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As the Obama administration attempts its health care overhaul, a new face of the uninsured is emerging: middle-income Americans. These are people who have lost their jobs and their health coverage because of the recession. Austin Jenkins of the Northwest News Network has this profile of one woman from the Seattle area. For the first time in her life, she's turning to a community health clinic for help.

(Soundbite of phone ringing)

CARMEN(ph) (Receptionist, Healthpoint Dental Clinic): Good morning, Healthpoint, this is Carmen. May I help you?

AUSTIN JENKINS: At the Healthpoint Dental Clinic in Redmond, Washington, Deborah Llavanes sits in the waiting room. She's here to get a couple of cavities filled. She discovered Healthpoint last winter when she got sick and needed a doctor.

Ms. DEBORAH LLAVANES: I am at Healthpoint because I do not have insurance coverage, and Healthpoint provides a sliding scale where, based on your income, you pay accordingly.

JENKINS: At age 53, for the first time in her adult life, Llavanes is uninsured. During the height of the real estate boom, Llavanes was working as a mortgage loan officer and made as much as $7,000 a month. Today, she's unemployed.

Unidentified Woman #1: Deborah?

Ms. LLAVANES: Good morning.

JENKINS: Soon, Llavanes is in the dental chair.

Unidentified Man: Let's do the (unintelligible).


Unidentified Man: ?because that one's bothering you and you do have one.

JENKINS: While Llavanes gets her cavities filled, I go next door to Healthpoint's medical clinic to meet Dr. Kim McDermott.

Dr. KIM MCDERMOTT (Pediatrician, Healthpoint Medical Clinic): I am a pediatrician, and I've worked here for almost 15 years.

JENKINS: Dr. McDermott says never in her career has she seen such a demand from people like Deborah Llavanes for the sliding-fee medical care her clinic provides.

Dr. MCDERMOTT: More patients who I would consider middle class are coming, and we didn't use to see that. We were more a safety net for the, you know, the poorest families in our state. But lately, I have seen more and more patients who, you know, had insurance and have lost it - so, a different demographic of patient than we used to see.

JENKINS: In fact, over the past year, Healthpoint reports a 27 percent jump in requests for appointments at its seven community health clinics in the Puget Sound region. Harder to come by are up-to-date national statistics on how the current economic crisis is swelling the ranks of the uninsured. The most recent figures, from 2007, showed nearly 46 million Americans lacked coverage. But everybody in the health care field expects those numbers to be up significantly when new data is released this fall.

One figure that can be tracked, though, is visits to emergency rooms. According to the American Hospital Association, six in 10 hospitals report an uptick in uninsured visits to the ER.

Ms. JOHNESE SPISSO (University of Washington Medicine): We began seeing our first changes as early as October and November of this past year.

JENKINS: Johnese Spisso is with University of Washington Medicine, which includes Seattle's Harborview Medical Center, a regional trauma center. Besides more charity care cases, Spisso says UW Medicine is noticing another trend line.

Ms. SPISSO: One of the things we have seen is people delaying more of what, we sometimes in the health care industry call, elective surgery, and it's really not elective. It's scheduled surgeries - so things they need to have done that aren't a crisis, we're seeing people delaying that if they've lost their insurance.

JENKINS: More than half of the nation's hospitals are reporting this trend.

Unidentified Woman #2: Well, we have you down, and?

JENKINS: Back at the Healthpoint Dental Clinic in Redmond, Washington, Deborah Llavanes stops at the billing desk after her appointment.

Unidentified Woman #3: I know that you don't have any insurance. Can you make a payment for today's visit?

Ms. LLAVANES: Can I pay, like, $20 today?

Unidentified Woman #3: Sure. Not a problem.

JENKINS: For NPR News, I'm Austin Jenkins in Olympia, Washington.

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