State Licensing Patchwork Blocks Medical Volunteers From Reaching Underserved Patients

A licensed dentist in Ohio can cross into Tennessee on a Saturday morning and treat dozens of uninsured patients at a Remote Area Medical pop-up clinic, free, no paperwork, no additional license required. Cross into a closed state instead, and that same volunteer must stay home.

That single distinction, between states that permit out-of-state medical professionals to volunteer and those that do not, determines how many of RAM's 172,900 licensed volunteers can be deployed at any given clinic, how many clinic days the organization can schedule in a given region, and ultimately how many of the more than 863,700 patients it has reached since its first U.S. clinic in 1992 ever got care at all.

RAM, headquartered in Rockford, Tennessee, operates more than 60 pop-up clinics per year, converting fairgrounds, gymnasiums, and civic centers into comprehensive health centers offering dental, vision, medical, and veterinary services. All care is free, first-come, first-served, and requires no insurance or identification. The scale of what is possible when the volunteer pipeline is unrestricted was on display in Wise, Virginia, in 2017, when more than 1,000 volunteers converged to treat 2,300 patients in a single weekend, a gathering recognized as the nation's largest pop-up free clinic.

In closed states, that pipeline narrows sharply. Out-of-state providers cannot legally practice, which limits both the number of volunteers RAM can recruit and the number of clinic days it can sustain in any given area. The same regulatory wall constrains RAM's telehealth program, which can only serve Tennessee residents under current licensing rules, sealing the model off from rural and low-income populations in other states who most need it.

Tennessee became a template for what reform looks like. Stan Brock, the British philanthropist who founded RAM in 1985 after managing a 4,000-square-mile ranch in what is now Guyana, 26 days' walk from the nearest doctor, was instrumental in passing the Tennessee Volunteer Health Care Services Act of 1995. That law permits health professionals holding valid out-of-state licenses to cross into Tennessee and provide free care. It remains the clearest proof that legal reform can expand volunteer capacity without compromising patient safety.

Federal lawmakers have tried twice to replicate that model nationally. The HEALTHIER Act, introduced as H.R. 860 in the 115th Congress in 2017 and reintroduced as H.R. 2216 in the 116th Congress in 2019, would direct the Department of Health and Human Services to establish a two-year grant program awarding states that adopt volunteer health care provider laws. The one-time grants would help states absorb any administrative costs associated with opening their borders to out-of-state medical volunteers, with participation limited to weekend clinics only. Neither version became law.

The cost of inaction lands heaviest on the patients who cannot wait. At RAM clinics, minor dental problems left untreated become infections; vision problems left unaddressed keep children from reading. Patients have described choosing which condition to treat when they finally reach a clinic, rationing care the way others ration groceries. Even Americans carrying insurance sometimes skip treatment because deductibles and co-pays compete directly with rent.

Brock, who died on August 29, 2018, at RAM headquarters in Rockford at age 82, did not live to see the federal fix pass. He was posthumously inducted into the Tennessee Healthcare Hall of Fame in 2024. RAM has now delivered more than $174 million in cumulative free care across a volunteer corps built largely state by state, exemption by exemption. How many states remain closed determines how far that number can still grow.