Cynthia Houston poses at the Community Health Center in Columbus Junction. Houston is uninsured and visits the clinic regularly for medical and dental care.(Brenna Norman/Brlington Hawk Eye)

About this project: IowaWatch.org, the Burlington Hawk Eye, The Gazette, Iowa City Press-Citizen and the Dubuque Telegraph Herald worked together this summer to report on the need for health care facing Iowans who do not have insurance. They reviewed more than two dozen documents and interviewed two dozen people.

Cynthia Houston didnt panic when she lost her job at the Mount Pleasant school district in 2008. She looked for another job and paid the extra money to keep insurance through COBRA.

She found work but couldnt afford insurance there. That was when she had a breakdown.

I guess youre in that nowhere land of: you dont really qualify for help with this, youre not old enough to get offered (insurance) for senior citizens, said Houston, 60, of Winfield. Youre 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 states health care delivery systems for uninsured Iowans reveals.

Geographic limits ensure that one program to which Houston was referred 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 predict fewer available primary care providers to handle growing demand for health care 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.

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Health care coverage for all Iowans difficult to attain