Charles Swadley led churches in Toano, Williamsburg, Richmond and elsewhere before he retired in 2011.
Measured and confident in the pulpit, Swadley is nothing if not uneasy these days. Years ago, he watched a fellow church member lose her husband to a stroke and heart attack — neither had had insurance for an extended period.
Now, Swadley worries primarily for his child. Changes to the Affordable Care Act could mean she may have to forgo routine medical work.
To him, she represents a large swath of people who would be adversely affected by changes to the Affordable Care Act.
"My daugher is a perfect example," he said. "She's a part-time worker, and she won't be able to keep up with the costs of care without insurance."
As elected officials in the nation's capital decide whether and how to shift health insurance coverage for millions of Americans, thousands in and around Williamsburg are wondering just what will happen to them.
Where we are now
One of President Donald Trump's campaign promises was to repeal and replace the Affordable Care Act. It's something the Republican-controlled House and Senate had been trying to do for years, only to be thwarted with President Barack Obama's veto.
Trump and Speaker of the House Paul Ryan introduced the American Health Care Act, but ended up pulling the bill before a vote on March 23 because of lack of support.
Repealing the ACA, according to an estimate from the Congressional Budget Office, would have left 24 million people without insurance within a decade. The White House's own analysis pegged the number at 26 million.
Some lawmakers thought the bill cut Medicaid coverage for too many citizens; others thought the proposed bill didn't cut enough.
Though it was designed to keep insurance costs down, the ACA has had the opposite effect in some areas. Rising costs of coverage have turned many people against the law, since they have to pay more for a similar amount of coverage.
National law, local impact
Bill Mann, executive director, of the Olde Towne Medical Center, said insurance costs are rising around the community for reasons unbeknownst to him. A larger percent of their patients are uninsured than before the health care law went into effect, Mann said.
Higher deductibles and copays have forced some patients to cancel their insurance, Mann told Williamsburg City Council in January.
"We're seeing the opposite of what you'd expect," he said. "We don't know why — it baffles me."
Judy Knudson retired in 2007 after 13 years as the executive director of the Olde Towne Medical Center and spoke about the role the center plays in the community.
"Olde Towne fills a gap between those people with jobs and good health care and people with no jobs, and no health care," Knudson said.
Places like Olde Towne did their part to help out before health care became a federal mandate. When Olde Towne started in 1993, it was place where uninsured women could get prenatal care. It's transformed over the years into a full-service facility that charges patients on a sliding scale according to their income and does not turn away those who cannot pay.
Williamsburg's workforce and economy make it especially sensitive to the health insurance wrangling, Knudson said, because many of the jobs here don't come with a wide-array of benefits, she said.
"This is a such a service-driven economy," she said. "You're talking about maids, waiters and more here. Typically, those jobs don't carry benefits like insurance."
Knudson said Virginia residents who lack insurance are constantly overlooked during the policymaking process.
"I have yet to see a proposal that actually deals with this population," she said of the uninsured. "What really would have helped is Medicaid expansion."
Sherrina Gibson, a principal analyst for Richmond-based Community Health Solutions, calculated that thousands in the Historic Triangle would benefit from expanding Medicaid.
"14,687 adults under age 65 in the 3 localities are uninsured and have household incomes below 138% of the (federal poverty line)," she said in an email. "These are the ones who would benefit by gaining eligibility if Medicaid in (Virginia) was expanded."
For one person that income level would be $16,400 per year.
Governor Terry McAuliffe has pushed to expand Medicaid, but lawmakers have rebuffed him four times.
Carol Sale, executive director of Yorktown's Lackey Clinic, said Virginia leaves much to be desired in terms of funding Medicaid.
"We're already 47th in terms of the money we spend for Medicaid," Sale said. "All together, Virginia has more than 400,000 uninsured people."
Like Olde Towne, the Lackey Clinic serves people who are uninsured. Staff provide free mental health care, dental care, medical care and prescriptions.
"What we're anticipating is that we will get a lot busier, before it gets calmer," Sale said.
The clinic, which does not charge for its services, is part of larger group of similar clinics referred to by the state as Community Health Centers, or safety-net clinics.
"Our safety net of clinics manages about one hundred thousand people per year, and they are doing all they can," she said. "You can do the math — there's already a gap there. They are already pushed to the limit, but most of us are expecting even more if the laws change."
How did we get here?
The spirit behind the Affordable Care Act was to help Americans around the country gain access to insurance and health care.
Places like Olde Towne and the Lackey Clinic can help keep people out of the emergency room who need not be there, Knudson said.
"Since you're getting primary care, you're not in the emergency room," she said. "We know the emergency room is by far the most expensive type of care."
Having lived abroad, Knudson understands what a health care system can mean for a family.
"I lived in Canada for a while," she said. "One of the things I appreciated was that I never had to worry about going (to get care). I knew if one of my children got sick, I could go see a doctor, or go to a hospital."
Swadley said he's concerned for those who would be left uninsured or under-insured if the ACA is repealed or replaced.
"Even if they do repeal it, there's no way they can replace it," he said. "What you'll end up with is a gutted bill. A lot of people really voted against their own well-being, and it's sad."
Knudson thinks there have to be options for those who don't have the financial means of securing good insurance.
"We have to have options for people who can't afford private care," she said.
Olde Towne Medical Center handles more than 15,000 patients a year. In a January city council meeting, Mann said the center could handle up to 3,000 more patients and that they welcome any and everyone.
Olde Towne plans to add a pharmacy and seek more volunteers, among other changes.
"I'm always looking for volunteers. We rely very heavily on volunteer doctors and dentists," Bill Mann said.
Wright can be reached by phone at 757-345-2343.
You can make an appointment or walk in.
Olde Towne Medical Center
Phone: (757) 259-3258
Address: 5249 Olde Towne Road
Monday, Wednesday, Friday 8:30 a.m. to 5:00 p.m.
Tuesday, Thursday 7:00 a.m. to 7:00 p.m.
Phone: (757) 886-0608
Address: 1620 Old Williamsburg Road Yorktown
Hours: Monday-Wednesday 8:30 a.m. to 5:00 p.m., Thursday 8:30 a.m. to 7:30 p.m, Friday 8:30AM-12:00PM