Patients Is Time And Patience”

Founded in 1985, RAM was originally designed to provide health care services to people living in inaccessible regions, like the Amazon rainforest. The nonprofit quickly started receiving requests to hold events in the United States.

RAM still holds international clinics and hosts events in areas affected by natural disasters, but its work is primarily centered around filling gaps here at home. The organization hosts two- and three-day clinics all over the country, where patients receive medical, dental, and vision services free-of-charge. Glasses are made on site, same-day.

Patients can start signing up at venues at midnight the night before clinics start, and many stay in their car until it’s their time for care. Doors open at 5:30 a.m., and services start at 6 a.m.

“We take care of the acute problem — if somebody needs to have an eye exam, they can’t afford to go to the doctor, or they can’t afford their deductible,” said Vicki Gregg, RAM’s clinic manager, as she was overseeing the Charleston event. “Our clinics are first come, first served. All we ask of the patients is their time and patience, and we will take care of them to the best of our ability.”

Based in Rockford, Tennessee, RAM goes where they are invited to partner with community health groups. So far this year, RAM has held clinics in Florida, Kentucky, North Carolina, Ohio, Pennsylvania, Tennessee, and Virginia. They’re scheduled to host more events in California, Georgia, Iowa, Nevada, New York, and Oklahoma.

Since 2017, RAM has worked with West Virginia Health Right, a local charitable clinic, to host the Charleston event. Patients at the June event were asked to choose between either vision or dental, while every attendee was offered medical services.

“The majority is dental — always,” said Gregg. “Dental is about 65 percent, roughly. Vision comes in second. Medical, we’re looking at about five to eight percent.”

It’s easy to understand why dental and vision services would be in such high demand: Neither Medicare nor private health insurance plans cover routine dental or vision care. State Medicaid plans generally only cover dental extractions or emergencies, and only limited vision services if they do at all. Private dental insurance plans and Medicare Advantage plans that offer dental coverage do not in reality cover much, because they often include annual maximums of $1,000 or $2,000; once the insurer pays that much, you’re on your own.

Millions of Americans suffer from visual impairment or blindness due to not having glasses, which are exponentially more expensive in the U.S. than in poorer countries. Meanwhile, more than a quarter of American seniors end up with no remaining natural teeth. The dental crisis is particularly acute in West Virginia — according to 2021 data, the state has the highest percentage of seniors with no natural teeth of anywhere in the country.

That worsening crisis did not deter Manchin from blocking an expansion of dental coverage: While consistently voting for ever-larger military budgets, he said he opposed “spending trillions more on new and expanded government programs,” calling it “the definition of fiscal insanity.”

“My Teeth Hurt Every Day — What I Got Left”

Robert sat on the Bible Center School’s gym bleachers, waiting nervously for his dental appointment. He had come to the RAM clinic to get a broken tooth extracted — but he needs the rest out, too.

“I was sent a couple of months ago to an oral surgeon to have my teeth removed,” said Robert, who did not give his real name. “They’re all bad. They want $3,000 to remove them. I’m on Disability Social Security, and I don’t have $3,000. And one of my teeth is broken in the back, and it’s cutting my jaw, the side of my jaw really bad.”

Robert, who was born and raised in Charleston, said he can’t work due to several health issues — he has heart disease and high blood pressure, making it hard to stand for long periods of time. He’s also bipolar and said he is on many medications.

He said he lives in constant pain due to the state of his teeth, and doesn’t have the money to take care of them.

If it weren’t for the clinic, Robert said, “There’s nothing I really could do. I have no way of raking up that kind of money. Ain’t no way. With bills, rent, car insurance, food, gasoline, there’s nothing there to save with what I make a month. I couldn’t afford it. I can’t save money.”

“My teeth hurt every day — what I got left,” he added. “So I have to deal with them.”

Patients often travel long distances to RAM events. Some patients at the Charleston clinic were from Kentucky, where the dental crisis is roughly as bad as West Virginia’s — and potentially even worse, by some estimates.

Laura McDavid and her teenaged son drove around 80 miles to the RAM clinic from northeast Kentucky, at the urging of a local social services organization. She said she’s suffering from a degenerative bone disease and needs to get all of her teeth removed.

“I’ve always had perfect teeth until the last probably four years,” she said.

McDavid said she hoped the clinic would mean being “on the road to hopefully getting all of them pulled so I can get dentures.” She said some of her teeth must be removed surgically, “but the least number of them that they have to do, the better.”

Working as a grocery store cashier, McDavid said she doesn’t have health or dental coverage. “I work a minimum-wage job,” she said. “We have no insurance.”

“I Fell In Love”

The Charleston clinic was manned by RAM’s small staff, plus dozens of volunteers. They did this work because they wanted to help people who are in pain — and because they believe everyone deserves to be treated with dignity.

“What got me was [RAM’s mission] to prevent pain and alleviate suffering,” said Ronnie Hatfield, RAM’s senior volunteer coordinator in an interview before the clinic. “I wanted to be a part of an organization that, with everything they do, they try to help people. I went to one clinic to kind of try it out and see how I liked it, and I fell in love.”

Loni Maughan, who previously worked for RAM, traveled from southeastern Ohio to volunteer at the Charleston event.

“People have to put their health care on the backburner sometimes, and there’s major trickle-down effects when that happens,” she said in between guiding patients to various treatment spaces. “So when RAM comes in and is able to help fill that gap, they’re not just helping that person for the day, but they’re helping them to really pick themselves up in lots of different areas — for their family, for their community, for their job. That’s why I come out to volunteer with them, and to step in where I can to help the patients and help them get the care they need.”

Andrea Board, a longtime surgical technician in operating rooms, drove from Winchester, Virginia, to help out at the RAM event. “I still have family here,” she said while walking through the vision clinic, a darkened room with stained-glass windows where people sat quietly waiting for eye exams. “I wanted to give back to the community where my family is deeply rooted.”

Board said she’s volunteered at several RAM events because “they don’t discriminate, they don’t ask questions, it’s very non-judgmental, and they’re here to help everybody who needs help.”

“Sometimes, this is the only health care that people will get for the entire year,” she noted, adding, “I love the fact that people get these new glasses that are life changing.”

Christy Barnett volunteered at the RAM clinic as a representative of a local church, helping feed RAM’s staff and volunteers. She said she chose to volunteer because of both religious conviction and a personal connection, explaining that West Virginia Health Right — the community health group partnering with RAM — helped her get her life back following a mental health crisis.

“They were there for me at a time that was my darkest, when I had no insurance and nowhere else to turn,” she said. “They treated me with dignity and respect, they gave me prescriptions, and had it not been for them, I don’t know that I would be as strong as I am today.”

“A Wonderful Thing In A Harsh World”

Melina, who only gave her first name, traveled from Conneaut, Ohio. She sat on a stage near the vision clinic for a long interview with the RAM communications team.

“​​Years ago, I thought I had a career with a major oil company,” said Melina. “I worked for them for over a decade, and then I realized they don't care about you. So now I think everybody should find what they're good at, and do it. Financially, it's rough. It's better, though. But it means that there's gaps in things like bank accounts.”

Melina said she first went to a RAM clinic shortly before the start of the COVID-19 pandemic, at a mall in Ashtabula, Ohio.

“I had a tooth that desperately needed to be taken out, and I was in excruciating pain,” she said. “Everyone was kind to everyone. I just have never seen people treat indigent people in particular with this much care, regard, and decency. They just treated us like we were valuable human beings and deserve good care.”

While she had been scared to have the tooth removed, Melina said the procedure ended up being “almost pleasant” and “the best dental care I ever had.” She said the Ashtabula RAM clinic helped set her up with an appointment to get bloodwork, and those lab results revealed she had anemia and needed to race to the emergency room.

“I think they saved my life,” she said.

Melina said she went back to another Ashtabula RAM event this year and got a filling, and she traveled around five hours to attend the Charleston event for a dental cleaning and women’s health services.

“When I get everything else fixed, I’m coming back to volunteer,” she said, calling RAM “a wonderful thing in a harsh world.”