Midterm Voters Split on Abortion and Trans Healthcare Ballot Questions

ST. LOUIS — Voters’ sweeping support of Democratic candidates in Tuesday’s midterm election didn’t translate into similarly clear outcomes for ballot initiatives on abortion access and transgender issues.

In Missouri, a state that President Donald Trump carried by an 18-point margin in 2024, voters rejected a proposal to ban both abortion and gender-affirming healthcare for transgender minors.

Opponents of the measure celebrated the result with a mix of cheers, tears, hugs, and dancing at an election night watch party in St. Louis — as many of the same people had done only two years earlier when Missouri voters enshrined abortion protections in the state constitution.

But in Washington state, which Trump lost by 18 percentage points in his most recent election, voters appeared to back a measure restricting trans kids’ participation in youth sports, with 60% of votes counted on Wednesday.

Masaki Yoshikawa phone banks for Let’s Go Washington, a group backing Initiative 638, which would prohibit transgender girls from competing in girls’ sports, on Oct. 19, 2026, in Bellevue, Washington. (Lindsey Wasson/AP Photo)

Voters also supported proposed restrictions on trans athletes in youth sports in Arizona and Nebraska. And as of Wednesday afternoon, similar restrictions as well as a ban on gender-affirming surgery for minors were leading in Colorado with about 80% of votes counted.

And while voters in Virginia and Nevada backed abortion protections, Idaho voters rejected them.

“Each state also has its own culture,” said Alina Salganicoff, director of Women’s Health Policy at KFF, a health information nonprofit that includes KFF Health News.

Missouri provides insight into voters’ motivations and thinking about the two separate but related issues. While political messaging in other states, including Virginia and Idaho, tied abortion and trans issues together, Missouri was the only state where the two were explicitly combined into a single ballot measure.

The measure that Missouri voters rejected Tuesday is part of a years-long battle over abortion access in the state. Missouri was the first state to ban abortion after the U.S. Supreme Court overturned federal abortion protections with its 2022 decision in Dobbs v. Jackson Women’s Health Organization, leaving each state to make its own abortion policy.

In 2024, Missouri voters overturned the state ban by passing a ballot measure adding abortion protections to the state constitution. Opponents of that measure argued it would also allow a state ban on gender-affirming care for minors to be overturned. The abortion measure passed by fewer than 100,000 votes while Trump carried the state by over 550,000.

Two years later, the state’s Republican-dominated legislature asked voters to reconsider, with this year’s measure to repeal the 2024 abortion protections.

The initiative also would have barred minors from gender-transition surgery, cross-sex hormone therapy, and puberty blockers. The legislature had already permanently blocked minors’ access to gender-affirming surgeries and temporarily blocked their access to new prescriptions for puberty blockers and cross-sex hormones until August 2027. The amendment would have enshrined those bans in the state constitution.

“Tonight is a loss for women, a loss for children, and a loss for life,” James Lawson, campaign manager for Her Health, Her Future, which supported the bans, said in an election night statement. He noted the campaign had built a coalition of doctors, pastors, parents, and volunteers and would continue its advocacy.

A survey of midterm voters by the NORC research organization, with questions from KFF, shows abortion was the stronger motivator of the two issues in Missouri, especially among those opposed to the proposed bans.

Of residents who voted against the measure, 59% said abortion policy was more important to their vote, while 33% said abortion and trans care for minors were equally important. The survey also found that 40% of voters opposed to the combined bans are supportive of restricting gender-affirming care while opposed to repealing abortion rights.

Of the voters who supported the bans, 26% said abortion was more important, 60% weighted the two equally, and 11% said trans care for minors was more important.

“This is the first time we saw these two issues linked,” KFF’s Salganicoff said. And while a sizable minority might be split on the two issues, “it’s not enough to move the needle on abortion rights when you have support in a state.”

Lindsey Dawson, director of LGBTQ Health Policy at KFF, said the Missouri survey data and broader election results across the country also appear to indicate that attempts to politicize trans care may not be as electorally significant as some had thought.

Outgoing Florida Gov. Ron DeSantis, a Republican, seemed to agree, telling reporters Nov. 4, “I knew Republicans were in trouble when I was reading an overview about what were they running ads on, and they’re spending hundreds of millions of dollars across the country on transgender ads.”

That may have been effective four years ago, DeSantis said, but during this election, it “was kind of like an attempt to just scare Republicans to vote.”

At the St. Louis watch party for the coalition opposing the proposed Missouri bans, Shira Berkowitz of the LGBTQ+ advocacy organization PROMO Missouri credited the group’s canvassing campaign with helping to sway ambivalent Missouri voters.

The group’s effort included a team of trans Missourians who went door to door to share their personal stories, answer questions, and try to have “transformative” conversations.

“We proved so powerfully that our visibility is not a liability,” Berkowitz said. “We weren’t just running a campaign; we were writing a playbook. What we built here in Missouri, we built to last.”

Shira Berkowitz of the LGBTQ+ advocacy organization PROMO Missouri addresses an election night watch party following the defeat of a constitutional amendment that would have banned most abortions and trans healthcare for minors in the state. (Bram Sable-Smith/KFF Health News)

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

This article first appeared on KFF Health News and is republished here under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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Democrats’ Election Rout Is Poised To Dramatically Reorder Federal Health Policy

Democrats’ decisive sweep of the U.S. House and Senate in Tuesday’s elections will reshape the direction of federal health policy — setting the stage for oversight investigations, a legislative push to reverse cuts to the Affordable Care Act and Medicaid, and a focus on lowering costs such as insurance premiums and drug prices.

The conclusive string of victories sets up Democrats to argue that voters — who said in preelection surveys that healthcare affordability was a top concern — have given them a clear mandate to overturn historic cuts President Donald Trump and Republicans made to public healthcare programs.

The breadth of success, including wins by Sen.-elect Abdul El-Sayed of Michigan and other progressives, is likely to embolden some Democrats to forge ahead with ambitious policy proposals such as expanding Medicare, the federal insurance program for people age 65 and older, to cover all Americans. Their plan is to be positioned as the party that prioritizes lowering healthcare costs for the 2028 presidential election.

Party leaders, though, will need buy-in from Trump to advance any healthcare agenda. While he has veto power, he may be interested in brokering legislative deals as he seeks to cement his legacy and deflect fallout from investigations into his administration’s handling of the war against Iran, mass deportations, contracting scandals, and other controversies.

Democrats were projected to win at least 237 of 435 seats in the House and at least 54 Senate seats as of Wednesday afternoon, according to The Associated Press. Several key races remained unresolved, including Senate contests in Alaska and Mississippi.

As election results continued coming out into early-morning Wednesday, Trump said in a phone interview with Politico that he had spoken with Democratic Party leaders and that voters had sent a message he must work with them “to make sure things go well for our country.”

“I don’t want to just be sitting there for two years vetoing everything,” Trump said. “They want to see things happen, too.”

But how Trump’s new conciliatory position plays out in undoing GOP-led changes, such as new work requirements for many adults enrolled in Medicaid, the state-federal program for low-income and disabled people, remains to be seen. Republicans touted their overhaul of Medicaid and other changes to health programs wrought by their One Big Beautiful Bill Act as signature achievements in midterm campaigns.

Democrats, however, will have to carefully balance their policy moves against their desire to investigate a host of concerns surrounding the nation’s top health official, Robert F. Kennedy Jr., who has dismantled U.S. vaccine recommendations, gutted the staff of federal health agencies, and cut public health funding.

“Democrats will put forward an expansive healthcare agenda, including reversal of cuts to Medicaid and the ACA, but achieving all of that will be impossible with President Trump still in the White House,” said Larry Levitt, an executive vice president at KFF, a health information nonprofit that includes KFF Health News.

New Year, New Congress, New Majority

An early order of business for Democrats in 2027 will likely be a legislative push to restore enhanced subsidies that reduced the price millions of people paid for Obamacare health plans. The larger subsidies were created during the covid-19 pandemic, as part of economic relief programs, but ended last year after Trump and the Republican-controlled Congress declined to extend them.

Rep. Hakeem Jeffries of New York, the current Democratic House leader widely expected to become speaker of the House, told CNN on Wednesday that the party should bring back the subsidies to help struggling families.

“My guess is it would be rolled into a broader budget negotiation or package that may or may not involve other healthcare priorities, like restoring Medicaid cuts or other things that are priorities for Democrats,” said Sabrina Corlette, a co-director of the Center on Health Insurance Reforms at Georgetown University.

If they act decisively, said Leslie Dach, who chairs the Democratic-aligned advocacy group Protect Our Care, Democrats could both renew the ACA’s expired subsidies and extend the enrollment period for 2027 coverage, which ends in most states on Jan. 15, shortly after the new Congress is scheduled to be sworn in.

They would need to act within days of assuming control, Dach said.

“Congress will be sworn in during open enrollment, at a time when people will be having to make difficult and horrific choices about their healthcare, given the further increases in premiums due to the Republicans,” he said.

Premiums for Affordable Care Act benchmark plans are set to increase by an average of 13% for 2027, according to KFF researchers.

With Congress likely to pass another short-term government funding bill in December, the stage will be set for incoming lawmakers to also fight a battle over Medicaid spending cuts in the spring, said Rodney Whitlock, a healthcare consultant who previously worked for Republicans in Congress.

Democrats — many of whom put healthcare affordability at the center of their election campaigns — are now well positioned to place that issue at the center of negotiations with Trump over federal spending.

“If you’ve got the opportunity for a battle in March over fiscal year funding — and Democrats picking and choosing what they want to make this first battle about with a unified, controlled Congress with the president — damn, doesn’t it scream healthcare?” Whitlock said. “Doesn’t it scream repeal or delay all the Medicaid cuts?”

Allison Orris, a partner at Manatt, advised clients before Election Day not to count on anything changing — even with Democrats in control.

“The White House ultimately will have to sign any legislation, and HR 1 was a signature accomplishment. It will cost money to undo or even just delay changes that were enacted in 2025,” she said, referring to the One Big Beautiful Bill Act.

What Else Could Happen?

Trump is likely to continue leaning heavily into executive actions to shape health policy from the White House. Democrats, meanwhile, will use their control of Congress to exercise oversight of the Trump administration and the Department of Health and Human Services.

Jeffries, the House Democratic leader, has promised the party will “hold the crooks accountable” by pursuing aggressive oversight of the Trump administration. Democrats on the House Committee on Oversight and Government Reform put out a report in June previewing investigations they may launch.

Specifically, Democrats want to zero in on clandestine drug-pricing deals Trump has made with pharmaceutical companies in return for relief from certain tariffs. No contracts or paperwork on the agreements have been made public. They also claim he benefited from stock prices that rose when companies received exemptions from price negotiation in Medicare under the 2025 GOP tax and spending law.

By taking control of congressional committees, Democrats will gain subpoena power, an important investigatory tool. But it’s unclear whether they can successfully pry documents from the government or companies because the Department of Justice, under Trump, is largely in charge of enforcing subpoenas. Nevertheless, subpoenas are likely to be issued regarding investigations into tariffs Trump has imposed and threatened to impose on prescription drugs.

Democratic congressional leaders will also be able to file lawsuits against the Trump administration to challenge the White House’s actions.

Democrats also have telegraphed plans to probe scientific decision-making around such controversial issues as allowing more sales of flavored vapes and White House promotion of the herbicide glyphosate — and any connections these actions have had to political contributions from companies.

Other industry oversight by Democrats would likely focus on preauthorization denials by insurance companies; scrutiny of Medicare Advantage, an alternative program to traditional Medicare run by commercial insurers; and the use of artificial intelligence in medical decision-making.

Also looming is a wider discussion of universal health coverage, including partial steps such as expanding traditional Medicare benefits to include dental and hearing care and lowering the Medicare eligibility age to 60 or younger.

Expanding the program to cover all Americans faces formidable challenges, even if Trump were open to it. Much of the nation’s healthcare industry — including doctors, hospitals, and insurers — would surely fight any legislative effort, and Democrats have never seriously grappled with the enormous implications of such a proposal for the federal budget, taxes, medical care, and broader society.

Other possible initiatives include implementing a federal solution to address the 10 states that have opted not to fully expand Medicaid to cover lower-income adults, as well as allowing children to remain on their parents’ health insurance policies beyond age 26.

Because the new Congress is not set to be sworn in until January, a lame-duck session through year’s end, for which Republicans retain the majority, will focus on funding the federal government and addressing some health programs set to expire.

One major move Congress is expected to make soon: a confirmation vote for Heidi Overton to lead the Food and Drug Administration, which has been without a top leader since May. Her confirmation is not guaranteed, however, with Democrats uniformly in opposition.

A handful of Republicans have questioned whether she will sufficiently restrict access to medication abortion, while some more moderate Republicans have expressed concerns, too — including Sen. Bill Cassidy of Louisiana, who questioned whether Overton supports the administration’s changes to vaccine recommendations.

Cassidy lost his seat after Trump endorsed a Republican primary challenger, Rep. Julia Letlow, who narrowly won election to the Senate on Tuesday.

Other issues enjoy bipartisan support, such as preventing cuts to Medicare payments to doctors, scheduled to begin Jan. 1, and making fixes to the No Surprises Act, a federal law that took effect in 2022 to protect consumers with private insurance from unexpected, out-of-network charges. But movement would be a long shot.

“Everyone gets hyped up for lame ducks, and they’re always a disappointment,” said Doug Holtz-Eakin, an economist and the president of the conservative-leaning American Action Forum.

But come January, Washington will need to find a way to work together to make healthcare more affordable — or risk ire from voters who have consistently ranked it as one of their top issues in recent elections, noted Matt Hogan, a partner at Impact Research, a Democratic polling firm.

When put together, healthcare and prescription drug prices are the top cost concern for voters older than 50, he noted.

Reining in prescription drug prices could be an area with bipartisan support — including from Trump, who claimed ahead of the midterms that lowering some drug prices was one of his administration’s greatest achievements. Both parties have proposed limits on pharmacy benefit managers, which negotiate drug prices on behalf of insurers and employers; patent restrictions for certain drugs; and the benchmarking of U.S. drug prices against the prices other countries pay.

“This is the third-straight election that’s really been focused on affordability,” Hogan said. “If members of Congress haven’t got the message yet, I expect them to now.”

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

This article first appeared on KFF Health News and is republished here under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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IVF Patients, Doctors Navigate Fetal Personhood Laws’ Unknowns

In the summer of 2022, Allison Mertzman and her wife, Leanne, asked their fertility clinic to destroy their embryos.

The married couple were living in California but storing their nine embryos for $3,000 per year at the clinic in Michigan, where Mertzman had resided before. After having two daughters through in vitro fertilization, the couple had decided they wanted more children. But Mertzman was diagnosed with breast cancer in 2021, and the women were waiting for a better time for implantation.

Then, in June 2022, the U.S. Supreme Court’s Dobbs decision overturning the constitutional right to abortion triggered laws in several states establishing “fetal personhood,” or legal rights for embryos beginning at fertilization. The couple wondered: If their frozen embryos were damaged while being moved across states with personhood laws, perhaps because of failed temperature controls, what would the legal ramifications be?

For the then-37-year-old Mertzman and her wife, state abortion and fetal personhood laws had a chilling effect: They chose not to take the risk.

“I was strong-armed into destroying my embryos,” Mertzman said. “I wasn’t ready to implant them for multiple reasons, but overturning Roe v. Wade was the tipping point.”

The laws aren’t just triggering confusion and anguish among IVF patients like Mertzman; they’ve also left clinicians who are tasked with making, storing, testing, and discarding embryos afraid they could face liability.

Fertility doctors worry that the new abortion laws will criminalize standard fertility care and expose them to felony charges or wrongful death lawsuits that are not covered by medical malpractice insurance policies.

Doctors who provide or assist with illegal abortions in states that have bans, such as Texas and Alabama, already face civil penalties of $100,000 or more, revocation of their medical licenses, or prison, including a potential life sentence. Thirteen states have total or near-total abortion bans.

At least 24 states have put some form of fetal personhood language directly into their abortion restrictions or broader civil or criminal statutes. Alabama, Georgia, Louisiana, and Missouri have some of the most sweeping fetal personhood laws related to pregnancy and embryos. In Louisiana, IVF embryos cannot be intentionally destroyed.

Allison Mertzman (left) and her wife, Leanne, wanted more children after having two daughters through in vitro fertilization. But when several states established legal rights for embryos beginning at fertilization, they chose to stop pursuing IVF. (The Mertzman family)

“I think when you have states define personhood at any stage of pregnancy, it opens the door for liability,” said Jessica Waters, a senior scholar in residence at American University. “We’re seeing states try to even criminally charge doctors from other states, so it’s not so far a reach that we will see IVF doctors have liability.”

Waters said standard IVF practices, such as discarding abnormal embryos, or mechanical errors that occur when flash-freezing embryos could also result in lawsuits under wrongful death statutes. These are all “real possibilities,” Waters said.

She said she hopes to see more efforts by states and the federal government to protect IVF doctors from these laws.

“Trump declared himself an IVF president, but under his watch in post-Dobbs, what we’re seeing is a climate where people engaged in reproductive healthcare can’t do their jobs,” Waters said. “I think it really interferes with the good practice of medicine.”

When asked for comment about a lack of prosecutorial safeguards for IVF doctors, White House spokesperson Olivia Wales touted President Donald Trump’s efforts to make IVF more available and less costly. Trump this year proposed a rule that would allow employers to voluntarily expand coverage of fertility benefits, including IVF treatments.

“No president has done more to help Americans struggling to start families than President Trump, whose administration has created a new fertility benefit option and slashed the cost of fertility drugs,” Wales said. “The administration will continue to explore additional policies to build on these historic successes.”

Legal Risks for IVF Doctors

In the meantime, the state laws are prompting doctors to seek more legal consultations, a costly step that can add to their financial pressures.

IVF clinics may also face surging insurance premiums and legal compliance costs in the most restrictive states, said Benjamin McMichael, a professor focused on healthcare law at the University of Alabama.

“We have gone from ‘Embryos are property’ to ‘Embryos are people,’” McMichael said. “And that could change the nature of underlying tort damages, because, certainly, the average person is worth more than property.”

For anti-abortion activists, the difference between an embryo and a person is negligible.

“Personhood laws ensure that there are no arbitrary distinctions about which human lives are acceptable or unacceptable,” said Emma Waters, a senior policy analyst for the Heritage Foundation, which has helped craft fetal personhood laws. “They underscore that the human embryos we create have a right to life.”

Alabama is the only state that gives broad civil and criminal immunity to doctors and allied professionals providing IVF care. Last year, Louisiana enacted legislation protecting clinicians providing IVF care from criminal liability.

That still wasn’t enough to calm Nicole Ulrich’s nerves. Ulrich, director of advocacy at the Fertility Institute of New Orleans, said she avoids even discussing the option of destroying embryos with patients, because Louisiana forbids intentionally destroying embryos left over from IVF treatment.

“My concern is being charged with murder or manslaughter,” Ulrich said. “The new law protects you but is not foolproof or ironclad. It still makes everyone a little nervous.”

She said she explains to patients at the outset that her clinic is not set up for long-term storage. Once embryos are out of state, patients can discuss with their transfer company what to do with embryos.

Some doctors who try to navigate this legal landscape differently fear the consequences. Damla Karsan, founder of Comprehensive Women’s Healthcare in Houston, said performing or aiding an abortion is almost always illegal in Texas. Yet she tries to stay true to the oath she took when she became a physician to help the sick and do no harm.

“I’ve helped multiple patients find care out of state,” Karsan said.

IVF doctors are seeing the changes at their practices. Clinicians say they spend more time counseling patients and answering their questions than before the Dobbs decision took effect.

Patients want to know whether they can limit the number of eggs they make and fertilize during IVF, to limit their liability risk, said Karenne Fru, the founder and medical director at Muna Fertility in Georgia. They want to know whether they are liable if an embryo doesn’t survive the freezing or storage process. They ask what will happen if pre-implantation genetic testing damages their embryos, whether they can transfer multiple embryos all at once, and how to handle miscarriages and ectopic pregnancies.

All the questions are “burdening my staff and myself,” and then some patients decide not to do IVF, Fru said.

But Fru said she makes some adjustments in certain IVF protocols to accommodate patient fears. Sometimes she can stop stimulating a woman’s egg production a day or two earlier than usual, to limit the number of mature eggs they make by 30% — “to optimize outcome but limit risk,” she said.

Patients’ Emotional, Psychological Fallout

When insurance companies and physicians are confused over whether procedures are legal, it can result in delays of necessary or emergency medical treatment and mental anguish for patients. The Heritage Foundation’s Emma Waters said she is “deeply grieved” that women have been made to feel they won’t receive proper medical care because of abortion laws.

Julie Cohen, a senior program manager at the Jewish Fertility Foundation in Birmingham, Alabama, found out eight weeks into her pregnancy in July 2022 that her “baby girl” had lethal anomalies. But at the appointment to sign paperwork for the hospital procedure to deliver her, Cohen said, her insurance company informed her it wouldn’t cover it and she might owe an estimated $20,000. The company thought it wasn’t legal under the state’s abortion ban, despite the state allowing the procedure for lethal fetal anomalies, Cohen said.

The company eventually reversed its denial, but “it was absolute agony to wait,” she said. “I couldn’t imagine what it could be like if someone didn’t have the resources or connections I had.” She was expecting a son by surrogacy this fall.

Lauren Hock had pursued IVF just as Alabama’s abortion and fetal personhood laws unfolded. Her first appointment at the fertility clinic was in June 2022, days after the Dobbs decision. She gave birth to a son in December 2023, two months before Alabama enacted its personhood law.

Lauren Hock had pursued IVF just as Alabama’s abortion and fetal personhood laws unfolded. She gave birth to a son in December 2023, two months before Alabama enacted its “fetal personhood” law. (Dakota Argo)

Then, in August 2025, the 34-year-old accountant was 14 weeks pregnant, again by IVF, when she started to hemorrhage. If the situation became life-threatening, her doctor told her, the state’s abortion ban meant the hospital would have to approve a procedure to end the pregnancy.

Four weeks later, she began hemorrhaging again. This time, the fetus died. So Hock’s doctors no longer needed permission for the procedure.

“People are failing to understand how dire these situations can be and how personal, high-stress, and emotional they could be,” Hock said. “I would have done anything to save my baby at that point, but I also could have lost my life with my baby’s life.”

Hock tried again, because she wanted a larger family. She is expecting her second child by IVF in March.

But the laws are making some women rethink their reproductive choices.

“More and more patients are coming to me scared and need help with decision-making,” said Lauren Berman, a clinical psychologist in Atlanta and a former committee chair with the American Society for Reproductive Medicine. “They wonder if they should move, get pregnant, or even have children after all.”

The new laws have also led many doctors to leave states with the strictest abortion and personhood laws.

According to a study published last year, after the Dobbs decision the number of OB-GYNs in the most restrictive states significantly decreased compared with states with no abortion restrictions.

With the Trump administration attacking nondiscrimination protections for LGBTQ+ people, Mertzman and her wife feared that their parental rights were also at stake. LGBTQ+ parents face significant legal hurdles and varying state laws for establishing parentage through assisted reproduction, said Sonia Suter, the Kahan Family Research professor at the George Washington University Law School.

“In this environment where there’s a lot of antipathy towards nontraditional families, any LGBTQ+ family has legitimate concerns,” Suter said.

Mertzman said she doesn’t regret her decision to have her embryos destroyed.

“I think there were parts I grieved,” she said, “but in the current day and age, I’m confident we made the right choice.”

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

This article first appeared on KFF Health News and is republished here under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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A Few Miles From the US Capitol, Dozens Slept in Their Cars, Waiting for Free Care

TAKOMA PARK, Md. — Friday night lights took on a whole new meaning at a high school here in this suburb of Washington, D.C.

Instead of fans packing stadium bleachers to watch football, on this recent October weekend the gymnasium, hallways, and parking areas were jammed with people desperately seeking healthcare at a free pop-up clinic.

The 2026 election season has been punctuated by affordability issues, with polls showing high healthcare costs are a top concern among likely voters. The staggering toll of people struggling to get care was on full display here just eight miles northeast of the U.S. Capitol — in an area where census data shows the median household income tops $108,000 and about 94% have health insurance.

Dozens of people slept in their cars overnight outside Takoma Academy to secure spots for free health, dental, or vision care, according to clinic coordinators and interviews with patients.

Though clinic doors were scheduled to open at 6 a.m. Oct. 17, the first patients drove up shortly before midnight. By 4 a.m., three hours before sunrise, about 80 cars had arrived. Patients were given numbers representing their place in line when they entered the parking lot, and they had to be on site when they were notified by text message that it was their turn.

(Eric Harkleroad/KFF Health News)

Kenys Bautista arrived at the school before midnight after driving 20 minutes from her home in Wheaton, Maryland. She wanted to be sure she got the medical and dental checkups that she had put off for three years because she didn’t have insurance or the money to cover the costs.

“It’s really sad that a lot of people like me had to sleep in their car just to see a doctor or dentist because we do not have health insurance,” Bautista said. She works as a payroll specialist for a small company but does not get any health benefits.

Bautista was one of 467 patients at the weekend clinic. Most received dental and/or medical care. Ninety-nine got vision exams, and many left with new eyeglasses, according to clinic organizers.

While most patients at the clinic were uninsured, 1 in 4 had health coverage, such as through Medicare or their employer. But many said just having coverage was not enough, because it left them with unaffordable out-of-pocket costs .

“I never thought I would need a clinic like this, but it’s gotten so expensive in the world,” Alma Walton said. She has Medicare, but routine dental care is not a standard benefit.

Walton, who lives in Camp Springs, Maryland, was 59th in line for care. She arrived around 1:30 a.m. “I wanted to make sure I could get in,” she said. She went to the clinic in hopes of getting a filling fixed after it cracked over the summer. She had postponed seeing a dentist.

Around 11 a.m., Walton was in one of the 30 dental treatment tents set up in the large gymnasium, having her filling replaced.

“You got here just in time,” John Renzi, a dentist volunteering at the clinic, told her just before he began drilling. “Any longer and this tooth would have been a goner.”

Dentist John Renzi replaces a cracked filling for Alma Walton. (Eric Harkleroad/KFF Health News)

The clinic was organized by Remote Area Medical, a Tennessee-based nonprofit that says it has provided free healthcare to more than a million patients over its 40-year history. The clinics initially targeted rural areas, such as in Appalachia, traditionally home to some of the poorest and least insured communities in the country.

In recent years, the organization has branched out into urban and suburban areas — such as around the nation’s capital, Baltimore, and Philadelphia — where having insurance is more common. The clinics rely on doctors and dentists donating their time.

At the Takoma Park event, more than 300 dental, medical, and vision professionals volunteered along with members of the U.S. Public Health Service.

According to a survey by Remote Area Medical, nearly 40% of patients here said they had not seen a dental provider — other than one provided at a RAM clinic — in at least two years.

And nearly two-thirds said they did not have a usual place for seeking care other than a hospital emergency room.

Over 700 people volunteered to help at the free clinic. (Eric Harkleroad/KFF Health News)

According to a survey by Remote Area Medical, nearly 40% of clinic patients said they had not seen a dental provider — other than one provided at a RAM clinic — in at least two years. (Eric Harkleroad/KFF Health News)

Dana Bensinger, a nurse specialist working at the medical care clinic, said many patients had high blood pressure or diabetes. They were given prescriptions for a 90-day supply of pills and told to connect with community health centers or free clinics where they can get free or low-cost primary care.

“We have seen a lot of folks who lose insurance or are not able to keep it, and so they can’t get their prescriptions renewed,” he said.

Many patients at the clinic showed up to get a tooth extraction — and with it, relief from dental pain.

“We call it point-and-pull dentistry,” said Tom Ritter, a retired dentist who was triaging dental patients. “You point to the tooth you want out, and we take it out.”

Tom Ritter, a retired dentist, triaged dental patients at the free clinic. He examined Josefina Guel’s teeth, and she later received a filling. (Eric Harkleroad/KFF Health News)

A clinic volunteer shows a jar of patients’ extracted teeth. “We call it point-and-pull dentistry,” Ritter says. “You point to the tooth you want out, and we take it out.” (Eric Harkleroad/KFF Health News)

Dentist Marsha Plater fills a cavity for Josefina Guel with help from dental assistant Anusha Patlola. (Eric Harkleroad/KFF Health News)

The dilemma, he said, is patients often need multiple teeth extracted and the volunteer dentists have only limited time for each patient. “We have to spread the love around because we have a busy schedule.”

Michel Boudreaux, an associate professor at the University of Maryland Department of Health Policy and Management, said the RAM clinic, about 5 miles from his campus, highlighted the growing difficulty people with and without health insurance face.

“Even in this suburban county there are a lot of uninsured people struggling with affordability and insured people struggling with high deductibles and copays,” he said.

Boudreaux called it “disheartening” that people felt they had to sleep in their cars overnight for care.

Having a government job with benefits was once seen as way of immunizing one’s family from rising health costs.

Cheromie Johnson, who works for the District of Columbia, said that recent dental work left her with a $12,000 bill.

She came to the clinic with her 6-year-old son, Cairo, to get eye exams. She was hoping they would each get a new pair of eyeglasses.

“This is very important, especially for him in school, and I drive, so we both need to see clearly,” Johnson said. She estimated the free vision care would save them more than $1,000.

Cheromie Johnson’s 6-year-old son, Cairo, receives an eye exam at the clinic. (Eric Harkleroad/KFF Health News)

Ryan Shaw, a physician assistant student, checks Cairo’s eye pressure. (Eric Harkleroad/KFF Health News)

An assortment of frames provided free to vision patients at the clinic. The clinic made 152 pairs of eyeglasses for 99 patients. Some received reading and distance glasses. (Eric Harkleroad/KFF Health News)

When asked what this busy free clinic said about the state of U.S. healthcare, she said: “It’s poor, and it needs to be revamped. But we all know that.”

John Osborn, dental director for RAM, was taking a break on a balcony that overlooked the gymnasium, now peppered with treatment tents and mobile equipment that had transformed the space into something from the TV show M*A*S*H from decades ago. He was not surprised to see people showing up on a Saturday morning for care. Over the past 35 years, he’s seen similar scenes at RAM’s clinics across the country.

He only wished that some members of Congress would have come by to bear witness.

“It would have been nice for them to see what people have to do to get healthcare,” he said.

A patient has dental work done at the clinic. (Eric Harkleroad/KFF Health News)

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

This article first appeared on KFF Health News and is republished here under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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