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This is WEEKEND EDITION from NPR News. I'm Jacki Lyden.

Nearly 46 million people in America are without health insurance. By some estimates, as many as a third of them are what you might call voluntarily uninsured. These are people who could afford coverage but don't buy it. As part of our series Are You Covered? Austin Jenkins of the Northwest News Network introduces us to a small business owner near Seattle who chooses to live life uncovered.

(Soundbite of splashing water)

AUSTIN JENKINS: The day starts early at Zenith Holland Gardens, a wholesale plant nursery in Des Moines, Washington. It's not yet eight o'clock and owner Lyn Robinson is already preparing a batch of plant food.

Ms. LYN ROBINSON (Owner, Zenith Holland Gardens): So I mix it up, the Techno Grow 13 to 13. And then later today I can fertilize all the rest of the pansies.

JENKINS: When she finishes with that chore, Robinson heads for her pickup truck.

(Soundbite of engine starting)

JENKINS: She's got a chiropractor appointment to get to. A few minutes later, sitting at a traffic light, Robinson, an athletic 52-year-old redhead begins to explain why she doesn't have health insurance.

Ms. ROBINSON: You know, as a small business owner, sometimes it's hard to pay the bills every month. Most months I can do that, but every couple of years I'll run into a dry spell where maybe for three or four months it's a struggle. And things like health insurance, medical premiums, I'm not going to be able to pay.

JENKINS: Robinson estimates health insurance would cost her $500 a month, a lot of money for a policy that might not cover the kind of preventive care she values. As we drive down the freeway, Robinson explains she's a big believer in alternative medicine. She regularly visits not only a chiropractor, but also a naturopath, acupuncturist and massage therapist.

Ms. ROBINSON: I'd rather use the $6,000 a year that I would be paying in health insurance premiums and put it toward actual care - pay the doctor directly.

JENKINS: On this day, Robinson is going to the chiropractor for a variety of aches and pains related to her active lifestyle. This summer she sprained her ankle on a 10-day backpacking trip. She also has a cracked rib from inner-tubing with her grandson behind a powerboat.

Dr. GREG SUMMERS (Chiropractor): (Singing) Good morning, Lyn.

How are you doing today, girl?

Ms. ROBINSON: I'm okay.

Dr. SUMMERS: Beautiful.

Ms. ROBINSON: I think I'm getting better.

Dr. SUMMERS: I hope so. Scoot down just a little bit.

JENKINS: At the chiropractor's, Dr. Greg Summers gets right to work on Robinson's rib. It sounds awfully painful.

Ms. ROBINSON: Yeah.

(Soundbite of yelling and gasping)

Dr. SUMMERS: On the other side you could. You bet. Miss me?

(Soundbite of laughter)

Dr. SUMMERS: Not like a dog misses a stick?

(Soundbite of laughter)

JENKINS: Several manipulations later, Dr. Summers is finished. And Robinson says despite her yelp, she feels good.

Ms. ROBINSON: At that moment it hurts, but always afterward it feels better.

JENKINS: On the way out she stops to pay her bill.

Ms. ROBINSON: Hey, Crystal.

Ms. CRYSTAL: Hello.

Ms. ROBINSON: I want to pay for today and for one other previous treatment.

CRYSTAL: Comes to 70.

JENKINS: As we drive back to the nursery, Robinson says another reason she's uninsured is she doesn't trust insurance companies. She thinks they interfere in the relationship between patient and doctor, driving up administrative costs and deciding what is and isn't covered. She likes the power of deciding where and when to spend her medical dollars. And just like as she climbs mountains and snowboards, Robinson believes she's taking a calculated risk by not being insured.

Ms. ROBINSON: I'm sure that there's people out there that are going to say that's crazy and irresponsible. Maybe it is. Maybe it isn't. Maybe we're just brainwashed into believing that we are supposed to have insurance to be fiscally responsible.

JENKINS: It's not as if Robinson's philosophy about health insurance hasn't been tested. Eight years ago, she fell rollerblading and badly broke her wrist. She had to have surgery. The whole ordeal cost her $14,000 out of pocket. You think an experience like that would've shaken Robinson's belief that she can go through life without the blanket of protection insurance affords. But, in fact, she says it had just the opposite effect.

Ms. ROBINSON: If I have one of those kinds of incidences once in 10 years, I can pay the bill because I haven't paid for worthless insurance premiums. I haven't paid out $6,000 a year for the false security that somebody's going to take care of me if something happens.

JENKINS: Self-reliant as she is, Robinson admits in a perfect world she'd like insurance if it was affordable and if the plan was tailored to her.

Sitting in her office at the nursery, she says she doesn't want to subsidize people who live unhealthy lives, and she doesn't want to pay the same premium as the average 50-something woman.

Ms. ROBINSON: If they could factor in my health. Like, I could be rewarded for the fact that I have low blood pressure, low cholesterol, low body fat, low resting heart rate, I should benefit from that. Those that don't have that maybe pay a little more. But maybe I pay a little more because I ski and snowboard.

JENKINS: Interestingly, Robinson says participating in this story has made her give a lot of thought to being uninsured and it's rattled her a bit. If she got really sick or hurt and racked up hundreds of thousands of dollars in medical bills, she could lose her business. For that reason, Robinson says she's just started shopping around for lower-cost, catastrophic coverage just in case.

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

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