Karla Benedict says she comes to Dorothy’s Place—a Salinas outreach center that provides food, showers, clothing, laundry and other services to homeless and hungry people—for the sandwiches and also for the free medical clinic on Wednesdays. She’s covered by Medi-Cal, but it only covers part of the cost of a visit to a regular doctor, and she can’t afford to pay the difference. Today she’s waiting in line to see Dr. Marc Tunzi about her asthma.

Tunzi directs the Family Practice Residency Program at Natividad Medical Center in Salinas. On Wednesdays, between 12:30pm and 2pm, he’s at the free clinic at Dorothy’s Place, ground zero for people in Salinas who don’t have health coverage.

Tunzi says that in Monterey County, this includes people who are completely uninsured, Medically Indigent Adults (MIA), Medi-Cal patients.

He says that in this county, Medi-Cal does not guarantee access to health care.

“It’s like this,” he says: “You have a hunting license. You own a gun. But that doesn’t mean you’re going to see a deer. Most private doctors don’t accept Medi-Cal. The last eight or 10 years that I’ve been coming to Dorothy’s Place, I’m actually getting referrals from the hospital.”

Patients can receive emergency medical coverage when they visit Natividad’s ER, but once they are out, they can seldom afford check-ups or medicines, Tunzi explains.

“People come here, they say, ‘Here’s my list of medicines. Here are my prescriptions. Do you have any of this stuff?”

At Dorothy’s Place, Benedict is having trouble breathing, but her albuterol inhaler makes her shaky. She says her youngest son doesn’t have Medi-Cal coverage because the state says he’s not eligible.

“If he gets sick in the middle of the night, who’s going to see him?” Benedict worries.

Throughout Monterey County, there are a lot of similar stories. They come from individuals and families who aren’t quite so bad off as Benedict (who is currently homeless), but still have to chose between buying food and buying medicine.

When it comes to providing health insurance to its residents, Monterey County is failing. According to doctors and health officials, about 80,000 Monterey County residents don’t have health insurance. That’s about 20 percent of the people who live here. Only Los Angeles County residents fare worse.

This growing problem touches all parts of the US. This week is National Cover the Uninsured Week, where influential groups (such as the US Chamber of Commerce and the AFL-CIO) and important individuals (former Presidents Ford and Carter serve as co-chairs, and ER star Noah Wyle serves as the campaign’s national spokesperson) team up with doctors, nurses, educators and health care advocates across the county to address the problem of the 44 million Americans living without health coverage—a number that includes 8.5 million kids.

Local doctors and patients feel the pain, perhaps more acutely than their colleagues in the rest of the US. It’s not only the 80,000 uninsured local residents; thousands more are underinsured. Around 65,000 receive Medi-Cal, the statewide public health insurance program, and another 5,000 quality for the Medically Indigent Adult (MIA) program, a limited-form of health insurance paid out on a sliding scale, and only accepted at Natividad Medical Center. Doctors and nurses classify both Medi-Cal and MIA patients as underinsured patients.

“So that’s about one-third of our population, who are uninsured or underinsured,” says Dr. Dana Kent, who works at the Seaside Family Clinic, one of the three health clinics run by the Monterey County Health Department. “Most of our patients are the working poor.

“It may be the Monterey County paradox. We have some of the richest people around, but we have a very high number of people living below the poverty line.”

According to an April report published by the Health Department, titled “Access to Health Care in Monterey County: Disparities and Challenges,” people who work in the service and agricultural industries make up most of the uninsured and underinsured.

“We have a population who works in the fields, who works in the tourist industries,” says Dr. Pedro Moreno, a family practice physician at Natividad. “Those two industries require many low-skilled workers, and many don’t offer health insurance. We have an industry that requires workers, many of whom come from South America, especially Mexico, and once we offer them a job, we don’t offer them benefits. Why is our uninsured population higher here than in other counties? Look at who is working in the fields.”

At a recent interview at Natividad Medical Center, a room full of doctors agreed that the county hospital’s financial troubles have made access to health care even more difficult in Monterey County. They all mention Natividad’s mission—the commitment to serve all county residents, regardless of their ability to pay—and they all say they’re extremely frustrated to no longer be able to fulfill it.

Since 2002, when hospital staff announced that NMC was facing an operating loss, Natividad’s been on very shaky ground. Its staff can no longer provide medical care for free. There are now stories of patients who were scheduled for surgery, had the IV placed, but didn’t have money to pay for the procedure and were told to go home.

“A vast majority of doctors came here because we are dedicated to the mission,” says Dr. Donald Pompan, an orthopedic surgeon. “A patient walks in with an elbow fracture, he’s seen in Monterey or King City, they tell him, ‘you need to get it fixed, go to Natividad.’ Now there’s no revenues. We can only fix it if they qualify for the MIA program, or if they have the money. The patient knows he needs the surgery but he can’t get it. He will have a permanent disability.

“You run a car on four wheels. You can’t run a car on three wheels. We have a health care system that cannot run on three wheels.”