SPENCER MICHELS: In the past eight years, Katie Salas has held 20 low-wage service sector jobs, including this one as a bartender in the San Francisco area, and not one of those jobs has provided her with health insurance.
KATIE SALAS: Most of the waitresses that I know don't have health insurance, or waiters.
SPENCER MICHELS: Salas is one of 46 million people in the United States without health insurance. In California, it's one out of five people-- numbers, according to a recent Kaiser Family Foundation report, that are growing as fewer and fewer employers provide insurance to their workers. This year 60 percent of companies provided coverage, down from 69 percent in 2000.
KATIE SALAS: What most people in the service sector have to do is just wait until something awful happens, until they get hit by a car, or until they're --
SPENCER MICHELS: And then what?
KATIE SALAS: And then you go to the hospital and you get these crazy bills, and the next thing you know, you're in debt.
SPENCER MICHELS: Salas got hurt in a bike accident and she ended up owing $2,000 for an emergency room visit, plus ambulance charges.
KATIE SALAS: It's a lot of money for nothing. They told me to go home and ice it.
SPENCER MICHELS: About 80 percent of the uninsured in America are like Salas, in that they work full or part-time. On a national level, ever since the failed proposals in the 1993 Clinton health plan, there have been no serious attempts in Congress to cover the uninsured.
But in the last few months many state officials have begun talking about the uninsured and a few legislatures, including those in Illinois, Massachusetts, Maine, New Mexico, New Jersey, Oklahoma and California, have been wrestling with a variety of proposals to take care of those without health insurance. Still, the problems persist and recently have become more acute.
According to Kaiser, small businesses are increasingly dropping coverage for low-wage earners, but the alternative -- buying individual insurance -- has become more expensive, with premiums going up 73 percent since 2000.
For a family of four, the Kaiser survey says, a year's health insurance costs nearly $11,000, which was too much for Mark Herrera. He is an example of how high insurance costs keep some Americans from buying insurance and then they pay the penalty.
Herrera had been a union carpenter but decided to start a contracting business of his own and since he thought he was healthy, insurance was a low priority.
MARK HERRERA: It was just not in the budget right now. I was trying to get established.
SPENCER MICHELS: But one day Herrera's life changed dramatically.
MARK HERRERA: I woke up with a massive headache, strong enough to wake me out of my sleep.
SPENCER MICHELS: He resisted going to a hospital for several hours, knowing he had no insurance. But eventually he went.
MARK HERRERA: Well, after a couple of hours, they determined that I had suffered two strokes, and through the X-rays they determined I had what they called a bleed on the brain.
SPENCER MICHELS: Doctors also found he also had an aneurysm that required brain surgery. He was turned down for Medicaid funding -- he didn't meet the criteria -- and started getting big bills.
MARK HERRERA: Yeah, I've got a $225,000 debt and yeah, if I come into any money, well, the first people I got to pay back is for this medical coverage, yeah.
SPENCER MICHELS: Doctors and hospitals have turned Herrera's accounts over to collection agencies.
MARK HERRERA: They do send me their collection notices or have notified me that it's not just in the doctor's office anymore; it's advanced into collections.
SPENCER MICHELS: Hospitals don't like being cast as villains in the debate over treating the uninsured says Martin Brotman, CEO of California Pacific Medical Center in San Francisco.
DR. MARTIN BROTMAN: We don't want to turn anybody over to collection agencies. That is so assaultive. We want to deal with people.
SPENCER MICHELS: Brotman says his not-for-profit hospital tries to work with the uninsured.
DR. MARTIN BROTMAN: If someone who is penniless and lives on the street comes to our emergency department, we don't ask them if they have money; we don't ask them if they have insurance. We take care of them. We also have standard charges that are submitted to the patients. However, if they cannot afford it and they state that to us, we do have a sliding scale, we do have financial counselors, we do have negotiation.
SPENCER MICHELS: Hospitals also get chastised for what they charge the uninsured. Anthony Wright is executive director of the consumer advocacy group, Health Access California.
ANTHONY WRIGHT: The people who are least able to afford it, are charged the most. A person who goes to a hospital is typically charged four, five, six times what an insurance company is expected to pay for exactly the same service.
DR. MARTIN BROTMAN: When we have contracts with plans, where there are large volumes of patients, we give reduced prices, of course. But the individual walking in the door will be facing a standard charge. With the cost of health care, you cannot open your doors and say "You come here no matter who you are, and we will give you very cheap health care," because you'd go broke.
SPENCER MICHELS: But Wright says just the fear of hospital bills keeps many people from getting treatment.
ANTHONY WRIGHT: An uninsured person is half as likely to go to the emergency room as an insured person and it's not because uninsured people have half as many emergencies. It's simply because they know that if they go to the emergency room, they will get a bill and that bill will be very major and have an impact on their financial future.
SPENCER MICHELS: Hospitals themselves don't even cover all their own employees. Jeannie Brewer is a doctor working at Alta Bates-Summit Medical Center in Oakland, California.
JEANNIE BREWER: A lot of people think that being a doctor somehow protects you.
SPENCER MICHELS: Brewer is not protected. She has numerous health problems herself and was treated for Multiple Sclerosis, depression and orthopedic problems.
JEANNIE BREWER: For an eight hour back surgery and a co-pay of 20 percent, it can be $5,000-10,000. It can be that much for hospitalization. Both of my daughters were hospitalized with diabetes.
SPENCER MICHELS: Because she works at the hospital as an independent contractor, she gets no health insurance, except a limited policy with high deductibles through her husband's work. And because of her preexisting conditions, she can't buy insurance either.
JEANNIE BREWER: I can't buy insurance; no one will sell to me, at any premium cost. All told we're out of pocket, usually about $15,000 to $20,000 a year -- even before my kids had diabetes, that's in a year where we would not have any hospitalizations.
I filed for personal bankruptcy this year, in June, after having liquidated every single asset I ever had.
RALPH WILLIAM BOONE: Oh, I got plenty of nothing...
SPENCER MICHELS: Getting health care has also been a struggle for singer and actor Ralph William Boone, who like most performers, has no health insurance and not very much money.
RALPH WILLIAM BOONE: I still cannot afford $1,000 or $2,000 or $3,000 a month. I'm still 54, I'm still black, I still have high blood pressure -- had it since I was 19 -- I still have gout. So I'm still high risk.
SPENCER MICHELS: But Boone has found at least a temporary solution to his health problems. After paying off $16,000 for medical and dental work, he was referred to the St. Anthony Free Clinic, next to a soup kitchen. St. Anthony is part of the safety net of free health care supported by donations, foundations and grants, designed to treat those who fall through the cracks of the traditional health care system.
RALPH WILLIAM BOONE: St. Anthony's I think is an excellent place. You're watching all these people lining up for health care and you're saving, "Jeez, you know, I'm a guy with two Masters degrees, am I not a success, you know?" ( Laughs )
SPENCER MICHELS: Ana Valdes is medical director of the clinic, which takes care of uninsured people who don't qualify for government programs like Medicaid.
DR. ANA VALDES: We are seeing a lot more families and a lot of working people who either don't get insurance through their employer or their employer offers insurance, but it's too much of their salary or too much of their paycheck for them to be able to afford it.
SPENCER MICHELS: Valdes says the patient load is increasing dangerously.
DR. ANA VALDES: We do a triage system to take those who are most sick and then figure out those we are going to have to turn away. Everyday we hit that capacity five minutes after our doors are open.
RALPH WILLIAM BOONE: No, I don't think St. Anthony's is the solution. I think places like St. Anthony's -- and thank God we have them -- I really do think they're stop gap places. I don't know what the answer is.
SPENCER MICHELS: Around the country, health care has been at the center of some labor-management disputes, and various proposals for government coverage of the uninsured are surfacing in legislatures. But many politicians argue that medical care is too expensive for states to solve and only a few partial measures have passed. Doctor Valdes says at this point, a consensus is needed.
DR. ANA VALDES: All the players -- the government, the providers -- need to really sit down at the table and look at what the needs of the community are and how we can address it. We certainly seem to have the resources and the question is: How do we equitably get those resources out there for everyone?
DR. MARTIN BROTMAN: Unless there is a national resolution, a national commitment to address the problems of the uninsured, it will never be addressed. Anyone who needs health care who is turned away from access to health care, that is unacceptable to me as a physician, to me as a member of the community.
SPENCER MICHELS: One study predicts that by 2010, the percentage of uninsured adults in California will climb to 29 percent.
DR. ANA VALDES: I definitely think it speaks loudly about our society and what our priorities are when we have so many uninsured people; they're not just homeless and addicted, but they're working, oftentimes they're educated, with Ph.D.'s, looking for jobs, or have a job, and they just don't have insurance.
SPENCER MICHELS: While emergency rooms and free clinics try to treat the uninsured, they can't keep up with the increasing numbers. Health advocates hope those numbers will focus national attention on the plight of the uninsured.