The energetic community service coordinator for Franklin County's Agency on Aging caters to senior citizens, helping them with issues such as health care.

Rugg's work involves finding solutions for area seniors on tight budgets. But now it was her turn; Rugg faced the prospect of losing her health insurance.

Her agency, a nonprofit with 17 employees, has fought an uphill battle to keep staff insured. The cost nearly drove them out of the market this year.

"I'm 45 years old, and I've never been uninsured in my life," Rugg said. "I could eventually be forced to find catastrophic insurance on my own for $700 to $1,000 per month or nothing."

That question surfaces more often these days in a state where 300,000 Kansans are uninsured. Among them are an estimated 50,000 children, state insurance officials report.

Some communities seeking to become healthier and lower costs have responded with new health and fitness programs, building new centers and encouraging more physical activity and healthier foods in local schools.

Some cities are opening new dental centers at their "safety-net" clinics, a growing array of nonprofit centers that rely heavily on government aid and charity to care for low-income Kansans.

But up-front doctor fees are too expensive, she said. And Ebenstein and her husband, a construction worker in Ottawa, dropped their $400 monthly insurance premiums because of cost.

Now medical bills have put them in a financial hole. She's grateful her children have insurance through the state, she said. But their health, Ebenstein believes, also relies on a stable place to live.

Across town at Rugg's office, the aging agency would like to combine their employees with those of other nonprofit agencies to spread the cost burden. But so far the efforts have run into brick walls.

"I think our health care systems are strained to the breaking point," said Billie Hall, president of the Topeka-based Sunflower Foundation, which offers grants for health improvement projects. "Unfortunately, there is no easy way and the solutions are very complex."

A 2004 study by the Kansas Health Institute found deep concern among Kansans on affordable prescription medicines, small businesses' ability to insure staff, low-wage worker coverage and healthy foods in public school vending machines.

Kansas' 10 percent uninsured rate falls below the national average. But that could change, Praeger said, if employers continue recent trends of shifting more insurance premium costs to employees. At the same time, Praeger added, the insurance industry is beginning to stabilize. Recovering from losses in the stock market and the 2001 terrorist attacks, a few companies are starting to offer "creative" products for low-income families.

At a time when obesity is skyrocketing and smoking is costing the public more than ever, there is no major study to gauge the health of Kansans. Unlike other states, the Kansas Legislature dedicates few dollars to research the health status of residents.

Bob St. Peter, president of the nonprofit Kansas Health Institute, recently told a crowded health care conference in Topeka that policymakers should consider the entire health care picture - not just medical services but the environment in which a child grows up.

Minority communities struggle harder than others to get adequate care and live healthy lifestyles. A health institute study earlier this year documented wide disparities among ethnic and racial groups.

"People call us from Rice County and others surrounding us, asking if they can be seen. They have needy sounding stories, but we just can't help them. We have more than we can handle right here."

Tesluk's clinic, PrairieStar Health Care, is a project of Health Care Inc., the local hospital's parent company. No one is turned away at the center, which aims to care for those left out of the private-care system and to steer uninsured patients away from seeking basic care in expensive emergency rooms.

"We know the budget is tight, but we absolutely need more support," said Karla Finnell, executive director of the Kansas Association for the Medically Underserved.

"I can't imagine how we'll get to where we need to be without it being inordinately painful," Finnell said of the long-term cost to care for all Kansans. "We're paying for 'universal' care right now in a very ineffective way."

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