On a cold and rainy Saturday morning, hundreds of people have camped out all night in cars or huddled in sleeping bags, splayed out in a school parking lot that has been turned into a makeshift medical clinic in Charleston, West Virginia.
By the time the doors open at 6 a.m., some will have been waiting for at least 14 hours to receive medical, dental, and vision care at this free mobile health clinic. Most here say they have no other health care option.
"I've never had health insurance - never," says Benny Cardenas, a construction worker who constantly worries he is an injury away from being in long-term debt. "This here, it's free. It's worth the sacrifice - a couple hours of no sleep (rather) than paying thousands of dollars."
Susan Stephenson, a truck driver from Houston, Texas, is already missing most of her upper teeth. Though she has medical insurance, she can't afford to go to the dentist. "The copay is so outrageous, it's like not having insurance at all," says Stephenson, who drove four hours to attend the RAM Clinic.
Insurance problems persist
Stephenson's story is common. Most Americans get health insurance through their employers, or through government-provided insurance for older and lower-income people. Millions of other people have received health insurance in recent years under the Obama administration's Affordable Care Act. But many still cannot afford basic dental or vision services.
Since the 2010 passage of the legislation known as "Obamacare," the uninsured rate has fallen from 16 percent to less than 9 percent, according to figures by the Centers for Disease Control and the U.S. Census Bureau.
But 23 percent of Americans have no dental coverage, according to the National Association of Dental Plans.
Even with insurance, costs can be prohibitive. Over 44 percent of Americans report difficulty paying for dental care and 11 percent of adults age 18-64 have foregone needed dental work altogether because of costs, according to a recent CDC study.
Ashley Bowman, who needs two cavities filled, has a state-subsidized health care plan, but it doesn't include dental coverage. "I'm not sure why," she says. "It just doesn't."
So she's huddled under an awning with several of her friends in the middle of the night - a small price to pay, she insists. "Just for one filling, that's already half your rent! That's a lot just for one tooth."
Partisan deadlock over voters' top issue
Perhaps unsurprisingly, health care is a major priority for U.S. voters. According to exit polls taken during midterm elections, 41 percent of voters identified health care as their top concern - beating out every other issue, including immigration and the economy.
It's not hard to see why. The U.S. spends approximately twice what other high-income nations do on health care, yet has the highest infant mortality rate and the lowest life expectancy, according to a March study published in the Journal of the American Medical Association.
The high costs are not because Americans are getting more medical care. Rates of doctor visits are roughly equal to the 10 other countries in the study. Instead, it concluded health spending is being driven by factors including the steep costs of prescription drugs, administrative tasks, and physician and nurse salaries.
But any legislative movement on health care appears more unlikely than ever after the election, which saw Democrats take back the House of Representatives, creating a divided Congress.
Many Republicans have called for a complete repeal of Obamacare, but would not be able to get such a plan through the Democratic-controlled House.
More liberal-leaning Democrats have increasingly proposed a "Medicare for All" program to expand government-run health care plans to cover all Americans. But Republicans fiercely oppose the proposal, saying it amounts to an inefficient government takeover of health care.
RAM filling the gap
Amid the partisan deadlock, privately-funded clinics like the one in West Virginia continue to provide free health care to as many people as they can across the country.
Each year, Remote Area Medical operates more than 60 mobile medical clinics. About 90 percent are in the U.S., mostly in rural areas.
RAM founder Stan Brock started holding the clinics in the 1980s in developing Latin American countries, such as Guyana, Mexico, and Haiti. It didn't take long before he realized one of the biggest needs was at home.
"You can blindfold yourself and put your finger on the map of the U.S. and we could go there and this will happen there," says RAM's Robert Lambert. "The need is just huge."
At this two-day clinic in Charleston, RAM provided about $300,000 worth of free medical care to 775 patients. That figure may be small when compared to the vastness of U.S. health care problems. But for people here, it's a lifesaver.
"If I didn't have a place like this to get my glasses, I'd be totally lost," says Rosemary Pauley, a retiree who says she's "blind as a bat."
"I'd be sitting at home doing nothing," she says.