This article about Representative Abigail Spanberger’s visit to the Free Clinic of Culpeper may also be read at

Written by Clint Schemmer

U.S. Rep. Abigail Spanberger heard plenty about health-care issues Tuesday and Monday as she barnstormed across Virginia’s 7th Congressional District to listen and talk to professionals and patients.

There were two big takeaways. First, Virginia’s Medicaid expansion, instituted by the General Assembly last year, is greatly reducing—by about a third—the number of people who are seeking care at the state’s 60-or-so free clinics.

Second, people are expressing great alarm at the skyrocketing price of insulin. Virtually everywhere Spanberger went, constituents mentioned it. The issue arose in Orange, Culpeper, Henrico and Powhatan.

“At the free clinics, Abigail heard about it from volunteers and providers,” a senior Spanberger aide said Tuesday night. “In Henrico, we heard it from patients and seniors themselves.”

At the Free Clinic of Culpeper, Director Chris Miller told the congresswoman that Medicaid is changing its patient population.

In 2018, the clinic served 615 patients. This year, after Medicaid expansion, it has helped 402 people, and those patients are trending younger, with the largest group between 35 and 42 years old, Miller said.

Every month, the clinic’s staff sees 15 to 20 new patients, about 40 percent of whom are Medicaid-eligible, she said.

If not for Medicaid, the clinic would have to start a waiting list to help the same number of patients, Miller said.

Of its patients, 40 to 45 percent are likely eligible for Medicaid based on their income, she said.

The clinic’s nurses and doctors “are probably the first people to tell these patients that they’re eligible for Medicaid,” Miller told Spanberger. “Many of them have not been in to see a doctor in years, if ever.”

Typically, these individuals don’t have health insurance, and don’t know what health-care assistance is available to them, she said.

“These are folks busy raising their families,” Miller said. “They’re investing everything they’ve got into their kids.”

Thanks to a state grant, the clinic helps patients navigate the cumbersome process of applying for Medicaid, which takes months to complete.

But at the free clinic beside Culpeper Medical Center, patients find a full array of medical services provided largely by volunteers, whether nurses, doctors or pharmacists.

“The big secret is how much Culpeper Medical Center supports us,” Miller said. The hospital provided nearly $2 million in free services to the clinic last year—the building, utilities, housekeeping, maintenance, and computer support.

The hospital also provides all the medical imaging and laboratory blood analysis for patients from the clinic, which opened in 1992.

“We appreciate your coming and becoming more aware, both of the issues and the great work that free clinics do,” Miller told Spanberger. “We don’t want people in Virginia to become complacent and think, you know, Medicaid expansion is perfect. There are still a lot more working families to be served.”

The congresswoman said, for family reasons, she has long been aware of the pressing needs met by free clinics in her district.

Spanberger’s mother is a nurse who used to volunteer at clinics in the Richmond area, and her youngest sister worked at one, she said.

Miller said Culpeper residents and groups join forces to help the county’s needier people.

“We always talk about this, but Culpeper people tend to do things together,” she told Spanberger. “We have, for instance, a cooperative of all our transportation providers that work on improving access, providing vouchers and gas cards and a van to take people from Culpeper to medical facilities at the University of Virginia. And we have a housing cooperative in the planning district’s five-county area that works to get grants and provide housing for people with disabilities and who need continuing care.

“Culpeper has a history of doing things collaboratively, and not worrying so much about county lines,” Miller said. “We’re lucky that way.”

Shari Landry, president of the nonprofit Powell Wellness Foundation, which governs the clinic, took part in Spanberger’s tour in Culpeper.

She urged more professionals and government officials to recognise the importance of how people’s living environment and social support affects their health.

“We find that, with some of the people our nurse are trying to keep out of the emergency room, that the problem might be loneliness, or it might be not knowing how to take your medications once you’re home,” Landry said. “The more we can look at ways to help people after they leave here and go home, the better. That helps make health care successful.”

Miller noted that, according to a recent Virginia Department of Health study, simple differences in access to health care mean a 10-year-difference in people’s lifespan. The study analyzed patients in the Richmond-area communities, living just seven miles apart.

Later Tuesday, Spanberger met for an hour with staff and board members of the Orange County Free Clinic. Dorren Brown, the clinic’s executive director, told her that the clinic is adding about 30 new patients each month. These are patients who don’t have Medicaid.

In the Richmond area, AARP Virginia shared data with Spanberger that shows how Virginians are being hit by high prescription-drug costs.

Twenty-nine percent of Virginians have stopped taking prescription medication due to cost, according to a 2016 analysis, AARP said.

From 2012 to 2017, for example, the price of cancer drug Revlimid has risen from $147,413 per year to $247,496; diabetes drug Lantus from $2,907 to $4,702 a year; and heart-disease drug Aggrenox from $3,030 to $5,930 per year, AARP said.

Some 767,000 Virginians have been diagnosed with cancer; 800,000 with diabetes or pre-diabetes; and 252,000 with heart disease, AARP said.

On her two-day district-wide tour, Spanberger met with local health-care professionals, providers, business owners, patients, seniors and veterans to learn more about the challenges facing 7th District patients, physicians and administrators. She toured several free clinics, visited health-focused businesses, attended a health-care open-enrollment event hosted by the Virginia Poverty Law Center, and met with staff and veterans at the VA clinic in Fredericksburg.

In Henrico County, Spanberger took part in a community forum with AARP Virginia to discuss the high cost of prescription drugs.

She began her tour Monday in Blackstone, Powhatan and Chesterfield. Tuesday’s stops included Culpeper, Orange, the Fredericksburg Community-Based Outpatient Clinic and the Pink Ribbon Boutique in Henrico.

Last month, the U.S. House voted 403-0 to pass Spanberger’s bipartisan legislation to help tackle the drug affordability crisis. Recently, she also introduced a bipartisan bill to stop harmful practices that block new generic alternatives from entering the consumer market.