Rhonda Gibson tries to crack a smile with an ice pack on her face after she got a tooth pulled and was still feeling some pain. She's from Coeburn, Va. and has no dental insurance. (Michael S. Williamson/The Washington Post)

A gravel parking lot deep in the green hills of Virginia coal country was packed to capacity by 4 a.m. Friday. More than 1,500 people with canes, wheelchairs, oxygen tanks, bleeding gums, black lungs and other ills had come to the Wise County Fairgrounds, camping in tents, sleeping in pickup truck beds or scrunched up in their cars, hoping to see a doctor.

At midnight before the clinic opened, there were 1,204 people in line. And over the weekend, thousands more will come.

This is what health care looks like for many of the folks in this corner of southwest Virginia. And it will keep looking like this, thanks to state lawmakers who could have helped their most desperate constituents but instead blocked, bickered and weaseled until Virginia forfeited billions in Medicaid expansion funds. The result: More than 400,000 people who would have qualified for Medicaid coverage will continue to go uninsured.

This was hard for some of the people gathered here to stomach. They wish they could afford to go to a real doctor’s office to get their blood checked or their rashes examined rather than the cow stalls and tents of this free clinic. The Remote Area Medical clinic sets up here every year, with volunteers providing free dental, eye and medical care to those in need.

Its creator is Stan Brock, that guy us ’70s kids saw on “Wild Kingdom” chasing cheetahs while Marlin Perkins narrated. Brock saw poverty and need all over the world but was struck by the desperation he saw in America.

After registering, Gary Mudei of Mt. Carmel, VA struggles to get to the dental area as he was hoping to get some work on his damaged teeth. (Michael S. Williamson/The Washington Post)

So now he walks through the tent in his familiar khakis and perfect posture. “God Bless you, Stan Brock!” a woman in a wheelchair yells as he walks by. He nods and smiles.

RAM has become part of the culture here. The schedule is printed across the entire front page of the Clinch Valley Times, and parking signs direct the parade of cars that roll in at all hours, slicing the early morning country stillness with city-loud rush-hour traffic.

At the fairgrounds, the pre-dawn darkness is illuminated by hundreds of tiny, orange lights — burning cigarettes — like fireflies. The smokers double down, because once they get past the chain-link fence and through the cattle stalls, volunteers tell them that they can’t smoke in the clinic. And each medical tent — with rows and rows of chairs, lights, dental drills and other medical paraphernalia — has a big sign outside reminding everyone “No Weapons.”

“You going to RAM? You go around this bend, then over the hill,” the window guy at the McDonald’s in Wise said over and over. At 3 a.m., there was a backup at the drive-through because all the people were asking for directions.

“Just tell them to go straight,” the frustrated night manager told the window guy.

Window guy, who is 23, said he was going to RAM on Saturday.

“I need to get my top plate,” he said, opening his mouth and running his studded tongue along the top row of gums. “They pulled all my top teeth out last year. I’m going tomorrow, when it slows down a bit, to get new ones.”

Holly Delp of Dryden, Va. waits for his wife in the dental area as a volunteer gives directions to some incoming patients. (Michael S. Williamson/The Washington Post)

Window guy can’t get more than 30 hours a week at McDonald’s, so he can’t get employer-paid health insurance. “I just wait all year for RAM. That’s my health care.”

Same goes for the 31-year-old father who sat under a tent’s sign that read “FILLINGS.” His two kids, 5 and 8, were sitting on his knees. They were getting three fillings between them.

Dad works in a deep coal mine. And his company doesn’t give him insurance.

“It’s because of Obama,” he explained to me. “Obama is closing all the coal mines, so now the mines can’t afford to offer us insurance.”

President Obama isn’t popular here, despite the passage of the Affordable Care Act, which is designed to help the very people who flock to RAM.

Jim Huffman, 65, was a coal miner, trucker and farmer his whole life in Tazewell County. He walks with a cane, takes 27 medications every day and wears a pin in his trucker hat that says “Obama is doing the job of 3 men: Larry, Moe and Curly.”

But he wishes Virginia had expanded Medicaid.

“I’ve fallen through just about every crack there is,” he said. “At one point, I couldn’t afford my medications. I dropped down to 169 pounds and spent 17 days in the hospital. But maybe that Medicaid expansion could’ve helped me, I don’t know.”

His former state senator, Philip Puckett (D-Russell), had been one of the Virginia Democrats in favor of expanding Medicaid. The legislature was deadlocked, and the debate was continuing. Then, out of the blue, Puckett resigned at a time when Republicans had arranged jobs for him and his daughter.

His betrayal handed Republicans the majority and stalled the effort to get more people insured. It also sparked an investigation by the feds.

Puckett’s name came up a lot in those tents, which are pitched just a few miles from his district.

“Now gimme a minute, I’m going to censor myself here,” Deborah Nagy, 60, explained as she prepared to tell me what she thought about her former senator.

“He was a downright polecat,” she said. “Talk about being let down.”

Nagy is one of about 21,000 in Puckett’s former district who don’t have insurance. She is a home health-care aide who makes too much for Medicaid and too little to pay for insurance herself through the Affordable Care Act.

“I’m another one who fell through the cracks,” she said. “Maybe if that expansion passed, I wouldn’t have to be here today.”

By noon, the folks who got in line Thursday were being examined after a 26-hour wait. Eyes were being dilated, blood drawn and teeth pulled.

A politician showed up and started shaking hands with the soggy people huddled under a huge, yellow-and-white striped tent, waiting to have their eyes checked. He told them: “I am working to make sure you get health care all year, not just one day a year.”

From the back row, Gilda Mountcastle, 54, a house cleaner from Keokee in Lee County, shouted: “We know Jesus. And we know Stan Brock. Who are you?”

“I’m the governor,” Terry McAuliffe said.

Mountcastle later told me that she knew he was the governor — she was trying to put him on the spot. She demanded to know how he is going to fix the state of health care in Virginia.

“We are proud, hillbilly mountain folk,” Mountcastle said. “We want to work hard. We don’t want handouts or food stamps. But we want to be able to afford to take care of ourselves and our family.”

“It’s time to close the coverage gap,” McAuliffe said, explaining that many of the folks at the fairgrounds this weekend are the very people who would have been helped by Medicaid expansion. He called it “the moral, social and financially responsible thing to do.”

To stand in line for 30 hours to get medical care one day a year “is not how you do health care in this country,” he said.

You’ve got that right. The tents, the livestock corral, the desperate, broken bodies. It is a shameful that Virginia has allowed partisanship and politics to stand in the way of caring for its people.

petula.dvorak@washpost.com

Twitter: @petulad

For previous columns, go to washingtonpost.com/dvorak.