The cost of health care coverage often is out of reach for many Americans and President Barack Obama is proposing to revamp a $2 trillion U.S. private health care system.  He proposes strengthening the employer-based health insurance that many Americans get through their workplaces.  For those whose employers do not provide insurance, the administration proposes measures to make buying their own coverage more affordable.

But now, people with low incomes find it especially difficult to pay the doctor or buy prescription drugs.  In Washington, a community health clinic is providing low income people with medical care at an affordable rate.

A woman from Bolivia came to be examined at the "Community of Hope" health clinic in Washington, D.C.  She works as a nanny for an American family.

She's a typical patient, says Nurse practitioner Laura Worby.

"Many of them [immigrants] work low-wage jobs, or they are chronically unemployed," she said.  "Many work in sectors of the economy that don't provide insurance, from daycare, to cleaning, to construction, to driving taxis, to working in restaurants."

Kalima Wasilo came to the clinic with her children. Recently, her husband was laid off from his job. She is from Benin and has been in the U.S. for three years. 

"Back in Africa, in my country, if you don't have the money it is not easy to get good health care," she said.

The non-profit clinic has been providing medical care for 25 years.  A few years ago, the clinic moved into a neighborhood in Washington that is economically mixed with sizable Latino and black populations.

"Community of Hope" charges small fees to help low income people who have little or no health insurance. No one is turned away, even if they cannot afford to pay anything.  The clinic provides basic medical care for illness like a cold or flu and provides dental care. 

Dentist Sonia Martin-Samuels says she is seeing more patients and they are waiting longer for care as low income people lose their jobs because of the downturn in the U.S. economy. 

"Patients have to wait quite awhile to get an appointment because we are just overwhelmed with patients," Martin-Samuels said.

Robert Chambers has diabetes and is getting his blood sugar tested.  He is both a patient and a member of the board of directors which oversees the clinic.  Half of the board is made up of people who are also patients. Chambers has held many jobs which provided no health insurance but now has some coverage.

He says, in the past, he would cut back on the insulin used to control diabetes so the medication would last longer. 

"I'm not really doing myself real justice, but you figure a little bit part of the dosage is better than no dosage," he said.  "Sometimes you may even skip a day just to keep some insulin on hand."
Chambers says with the high price of health care, he hopes President Obama's health care reform will become a reality. 

"It needs to be at a cost that's reasonable enough that anyone can have it," he said.

Many patients have come to the clinic for years and now their children are coming.  But as the demand for the clinic's services have gone up, there is now a long waiting list.