美国国家公共电台 NPR When Sleeping In The Car Is The Price Of A Doctor Visit

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Here's one big reason that Democrats 1 and many Republicans express doubts about repealing 2 the Affordable 3 Care Act - the law allows states to expand their Medicaid coverage 4 - many did, and millions of people received coverage. A proposed Republican replacement 5 would take hundreds of billions of dollars out of Medicaid, making it unclear how the coverage would change in state after state.

To understand what it all means, it helps to visit a state that never expanded Medicaid in the first place to see what happens there. NPR's Sarah McCammon traveled to Tennessee.

SARAH MCCAMMON, BYLINE 6: Missing teeth are all too often a punchline 7 in conversations about poor people in rural places. But when your teeth need attention, it's not funny.

HEATHER WALLACE: Basically, it's just like a nerve pain. Your whole body locks up, it - you have to stop for a second to try to breathe. And sometimes, if it hurts bad enough, you might cry (laughter).

MCCAMMON: That's Heather Wallace. She and her husband James are both in their 20s. They traveled about two hours from Knoxville, Tenn., to a free medical clinic in Chattanooga earlier this month. James Wallace says they each earn around $8 or $9 an hour working in hotels. Health insurance and dental care aren't part of the deal.

JAMES WALLACE: We don't have it. We can't afford it. And we don't make enough to be penalized 8 at the end of the year. So either which way it goes, we don't have the money to pay for it.

MCCAMMON: The Wallaces were camped out on a blanket outside Red Bank High School in Chattanooga on a Friday afternoon, hours before the clinic was set to open Saturday morning. The nonprofit group Remote Area Medical puts on dozens of these clinics around the country each year. Founder 10 and President Stan Brock says even under the ACA, many of these patients still lack health insurance, let alone dental and vision. Those who have some kind of insurance often can't afford the co-pays and deductibles.

STAN BROCK: That is something that we hear all the time. It's costing me so much money before my insurance kicks in.

MCCAMMON: The Wallaces say they make too much money for Medicaid. And they looked into an Obamacare exchange plan but couldn't afford the premiums 11.

H. WALLACE: Obamacare was not what they said it was going to be.

MCCAMMON: Heather Wallace says maybe we should have a system like Canada, where everyone is covered. James Wallace agrees.

J. WALLACE: Making it to where everybody can have health insurance and they'd have more productive members of society...

H. WALLACE: Exactly.

J. WALLACE: ...And maybe drop the percentage of Americans on food stamps.

MCCAMMON: During the campaign, President Trump 12 often promised to replace the ACA with something much better. But the Congressional Budget Office estimates a plan passed by the House of Representatives would leave 23 million more Americans uninsured. And Senate Republicans have not revealed the details of their plan.

On Saturday morning, after a long night spent reading and trying to doze 9 off in the car, 55-year-old Sabra Howard finally got to see a dentist. She has several health issues, but she's most concerned about her teeth.

UNIDENTIFIED MAN: Sabra, what brings you over today?

SABRA HOWARD: I wanted to see about cleaning and any fillings that I may need.

UNIDENTIFIED MAN: OK.

HOWARD: I don't have any top teeth anymore. I just have bottom.

UNIDENTIFIED MAN: OK.

MCCAMMON: Howard, who lives just outside Chattanooga, loves her work-from-home customer service job, but it doesn't offer benefits. And she can't afford the premiums for plans offered through the exchange. She says she voted for Trump.

HOWARD: Well, I wanted change.

MCCAMMON: And she hopes he can follow through on his promise to reform the health care system, though she's not sure about the details.

HOWARD: I just want him to sit down and talk with, you know, the people that are smarter than me and come up with a good plan that will help everybody.

MCCAMMON: You seem pretty smart. What do you think - what do you want to do? I mean, do you think that there should be more government support for it, or is there some other parts that you think would be better?

HOWARD: I don't really think government should be all in it, but I think that a lot of people need someone to speak for them.

MCCAMMON: Howard says she just wants to be able to take care of herself. She spent years prioritizing her children's care over her own, and now her dental problems are compounding her financial difficulties.

HOWARD: I actually have my insurance license 13. And I passed up an opportunity to go ahead and do that because of my teeth because I felt like, you know, I'd be sitting there talking to a client. And next thing I know, they realize I don't have teeth. And who wants to buy insurance from somebody that, you know, don't have any teeth?

MCCAMMON: Howard says she's working toward getting a position with benefits. In the meantime, she's hoping to get dentures at another free clinic on another day. Sarah McCammon, NPR News, Chattanooga.