Breaking one's back is a traumatic experience.

Add to it the extra trauma of not having health insurance and having thousands of dollars in medical bills, and it becomes even worse.

That's exactly the position Springville resident Lois Roberts found herself in a few years ago. She doesn't work outside the home and her husband is on permanent disability; they can't afford insurance and she doesn't qualify for any assistance programs, so they footed the bill themselves.

Roberts is one of the approximately 47,900 people in Utah County without health insurance, a number that's increased during the last year. According to the state health department's most recent report, the number of uninsureds rose by almost 10 percent from 2004 to 2005, with 11.6 percent of the state now living without insurance. The increase correlates with the rising cost of health care and the decreasing number of employers who offer it.

"We kind of understand that what's really behind it is fundamental economics," said Norman Thurston, a health economist with the governor's Health Insurance for the Uninsured Workgroup.

The state government is taking steps to combat the increasing rate and number of uninsured people, including the governor's initiative, which aims to halve the number of uninsured Utahns by 2010. Two state senators are taking aim at the insurance industry, demanding reasons for skyrocketing health care costs.

"When more and more individuals are losing coverage or have to meet astronomical first pays or co-pays just to see a doctor to receive medical attention, then something must be done," Sen. Gene Davis, D-Salt Lake City, wrote on www.senatesite.com. "The health care system is broken, and part of the problem is patient choice and access to affordable health care."

Most people who don't have health insurance fall into two general categories -- those who simply can't afford it and those who see the cost as being greater than the possible benefits.

The second group consists mostly of young adults, Thurston said. As fewer employers offer health insurance, people in the 19- to 26-year-old age range who are healthy and don't go to the doctor often decide an individual plan isn't of enough value, a perception he said is logical provided nothing serious goes wrong.

"Health insurance really doesn't help you much if you need to go to the doctor once a year for allergies," he said, adding the value in having health insurance is if a catastrophic illness or injury besets an individual. "Even young, healthy people should think about the what-ifs of life."

Most of the rest, though, know they need it but can't afford it. As a result, people without insurance put off going to the doctor until it's necessary, and by then their treatment is usually more expensive, especially if they go to an emergency room instead of a doctor. The hospital, to make up the costs of people who don't pay in full, has to charge more to private insurance companies, which pass the higher costs on to their consumers.

"When a person doesn't have health insurance, it doesn't mean that they won't have health care needs," Thurston said. "There's some concerns that people without insurance may not have as good access to the system and they may not access it in the best way, so it does not lead to the best outcomes."

A health catastrophe and the resulting medical bills also can lead to a financial catastrophe; several studies in Utah have found unanticipated health care costs as one of the leading causes of personal bankruptcy, he said, which just continues the cycle. Since procedures like gallbladder or knee surgery run up bills in the thousands of dollars, anyone needing more than basic medical care can fall into the cycle. And since uninsureds usually go without preventive care, they're more likely to have serious medical needs.

These are typically the people that Kristen Erekson, the medical care coordinator at Community Health Connect, sees. Doctors around the county who work with uninsured people send patients with acute specialty care needs to the group, and the organization connects them with doctors or dentists who donate their services.

"They can't be ignored," she said of the medical complaints she's heard; patients often needed gallbladder or hernia surgeries, ophthalmology attention, orthopedic surgery or dental work. Other organizations deal with episodic or primary care concerns.

Both Erekson and Thurston said they worry about the future, with both health care and health insurance costs rising, and how the state will address those needs.

"I'm interested in seeing what kind of solutions we can come up with, because there's definitely a problem," Erekson said.

So would Roberts, who struggled until she got accepted to Mountainlands Community Health Center, a nonprofit organization that provides health care for people without insurance, but still has difficulty paying for lab work and specialized needs.

"It's just frustrating that there's nothing available," she said.

Heidi Toth can be reached at 344-2543 or This e-mail address is being protected from spam bots, you need JavaScript enabled to view it

Where to go if you don't have insurance:

Seraphine Clinic: 560 S. State St., Suite B-1, Orem; (801) 434-8000; offers primary and urgent care for reduced fees.

Mountainlands Community Health Center: 215 W. 100 North, Provo; (801) 374-9660; offers dental, primary and urgent care on a sliding fee scale.

Volunteer Care Clinic: 151 S. University Ave., Provo, Room 1709; (801) 812-8094; offers immediate care on Tuesday and Thursday nights at no cost.

Food and Care Coalition: 60 N. 300 West, Provo; (801) 373-1825; offers dental care.

Planned Parenthood: 1842 S. Columbia Lane, Orem; (801) 226-5246; provides Pap smears, breast exams, pregnancy tests for a fee.

Subgroups most likely to be uninsured:

Adults between 19 and 26 years old -- 23.3 percent

Families at or below the 200 percent poverty level -- 23.4 percent

Adults without a high school diploma -- 47.4 percent

Utahns of Hispanic or Latino descent -- 37.4 percent

Source: Utah Department of Health