Louie Sears has an Ace bandage wrapped around his left arm where he fractured it nearly four weeks ago while playing softball.
He can't find a doctor who'll take his Medicaid.
"So I'm sitting here with a broken arm and I don't have the $800 they want," said the 36-year-old carpenter from Carson City. "I wish I did."
Mike Dunn, a 68-year-old retiree, had group health insurance up until it expired about six months ago. That's about the same time his primary care doctor, John Bower, closed his office. After calling 22 area doctors, he commutes about 45 miles to a geriatric center at Washoe Medical Center. There's a lot of seniors in this area, he said, and doctors are telling him that Medicare doesn't reimburse their full costs of seeing these patients.
"In my opinion, doctors and the cost of what they do gets out of hand," Dunn said. "No doctor gets paid what he's worth unless the person has two insurances."
Sears and Dunn are among many Carson City residents having a hard time finding medical care. The rising costs are keeping patients who are uninsured or use government assistance for their health care from receiving the care they need and driving some doctors out of business. Two Carson City doctors have closed their practices in the last year. Most others are full and not accepting new patients. Several doctors merged offices to stay in business.
In Nevada, 18.5 percent of the population - 443,000 people - do not have insurance. These Nevadans are more than twice as likely as those with insurance to say they are in poor or fair health.
Uninsured Nevadans are more likely to miss out on important cancer screenings. More than 70 percent of insured Nevadan women get mammograms, but fewer than half without insurance get the breast cancer test, according to "The Coverage Gap: A State-By-State Report on Access to Care" issued in April by the Robert Wood Johnson Foundation.
There is some help available for the uninsured and for those on government assistance in Carson City in the form of the non-profit Sierra Family Health Center, but many patients are not taking advantage of it.
Dr. Cesar Udani decided to practice at the Sierra Family Health Center because of his experiences treating low-income patients in the Philippines. The health center is operated by the nonprofit company Nevada Health Centers Inc.
"I have a lot of experience and compassion for people who can't get access to health care because they only have Medicare, or they are uninsured," he said while standing in the hallway of the 2527 N. Carson St. clinic. "I believe we are delivering good care to these individuals."
Sierra Family Health Center is a federally qualified community health center, which means it is reimbursed for the full cost of the Medicare or Medicaid patient's visit.
Patient visits are increasing and the waiting room is full on most days at the only clinic in Carson City directed at uninsured patients or those on Medicaid or Medicare.
"A private physician or specialist barely gets enough back to cover his or her costs," said Steve Hansen, chief executive officer for Nevada Health Centers Inc., which operates Sierra Family Health Center in Carson City and 21 other health centers in the state.
It offers a sliding-fee scale for the uninsured. The federally qualified health center is given incentives to see Medicaid and Medicare patients.
Those without insurance make up almost half of the health center's patients. It had about 14,400 patient visits from June 2005 to March and about 22 percent of all patients were on Medicaid, 12 percent on Medicare, 44 percent uninsured. The remainder have insurance or some other means to pay, said Linda Costa, chief financial officer for Nevada Health Centers.
The Sierra Family medical center hasn't been the answer for everyone. Dunn, the 68-year-old Carson City man, said he was never referred to the center. Dunn has heard of it, but he thought it was just for poor people.
"No doctors recommended that I call them, maybe they didn't know about it," he said. "Or maybe they didn't care."
Nevertheless, the Carson City health center's patient visits climbed about 16 percent from the previous year. The average patient visit costs $65.
But this medical center isn't good for those private physicians who have to compete with it, according to physicians such as Anthony Zimmerman, of Rabbitbrush Healthcare in Carson City.
"Sierra Family Health Center competes with everyone in town with regard to subsidies for Medicare and Medicaid," he said. "They have an unfair advantage on us with regard to reimbursement."
Zimmerman continues to take Medicare and Medicaid patients, but said he gets paid half the price of what the medical center does. He said this discourages doctors from seeing these patients.
But even seeing insured patients doesn't guarantee a high amount of return. Many doctors blame the crisis in medical care on the low reimbursements from other health insurances.
Dr. Bryan Ricks moved his practice into the ARC Medcenters in September because his overhead is increasing "at an alarming rate and insurance reimbursement has remained low and is starting to decline."
Charles Duarte, administrator of the state Division of Health Care Financing and Policy, which oversees the Medicaid program, said there are serious problems with access to specialty health care. Insurance is unaffordable to many people. Doctors and hospitals are absorbing costs. Employers are seeing double-digit inflation on premiums every year. Some drop health care plans, he said. He believes corporate America needs to take the first step in dealing with it.
"Nobody seems to want to address it because it's so huge," Duarte said. "Something has got to be done, but we'll see what happens."
• Contact reporter Becky Bosshart at bbosshart@nevadaappeal.com or 881-1212.