New census data provide a clearer picture of the medically uninsured.
In Stanislaus County, about one in four adults, ages 18 to 64, live without health coverage. The figure includes healthy young adults who often disregard the need for health insurance.
Among county residents in the 40 to 65 age group, who are at higher risk for chronic health problems, the data shows that 15 percent lack insurance to pay for treatment of diabetes, high blood pressure, heart disease or cancer. They have no protection against hospital bills that could drive them to bankruptcy.
Children in California are usually covered by their parents' health plans or government programs, but 11 percent of Stanislaus County children are not covered. A local official said the 16,000 children are probably uninsured because their families have not applied for services or have not gone through the renewal process for the state's Medi-Cal program.
The 2007 data comes from the Census Bureau's Small Area Health Insurance Estimates, which provide county-level health coverage information by age, sex and income category.
Local health officials believe the number of uninsured has grown since 2007 in a county where unemployment has hovered near 20 percent during the recession.
A recent survey by the UCLA Center for Health Policy Research put the uninsured rate at 22.3 percent for Stanislaus County residents ages zero to 64, compared with 17.2 percent in the 2007 census data.
The census numbers are older but offer more details on the county's uninsured population.
According to the data, 37,400, or 24 percent, of the county's 155,000 men younger than 65 were without insurance in 2007. Of the 156,580 women in that age group, 26,150, or 16.7 percent, did not have coverage.
People with smaller incomes were more likely to be uninsured. Almost 28 percent of middle-aged adults earning $40,300 or less for a four-member household didn't have coverage for medical bills.
The rate was 33 percent for men and 23 percent for women in that income category.
Without insurance coverage, people are less likely to have regular checkups, they postpone treatment for medical conditions and might suffer premature death, health experts say.
Marlene Perez, a health educator for a Golden Valley Health Center in Modesto, said some uninsured patients wait until they are in severe pain before they come to the Sixth Street clinic,whose discounted fees are pegged to income.
Some learn their constant headaches are caused by hypertension. Others may be diagnosed with cancer.
"The risk is not having the health condition identified early enough to treat them," Perez said. "If they had been screened earlier, they might have been able to survive it."
Jacqueline Sutton, 23, of Modesto said it's tough for her young family to live without health insurance. She is pregnant with her second child and recently found out she has diabetes.
"My husband's job doesn't cover him for any medical," she said. "When he needed to have a tooth pulled, he used his dad's credit card."
Her pregnancy should qualify Sutton for Medi-Cal. She went to the Golden Valley clinic this week to start treatment for diabetes and learn to monitor her blood sugar at home.
Officials who have daily contact with the uninsured say the numbers are getting worse.
In the past year, the county's health services program for poor adults approved more than 9,400 applicants, up from 7,500 the previous year, said program manager Maria Blanco.
The cause for the surging enrollment is people losing their jobs and exhausting their COBRA benefits, she said.
To deal with a shortfall in state funding for the safety-net program, the county early this year started to charge large co-payments to patients with incomes exceeding $600 a month. It reversed the policy after a patient advocacy group threatened a lawsuit.
More than 1,300 applicants didn't meet the eligibility requirements for the program this year and were turned away.
"If they get sick and are going to the ER, the emergency room is very expensive, and if it turns into an inpatient stay, that can be very expensive," Blanco said. "I am hoping with the new health care reform, we will be able to transition the uninsured into one of those coverage options."
The national reforms, adopted by Congress in March, will allow people to buy insurance through state-run exchanges starting in 2014.
In the meantime, patients including Julia Gonzalez of Modesto resort to safety-net clinics such as Golden Valley, which allows her to pay fees as low as $35 to see a doctor.
Gonzalez, 48, got her diabetes under control and didn't see a physician for a year. She recently learned her blood sugar was elevated again.
Golden Valley's Perez said the Sixth Street clinic is getting an influx of people who were laid off by canneries and other companies.
"We see a lot of people who used to have insurance and no longer have it," she said. "Our patient volumes are more and more every day."
On the Net: Go to www.census.gov/did/www/sahie and click on "create interactive tables."
Bee staff writer Ken Carlson can be reached at firstname.lastname@example.org or 578-2321.