THE BURNED OVER DISTRICT

When Obama and the Democrats finally succeeded in passing the ACA, millions of Americans gained access to affordable health care. But thanks to Republican efforts to derail that idea in the passage of the bill and succesive efforts have managed to prevent millions of other Americans from reaching that goal. Free clinics and other patchwork efforts try to fill that Republican created void.

They took a bus into the center of Cleveland, Tenn., a manufacturing town of 42,000, and slept for a few hours at a budget motel. Then they awoke in the middle of the night and walked toward the first-come, first-served clinic, bringing along a referral from a social worker for what they hoped would be their first doctor’s checkup in more than four years.

“Urgent needs from head to toe,” the social worker had written. “Lacking primary care and basic medication. They have fallen into the gap.”

Only when Stevie and Lisa arrived at the clinic a little after 2 a.m. did it occur to them how large that medical gap has become in parts of rural America. Dozens of people were sprawled out in sleeping bags on the asphalt parking lot. Others had pitched tents on an adjacent lawn. The lot was already filled with more than 300 cars from all over the rural South, where a growing number of people in medical distress wait for hours at emergency clinics in order to receive basic primary care. Tennessee has lost 14 percent of its rural physicians and 18 percent of its rural hospitals in the past decade, leaving an estimated 2.5 million residents with insufficient access to medical care. The federal government now estimates that a record 50 million rural Americans live in what it calls "health care shortage areas," where the number of hospitals, family doctors, surgeons and paramedics has declined to 20-year lows.

What’s arrived in their place are sporadic free clinics such as the one in Cleveland, where a nonprofit agency called Remote Area Medical brought in a group of doctors, nurses and other volunteers for the weekend to transform the local high school into a makeshift hospital. There would be a triage station in the entryway, bloodwork in the science lab, kidney scans in the gym, dental extractions in the cafeteria, and chest X-rays in the parking lot — a range of medical care that would be available for only two days, until the clinic packed up and moved on to Hazard, Ky., and then Weatherford, Okla.

“We’ll do as much as we can for as many as we can,” a clinic volunteer promised as she patrolled the parking lot late at night and handed out numbers to signify each patient’s place in the line. No. 48 went to a woman having panic attacks from adjacent Meigs County, where the last remaining mental-health provider had just moved away to Nashville. No. 207 went to a man with unmanaged heart disease from Polk County, where the only hospital had gone bankrupt and closed in 2017.

Stevie and Lisa's story is heartbreaking enough on its own. When you combine it with the knowledge that those who prevent them from having affordable care are fat and sassy and have their medical care paid for by taxpayers and see no reason why anyone else should have it. And why Tennessee is in too many ways a model for the kind of 3rd world shithole the Republicans want the rest of the country to be.