He had little income, no health insurance and no English-speaking skills. Luckily, he learned through a Hispanic newspaper about Casa De Maryland, a Silver Spring advocacy center for immigrants.

Every Thursday a Mobile Medical Care van parks outside the center and gives free medical treatment to uninsured, low-income people like Barrantes — if they have an identity document. The van provides health screening, treatment for chronic diseases like blood pressure, diabetes and asthma, and medications for routine ailments. Funding comes from the county and from services donated by hospitals, doctors and other medical professionals, said Michelle Ghabranious, clinical director for Mobile Medical Care Inc.

Barrantes, 40, is poor (earning about $50 a day when he can find work), a non-citizen and Hispanic -- all which put him at greater risk of being uninsured.

He is one of 740,000 uninsured Marylanders, or 15.3 percent of the non-elderly population, according to the Maryland Health Care Commission’s numbers for 2002-2003, the most recent available.

Of the elderly 65 and older, 99 percent are covered by Medicaid, Medicare or some sort of private insurance, said Ben Steffen, deputy director for Data Systems and Analysis for the Maryland Health Care Commission.

That total number of non-elderly uninsured grew by 50,000 from the previous two-year snapshot, when 14.4 percent of the population had no health insurance. But because of population increases in the state, the increase was statistically insignificant, Steffen said.

Advocates for the poor point out that they are accounting for increasing percentages of the uninsured totals.

In the 2002-2003 tally, the poor accounted for 21 percent of the uninsured in Maryland, and the near-poor 28 percent, Steffen said. That is up 3 percent for the poor and 5 percent for the near-poor from the 2001-2002 numbers.

Minorities remain at a greater risk of being uninsured than the rest of the population, with Hispanics being at the greatest risk. Hispanics accounted for 23 percent of the uninsured in Maryland while comprising just 7.2 percent of the total population.

Nearly half of all Hispanics in Maryland – 48 percent -- are uninsured, Steffen said.

“If you are a non-citizen Hispanic that figure jumps to almost 69 percent,” he said. “Clearly, if you have multiple risk factors for insurance coverage -- low income plus non-citizenship -- risk of being uncovered increases.”

Many uninsured Hispanics can be found on Maryland’s Eastern Shore or in Western Maryland, where migrant laborers work, often illegally, in low-paying agricultural jobs or other kinds of low-income employment, said Natali Fani, an advocacy specialist at Casa de Maryland.

African Americans, who comprise 32 percent of the uninsured but just 28.7 percent of the population, are the racial group second most at risk of being uninsured, officials said.

Adults without dependent children account for 61 percent of the uninsured population.

Young adults, ages 19 to 34, comprise 41 percent of uninsured and are less likely to have health insurance regardless of income.

Being uninsured can lead to disaster for patient and hospital alike, Fani said.

“When people don’t have insurance, they don’t go to the doctor,” she said. “The result of this is they go to the hospitals and the clinics (only) when there’s an emergency, which increases the costs for the hospital as well.”

This is common with uninsured people who have diseases like diabetes, Fani said. If the problems mount incrementally until there is a medical disaster, the costs increase for everyone involved, said Nancy Fiedler, spokeswoman for the Maryland Hospital Association.

“If they wait until they’re in a diabetic coma, for instance, instead of managing their insulin, that translates into higher health care costs for all us,” Fiedler said.

The 7 Percent Cost

Many uninsured patients are unable to pay for health care costs. The result is that paying patients and their insurance companies must cover an extra 7 percent for every hospital visit on top of their regular bill.

“You have to generate an extra 7 percent ... to account for the uncompensated patients,” said Bob Murray, executive director of the Health Services Cost Commission, the governmental body that sets hospital rates in Maryland. 

Even then, hospitals that see an unusually high volume of the uninsured, like the R Adams Cowley Shock Trauma Center at the University of Maryland in Baltimore or the Bon Secours Health System Inc. in Marriottsville, end up eating some of the costs of the care they give, said Fiedler.

Part-timers, Menial Laborers at Special Risk

Alma Roberts, president and CE0 of the Center for Poverty Solutions, a Baltimore-based  advocacy group, cited a number of reasons that the poor are increasing their ranks on the uninsured lists.

She said low-income workers are not working enough hours to qualify for health insurance, or are piling together low-paying jobs to make ends meet where none adds up to a full-time position, or are working for small employers that don’t offer health insurance.

“They either think they are young enough, or they can’t afford it, or a combination of the  two,” she said.

Roderigo Jacomo, 33, of Langley Park, said he was waiting in line at Casa De Maryland  on a recent Thursday because private-practice doctors cost too much.

“Usually you can find a doctor, but it might be very expensive, and here if you can get an  appointment, it’s much more economical,” he said.

Jacomo, who cuts grass for $8.50 an hour, said his employers offer him on-the-job injury insurance but not health insurance.

Many college students, not backed by any other health care plans, opt for their college’s health care plan. At the University of Maryland about 2,000 students have signed up for the college’s Mid-Atlantic Medical Services (MAMSI) health insurance plan, which costs $1,278 for a year.

 “Usually if they’re taking the student plan, it’s because they don’t have insurance either through their parents or their job,” said Joann Rubenstahl, an accounting clerk in the university’s health center. The university does not keep track of how many students have no health insurance at all, she said.

While the state does not track uninsured college students, either, statistics show that 18 percent of the uninsured in Maryland are between the ages of 19 and 24.