Ms. Valdez’s medical situation is similar to other area individuals who would have slipped through the health care system, if not for the free clinic.

Ms. Valdez, 58, has several chronic diseases, including arthritis and diabetes, and says she doesn’t know what she would have done if the clinic hadn’t been available to provide her health care. She doesn’t qualify for government assistance programs.

Ms. Valdez, like all Temple Community Free Clinic’s clients, is employed. She works for a local nursing home, but it doesn’t offer its employees health insurance.

“I couldn’t afford to pay it if they did have it,” Ms. Valdez said.

In Bell County, 44,531 individuals, 17.4 percent of the population, have no health insurance, according to statistics from the Texas Health Institute using 2005 census numbers.

The largest segment of the population in Bell County without coverage is Hispanics between the ages of 18 and 34, with 41.2 percent of them lacking health insurance.

We’ve been in a health crisis in Texas for awhile, said Rita Kelley, Bell County indigent health services director.

“At all levels, folks are trying to figure out how can we provide financial access to health care - in Texas we have our work cut out for us,” she said.

The reasons are many for the health care problem, Mrs. Kelley said. Health insurance isn’t offered by an employer, an employee can’t afford the premium even if it’s offered, and some choose not to pay the premium.

“Though some like to point to the undocumented worker as being the problem, those numbers are miniscule,” Mrs. Kelley said.

Senate Bill 10, passed by the Texas Legislature in 2007 and signed by the governor, was designed, through Medicaid reforms, to increase the percentage of Texans with health care coverage, focus on prevention and emphasize individual choice.

A component of the bill, she said, allows groups to come together to develop a health coverage product.

A group that includes Williamson County is looking at a regional approach to provide primary care coverage for people who work in small businesses, Mrs. Kelley said. Under consideration is a product where the employer would pay half and the employee would pay half.

“What they have come up with so far is too expensive,” she said.

“It’s not just people who can’t afford the premiums, small businesses can’t afford to provide insurance,” Mrs. Kelley said.

Studies have shown that for the average employee the breaking point for an insurance policy is $50 per covered individual per month, she said. Any more expensive and the worker will not take the coverage.

“The problem is getting a product worth having at that cost,” Mrs. Kelley said.

Wellness plays a role in being able to provide health care, she said. Senate Bill 10 addresses prevention programs with the understanding that paying on the front end will ultimately save money.

“If everyone had coverage, there would not be enough providers to take care of all of the illnesses that plague the country,” she said. “Even with health insurance we need to look at the preventable illnesses and how to encourage people to take better care of themselves.”

In the county’s indigent care program, diabetes has the highest frequency of diagnosis, Mrs. Kelley said, and it’s not the most expensive to treat.

“The other top illnesses are hypertension and respiratory … a big part of that is lifestyle,” she said.

To participate in the county indigent care program the person can’t earn more than 21 percent above the poverty level.

The program sees about 350 individuals a month, but receives applications for three times that number, Mrs. Kelley said.

Part of the problem, she said, is the slim margin of profit for health care providers, with payments of about 36 cents on the dollar for indigent health care and Medicaid.

In 2007, Scott & White Memorial Hospital provided $35.2 million in charity care while Scott & White clinic provided $12.5 million in charity care. During the same year, the medical center wrote off $55.9 million in bad debt because of patients’ unpaid bills, hospital officials said.

King’s Daughters Hospital provided $4.1 million in charity care in 2007, an increase over 2006. The hospital is expecting an increase of 4 to 5 percent in 2008, according to hospital officials.

Single parents make up 60 percent of the HELP Center clients, said Judy Morales, director of the HELP Center, a county program that offers screenings and referrals to various assistance programs and coordinates with other agencies. It also offers short-term and crisis specific financial assistance.

“Many make just enough money not to qualify for medical assistance programs,” Ms. Morales said.

The elderly are also steady clients of the HELP Center, seeking assistance with utility bills, she said.

“They’re living on fixed incomes, yet the price of everything, including medications, is going up,” Ms. Morales said.

Temple’s Community Free Clinic doesn’t treat sexually transmitted diseases, provide birth control, or gynecological care, according to Connie Minnick, Community Free Clinic director.

“We take care of everything else,” she said.

Most of the patients, 80 percent, suffer with chronic diseases, Ms. Minnick said.

The clinic has been open for about 15½ years and has had more than 65,000 patient visits in that time. Patients are seen two days a week.

The clinic’s clients are a different sort of patient, she said.

“They didn’t go to the emergency room and run up bills they couldn’t pay … they just didn’t go to the doctor, because they couldn’t afford it,” Ms. Minnick said.