Northwest Iowa's uninsured usually have jobs but a safety net isn't always available; maneuvering through health care delivery system is no easy task

Cynthia Houston didn't panic when she lost her school district job in 2008. She looked for another job and paid the extra money to keep insurance through COBRA. She found work but couldn't afford insurance there. That was when she had a breakdown.

"I guess you're in that nowhere land of: you don't really qualify for help with this, you're not old enough to get offered (insurance) for senior citizens," Houston, 60, said. "You're kind of out there on your own."

She eventually found help. But state efforts to help Iowans without health insurance pay for doctor visits and other medical care fail to reach all who could use the assistance, a review by five Iowa news organizations of the state's health care delivery systems for uninsured Iowans reveals.

Geographic limits, alone, ensure that one program Houston was referred to -- IowaCare -- does not reach all Iowans who need it, even though it is considered to be a last resort for Iowans ineligible for other programs that fund accessible, affordable health care.

One in 10 Iowans lives without health insurance. Estimates range from 312,600 by the Kaiser Family Foundation to 342,000 by the U.S. Census Bureau. They live in a state where some health care professionals -- although not all -- predict there won't be enough available primary care providers to handle growing demand for health care in Iowa from aging baby boomers, working people with inadequate insurance coverage and others entering the health care market.

"It seems to me, from my perspective, to be a perfect storm," Wendy Gray, executive director of Free Clinics of Iowa, said about that anticipated convergence of trends.

The health care workforce, which includes specialists, physician assistants, nurses and others, is a concern, said Dr. Stephen Eckstat, board president of Free Clinics of Iowa and CEO at Mercy Clinics Inc. of Des Moines. But, he said, he expects Iowa to have enough primary care doctors, with Des Moines University and University of Iowa Hospitals and Clinics graduating them and the doctors staying here.

The most serious concern, Eckstat said, is that people increasingly cannot afford insurance. "The crisis is financial," he said.

Free Clinics of Iowa's network of 33 free medical clinics dealt with more than 13,600 patient visits in each of the past two years, up from 13 clinics handling 5,018 clinic visits in 2005. It did not count the number of patients making the visits but about 11,000 visits each of the past two years were by people lacking health insurance, the organization's records show.

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Finding health care coverage for every Iowan an elusive dream