Dr. Misty Clark, a dentist who operates her own practice in Prestonsburg, pulled up her schedule Tuesday afternoon and shook her head.
Her calendar showed five and a half hours of vacancies — an usual sight for Clark, who normally fills her schedule with as many as three patients an hour. But since last week, when Gov. Matt Bevin cut dental and vision coverage for about 460,000 low-income Kentuckians on Medicaid, more than half of Clark's patients have been turned away.
Jessica Clark-Boyd, the office manager at Healthy Smiles Family and Cosmetic Dentistry, which Misty Clark operates, said the staff has rescheduled dozens of patients for appointments next month, hoping their insurance will be restored by then.
If not, Healthy Smiles could be in big financial trouble.
"It's gonna hurt us," Clark-Boyd said. "I just hope it gets resolved."
The hardest part, Clark-Boyd said, is telling patients, such as Lynda Joseph of Pikeville, their insurance has been cut.
Joseph called Healthy Smiles Tuesday to ask about her appointment later this month, when she was supposed to get a tooth extracted. Joseph said she knew her Medicaid benefits were changing, but she didn't realize Bevin had eliminated her dental and vision coverage until she spoke with the staff.
"I cant understand why (Bevin) would cut it when most Kentuckians are on poverty level anyway," Joseph said. "Why can't he understand that dental insurance is just as important as medical?"
Joseph works at Wal-Mart part-time. She said her hours fluctuate, so she never knows exactly how much she'll make each week.
Now she doesn't know when she'll be able to get her tooth pulled.
"I don’t mind paying the premium," she said. "Even if the premiums became higher, I wouldn’t mind that. The question is, am I going to be able to pay for it out-of-pocket?"
On Tuesday morning, Clark-Boyd made the drive to Pike County to hear from several Democratic state lawmakers from Eastern Kentucky who gathered at a public library to criticize Bevin's decision and call for him to reinstate benefits. They included House Minority Floor Leader Rocky Adkins of Sandy Hook, Rep. Chis Harris of Forest Hills and Rep. Angie Hatton of Whitesburg.
At the beginning of July, Bevin announced he would eliminate dental and vision coverage for some 460,000 Kentuckians after a federal judge rejected the governor's plan to overhaul the state's Medicaid program by requiring recipients to work or volunteer and pay monthly premiums. Those affected are people who received Medicaid under an expansion ordered by former Gov. Steve Beshear for working-age people who are only slightly above the federal poverty level.
Dental and vision benefits for children and pregnant women have not been changed.
The Republican governor blamed the judge for the cuts, calling them an "unfortunate consequence" of the ruling, and saying the rollbacks in coverage were necessary to save money.
Critics have questioned the legality of Bevin's decision, saying the state did not provide an adequate time for public comments on the changes and did not follow the federal government's reporting requirements.
Democratic lawmakers criticized both the moral and economic impacts of Bevin's decision, saying it unnecessarily strips health care benefits from working families and could hurt the state's economy, particularly in Eastern Kentucky.
Harris called the cuts a "mean-spirited attack on Kentucky's working poor" and said "nobody should suffer because of the size of their wallet."
According to a report from the liberal-leaning Kentucky Center for Economic Policy, Kentucky's Medicaid expansion program in 2014 has led to significant and positive impacts on the state's economy and Kentuckians' quality of life.
From 2013 to 2016, Kentucky's uninsured rate dropped from 14.9 percent to 5.5 percent. That decrease, according to the report, has pumped billions of dollars into the economy and created thousands of jobs — half of the net job growth in Kentucky since December 2007 came from the health care sector.
"Those of us that live here understand that we had a downturn in the coal economy, and it costs us thousands of jobs," Adkins said. "The industry that we have seen in our region that has actually been able to grow some, to be able to invest in its infrastructure, to be able to provide quality health care throughout our region, has been the health care industry because of the expansion of Medicaid."
The House Democratic Caucus also sent a letter Tuesday to state Health and Family Services Secretary Adam Meier asking him to answer questions about Bevin's cuts and the laws that apply to it.
The letter also asks the cabinet to share any analysis it has that shows the state will save money from the cuts.
In Pike County, Adkins and others said health coverage and ongoing treatment can prevent costs in the long run by catching diseases early and allowing physicians to instruct their patients on how to avoid major health problems.
Bill Collins, the former president of the Kentucky Dental Association, called on Bevin and his supporters to "show heart and compassion to your fellow man."
"Let's get this right," Collins said. "People's lives are dependent on it."