The Problem Isn’t Which Card You Carry
Congress let the ACA subsidies expire. Millions of people just lost affordable coverage — not because they got healthier or richer, but because a budget line item ran out. That’s the whole problem in one sentence: your healthcare depends on which program survives the next vote.
If you’re working, your coverage depends on your boss. If you’re retired, Medicare premiums eat your COLA. If you’re uninsured, one ER visit can bankrupt you. If you’re a veteran in a rural county, good luck getting to the VA.
Medicare is just the ACA in different clothing. Both are insurance schemes — they broker access to care instead of delivering it. The VA is different. Salaried doctors. No billing department trying to deny your claim. The mission is care, not profit. It’s the one system that works the way healthcare should work.
I’m on Medicare. I thought it would be better than the ACA. In many ways, it’s the same or worse. I run every prescription through three different options to find the best price. The expensive ones go to the VA — I’m lucky I have that option. Even so, my medication costs top $1,000 a year.
FL-3 Isn’t Short on Capacity
UF Health Shands. The Malcom Randall VA Medical Center — one of the five busiest in the country. HCA’s new $231 million hospital. Palms Medical Group’s 12 rural clinics serving everyone on a sliding scale.
The capacity is here. The connection isn’t. If you live in Dixie County, a routine VA appointment is 90 minutes each way. Hamilton County is even further. That’s a whole day gone for a checkup — if you have a car, if you can take the time off, if you're well enough to drive.
The Plan: Mobile Clinics Across FL-3
This isn’t a new idea that needs inventing. Mobile clinics already operate across the country. North Florida Medical Centers already runs one in parts of our region. The VA has had the legal authority to share medical resources with community health centers since 1966 (38 USC 8153). The MISSION Act says if you're more than 30 minutes from a VA facility, you’re entitled to community care. FQHCs (Federally Qualified Health Centers) already provide sliding-scale care across the district. HRSA (Health Resources and Services Administration) grants already fund exactly this kind of expansion.
The legal authority exists. The funding programs exist. The operating model is proven. What’s missing is someone who writes the proposals, brokers the partnerships, and gets the vans on the road — and a congressman in Washington making sure nothing falls through the cracks between the VA, the FQHCs, and the grant offices. These things can stall quietly if nobody’s following up.
The pieces are all here. Nobody's connected them.
What's on the van
Each unit is a self-contained clinic on wheels: exam room, basic lab capability, pharmacy dispensing for common prescriptions, and a telehealth station connecting to specialists at UF Health or the VA. Not a screening booth — a real clinic visit, same day.
What it covers
- Primary care — family medicine, chronic disease management, labs, behavioral health screening. Same place, same day, every week on a reliable schedule.
- Women’s health — prenatal care, postpartum follow-up, well-woman exams, staffed by providers trained in women’s health. Rural OB is in crisis across North Florida. Nobody should skip prenatal care because there’s no clinic in the county.
- Behavioral health and crisis support — counseling, substance abuse screening, and suicide prevention resources. No referral runaround.
- Veterans served first under existing VA sharing authority. Everyone else on a sliding scale through FQHC partnership. No one turned away.
How it’s staffed
Each van route needs 6–8 people: a nurse practitioner or PA, a community health worker, a driver/logistics coordinator, and support staff. The staffing model is part-time by design — compatible with school schedules, second jobs, and caregiving. Think AmeriCorps, not hospital shift work. Service Corps members from the jobs program fill support roles, getting real clinical experience while the community gets care.
How many, and where
The goal is a van route in every underserved corridor of the district. You start where the gaps are worst and scale from there. The route map gets built with local providers, not drawn from Gainesville. Where a local doctor already exists, we don’t duplicate — the mobile unit fills gaps, not competes.
The vans anchor at places people already know: churches, fire stations, community centers, college campuses. Santa Fe College, for instance, has thousands of students with no student health center — the van parks on campus and serves students and the surrounding community at the same time. Between van visits, a small supply room on campus stocked with basic medical supplies and staffed by trained student peers keeps the connection alive — triage, supply pickup, help with paperwork, so the van’s clinical time isn’t spent on things that can be handled in advance.
Each van costs $250,000–$390,000 upfront (coverable by a single HRSA New Access Point grant) and roughly $275,000 per year to operate. Start with the first routes, prove the model, then expand.
This Is One We Can Start Locally
The long-term vision: Mobile clinics become permanent rural clinics. Urgent care plus telehealth. The VA model — salaried employees who serve the mission — expanded to serve everyone. Not another insurance card with a different logo.