WISE COUNTY, Va. (WYMT) - Last week, President Obama announced more than seven million people have signed up for healthcare coverage under the Affordable Care Act.
The law provides federal dollars for the expansion of Medicaid, which Kentucky and 25 other states accepted.
CBS's 60 Minutes came to Wise County in Virginia, one of the 24 states that refused to expand Medicaid, and explored how people are coping with the coverage gap.
Republicans in states like Virginia have opposed expanding Medicaid, saying the costs would be too high.
In Wise County, coal layoffs and widespread unemployment have hit hard. Doctors say they have exasperated already dire health outcomes in the region.
"This is a third world country of diabetes, hypertension, lung cancer, and COPD," said Dr. Joe Smiddy, a lung specialist who also serves as medical director for the Health Wagon.
Working in the coverage gap, some volunteer nurse practitioners drive the Health Wagon, an old RV converted into a mobile medical clinic, across six counties in the region, bringing treatment to those who could otherwise not afford it.
"They are people that are in desperate need, they have no insurance, and they usually wait, we say, until they are train wrecks," said nurse practitioner Paula Meade. "Their blood pressures come in at emergency levels. We have blood sugars come in five to six hundreds, because they can't afford their insulin."
Walter Laney has no insurance, and his out-of-control diabetes cost him his sight in one eye. He now receives treatment from the Health Wagon.
"They got my blood sugars back under control. Before this year, I was in the hospital three, four times. This year I ain't been in none since I've been seeing them. If it hadn't been for them, I don't think I'd be here today," he said.
Operating since 1980, the Health Wagon relies on federal grants, as well as corporate and private donations, to continue serving uninsured people struggling to get by.
Virginia's new Democratic governor wants the state legislature to expand medicaid to cover the gap, but resistance from the Republican-controlled House could lead to a shutdown of state government.