TOLEDO, Ohio — The debate over whether Ohio should make health care coverage available to more low-income residents has been framed largely by numbers and dollar signs.
Behind those figures, though, are thousands of people who have little or no access to medical care and treatment programs. Many are making just enough to stay above the poverty line.
While the fate of Medicaid expansion remains on shaky ground in Ohio, those who would benefit the most from widening the taxpayer-funded health insurance program are adults who don't have children at home.
Some lost their jobs during the Great Recession and have been unable to find steady work. Others have chronic conditions that make keeping a job a challenge. Some have battled drug addiction or mental illness.
Carol Herbin, of Columbus, has spent the last five years looking for work and picking up odd jobs after a hospital eliminated her position in its registration department. Before that, she worked for 27 years with an insurance company processing claims.
She no longer has health insurance and relies on organizations that give out medication to the needy. Just a few months ago, she waited seven hours at a church for blood pressure pills.
"I've never been in this situation," said Herbin, 59. "I've seen this other side, and it's very humbling."
The little money she makes singing with a church band and at temporary jobs likes distributing Girl Scout cookies to troop leaders goes toward paying her mortgage and buying food. There's nothing left over for medicine or doctor visits, she said.
"If you don't have any income, what do you cut out?" she said.
Many of those without health insurance rely on free clinics or end up in hospital emergency rooms when their ailments become too much to ignore.
Shari Bell, of Cincinnati, has been to the emergency room five or six times in the past year to deal with a thyroid problem, her most recent trip coming just two weeks ago. She says she needs surgery but can't afford it.
Her family chips in to buy her medication. "I have to wheel and deal every month to get the little medicine I have," she said.
Bell, 45, said her thyroid problem affects her vision, causing her to see double and sometimes leaves her eyes swollen shut. She lost her job as a cashier because she couldn't read the numbers on the register.
Having better health care could change her life, she said. "Maybe I'd become a productive citizen," she said.
Expanding Medicaid is a central element of President Barack Obama's health care law, but the idea is being met with resistance in the Ohio legislature.
The state estimates that 366,000 Ohioans would be eligible for coverage beginning in 2014 by expanding Medicaid, which already provides care for one of every five residents in the state.
But Ohio lawmakers want to craft their own Medicaid plan that may or may not include adding more people to the state's Medicaid rolls. Among the other proposals they'll likely consider is using federal money to buy private insurance for low-income residents.
Shawn Trammell, of Cincinnati, doesn't care what the final plan looks like as long as it makes health care an option for people like him.
He has arthritis and other ailments that make it difficult to keep a steady job. He works occasionally in landscaping and doing plumbing and electrical jobs.
Suffering from back pain shooting down his leg earlier this month, he went to a hospital emergency room, where he got muscle relaxers and a prescription for pain medicine.
He couldn't afford the $21, though.
"I just had to go without it," said Trammell, 45. "I go day by day. I'm really trying to work, but I need help getting on my feet."