Robin Lauderdale traveled to a free clinic last weekend for a general medical checkup. She suffered a stroke a year earlier, and her blood pressure now was running high, she said.
Lauderdale, 43, of Lenoir City, Tenn., cleans houses for a living. Self-employed, she has no health insurance. Lauderdale said she has gone three years without a mammogram, and has not visited a dentist in six years.
Her story of fragmented care isn't unusual for the 46 million-plus Americans who have no health insurance.
The uninsured often have trouble accessing a physician in a private practice, says Kathleen Stoll, director of health policy for consumer advocacy group Families USA. "A lot of times you won't get to see a doctor if you don't have an insurance card,'' she says.
Many of those without a card wind up getting services in a hospital emergency room -- the most expensive form of primary care.
Sunday night's historic vote on health care reform, though, will deliver some immediate help to the uninsured. Small businesses will get tax credits to provide health insurance. Children will be allowed to remain on their parents' health plans up to age 26. People with pre-existing medical conditions will be eligible for a new, federally funded ''high-risk'' insurance program.
Still, the biggest help for the uninsured -- subsidies to buy coverage in an insurance marketplace or exchange -- won't arrive until 2014, when the full reform plan kicks in, Stoll notes.
In the meantime, people without health insurance have some options for medical services. They include:
COMMUNITY HEALTH CENTERS
These federally funded centers are located in ''underserved'' areas where primary-care physicians are generally scarce. Services can range from ob/gyn and pediatrics to mental health and dentistry, with a focus on primary and preventive care. Patients are charged a sliding-scale fee based on their income. About 40% of their patients have no insurance.
Community health centers can provide a medical home for patients. Yet if people need specialist care, a health center can experience difficulty finding a physician who would accept them.
The 1,200 health centers nationally have seen a 21% rise in visits by the uninsured amid the economic downturn, says Amy Simmons, a spokeswoman for the National Association of Community Health Centers.
Community health centers "do an outstanding job,'' says Dr. Ateev Mehrotra, a Rand researcher and professor at the University of Pittsburgh School of Medicine. Despite funding increases, though, the health centers can't keep up with the rising load of patients with no coverage, he says.
Hundreds of these walk-in clinics have popped up in the past five years within retail stores such as Walgreens and CVS/pharmacy. The average charge is $60 to $75, according to the Convenient Care Association. About 35% of patients pay out of pocket, though some may have high-deductible or catastrophic insurance plans.
Patients at retail clinics generally see nurse practitioners, who treat primary care ailments including sinus infections, strep throat, skin conditions and minor injuries. The clinics also administer immunizations and now offer services to help manage chronic diseases such as diabetes. Their prices have been found less expensive than doctors' offices.
URGENT CARE CENTERS
There are 8,700 urgent care centers nationally, owned by physicians, hospitals or for-profit companies. Located mainly in urban and suburban areas, these health centers provide more comprehensive services than retail clinics for people who have a sudden medical need. ''It's a no-appointment model,'' says Lou Ellen Horwitz, of the Urgent Care Association of America.
Their prices tend to be higher than a retail clinic. A leading urgent-care provider, Concentra, with 307 centers nationally, sets a basic visit price at $85, and includes physical therapy among its services. About 12% of urgent-care patients pay out of pocket, Horwitz says.
Patients generally can get services for free or a low co-pay at these clinics, which feature volunteer doctors and nurses. Free clinics have seen a surge in demand, with the number of patient visits doubling from 4 million in 2008 to 8 million last year. They provide preventive and primary care and low-cost prescription drugs to patients. (See www.freeclinics.usa).
Free clinics also may have trouble linking a patient to specialist care if needed, says Stoll of Families USA.
One volunteer-based organization, Remote Area Medical, offers free weekend clinics around the country. On a single weekend, RAM can draw more than 1,000 patients.
Despite these and other options, many uninsured still fall through the health care cracks. A main goal of health reform, though, is to extend coverage to millions of more Americans, so people like Robin Lauderdale can receive more regular care -- and prevent untreated medical problems from getting worse.
Uninsured? Where You Can Find Medical Help Between Now and 2014