Two more arrive. A gray-bearded man with a pirate bandana steps from the shelter of his Subaru. A sunken-cheeked woman rushes up on her bike.

“Woohoo! We have a full car!” the driver says brightly after they’ve all climbed aboard. The riders smile back, some with a hint of resignation. It’s time for the weekly trip to the clinic in Mad River, about 30 miles down a winding mountain road near the Trinity Alps. The tight twists and turns are hard on the stomach, but even harder on the joints — especially if you have chronic Lyme disease, as more than a few of these riders do.

Jeff Clarke, the 58-year-old in the black bandana, has Lyme, acquired long ago from deer ticks that dwell in the region’s sprawling forests. But today he’s going to ask about a lump that’s been growing in his left breast. It’s starting to hurt, and he’s worried. His fellow riders list their own ailments matter-of-factly: asthma, dental decay, diabetes, drug addiction, heart disease and much more.

They wouldn’t be making this trip if they didn’t have to. In Hayfork, “we’re down to the remnants of the medical personnel,” says Clarke, a well-spoken musician with a love for science, cats and NPR. “It just came to the point where if I needed to deal with anything important I just felt much more comfortable going over to Mad River.”

Like so many isolated American towns, Hayfork has lost its vitality and much of its youth to bigger places. For all its tree-lined ridges and breathtaking views, Hayfork is well beyond the tourists’ byways — more than an hour from the city of Eureka on the west and Redding on the east. It’s a 45-minute drive just to Weaverville, the tiny Trinity County seat.

Whether they’re too poor to leave or charmed by the star-filled skies, Hayforkers have mostly made their peace with isolation: No retail stores, theaters, museums, fancy restaurants – and Internet access that is iffy at best.

“We were always 20 years behind everything,” says Shannon Barnett, a 41-year-old a former school teacher who grew up here. “We were all just fine with that. Now it’s different.”

She’s referring to the exodus of basic health services.

For decades, Hayfork had been fortunate. Well after the rise of urban health systems and their intricate business models, it had a tight-knit local “system” founded on the simple, generous commitment of two people: a general practitioner and a pharmacist.

“He was everybody’s doctor,” Barnett says of Dr. Earl Mercill, a GP who moved up from the Central Valley almost 50 years ago. “You never thought about going to anyone else.”

But it’s been years since Mercill retired. Now his clinic is staffed by doctors who rotate in from Weaverville once or twice a week, and otherwise it’s run by physician’s assistants. There are no hospitals for miles, though helicopters swoop in for emergencies when needed.

The Mad River clinic isn’t an ideal alternative.  It’s bigger than Hayfork’s and offers a wider array of services but it’s still staffed mostly by physician’s assistants and about an hour away by bus. It’s so backed up with patients it can take weeks to get an appointment, Clarke says.

In these tiny towns of California’s  far north, lacking insurance is not the biggest obstacle to care. Even before Obamacare took effect, a, roughly the same as in the rest of the state. A good number are on Medi-Cal.

What’s ailing these people is geography – that, and poverty. The median household income in , well below the , according to the American Community Survey.  Unemployment is extraordinarily high – estimates range between and . Many people lack a sturdy car to drive, or even money for gas.

In the federal government’s parlance, Hayfork is a “medically underserved” community – one of roughly 3,500 in the country and 170 in California, according to the federal government’s latest numbers. By definition, these areas have too few primary care providers, high infant mortality, pervasive poverty or a significant elderly population. Some are islands of deprivation within otherwise well-stocked urban areas. Others are dots on the map like Hayfork, far from where doctors and medical services are clustered. According to the National Rural Health Association,

Health care is available on the other side of the mountain, says Greg Schneider, a 65-year-old writer and band mate of Clarke’s. “The problem,” he says, “is getting there.”

Lumberjacks and Janes

In 1967, long after its rise and fall as a gold-mining town, Hayfork struck it rich. That’s when a friend told Mercill, then practicing in tiny Arvin, Calif., that an even tinier town south of Oregon badly needed a doctor.

Mercill was intrigued. He visited a few times with his large and growing family (he and his wife Marianne eventually raised eight kids, four of them adopted).

Hayfork was still a mill town then, filled with lumberjacks and janes, as the women were known. It had restaurants, shops and even a thriving art and music scene.

After praying on the decision, the family moved up north, built a house and settled on 40 acres outside town. A few months afterward, Mercill opened his clinic downtown.

He was beloved almost from the beginning. He made house calls in the middle of the night — sometimes walking over precariously narrow log bridges or shuttling to his patients’ homes by snowmobile.

He delivered babies by flashlight after storms knocked down power and waited by his patients’ bedsides for hours until they felt better, sometimes charging little more than a slice of cake.

“If they didn’t have any money, I saw them,” Mercill recalls, frail now, but with a keen long-term memory. “If they could pay later, fine. If they didn’t, they didn’t. I never went hungry.”

Mercill couldn’t do everything, of course. If a patient needed a specialist or surgery he sent them to colleagues in Redding or Weaverville. Sometimes he drove along with them and assisted in the operating room.

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In 1982, pharmacist Gerry Reichelderfer came to Hayfork, also on a friend’s recommendation. He fell in love with mountain life, and took over the drug store next to Mercill’s clinic.

Reichelderfer lived just seven minutes and a single stop sign away from his shop. He’d drive over and open up anytime people needed a prescription. If they couldn’t pay right then, he’d put it on an I.O.U. or let it slide.

The men joined forces, talking daily by intercom. The partnership would last nearly two decades.

A Turn of Fortune

In the late 1980s, the logging industry started to crumble. Partly because of pressure from conservation groups, the mills in Northern California dominoed shut. By the time Hayfork’s mill closed in the early 1990s, the population — never higher than the low thousands — had dwindled.

“When all the workers left, they took all the families and young children,” says Rick Simmons of the Trinity County Historical Society.  “What was left over was people unable to go anywhere.”

Homelessness, poverty and drug addiction took hold. An underground market began to sprout around marijuana — bringing drifters, seasonal trimmers and unofficial security forces to town. The forests became a dangerous place to wander.

Clarke, a runaway and hitchhiker in his youth, was in some ways typical of Hayfork’s new generation. He arrived in the 1980s, in the clutches of methamphetamine addiction, a habit he picked up in the bars where he played guitar. For years, he landed jobs and lost them — working as a wood chopper, sandwich maker and cabinet craftsman. He started seeing a woman he met in rehab, then split with her, but not before they had a daughter. They named her Stormy Brooke. He gained custody and lost it more than once.

He wanted to get sober for her, if not himself. Seeing no hope for professional help locally, he drove to a clinic in Weaverville. His first need, he told the counselor at the desk, was housing — a roof over his head.

“He repeatedly said that’s not my job,” Clarke says.

Clarke stopped trying to seek addiction treatment after that. “Most of the progress I’ve made in the last few years has been behind the 12-step stuff I do,” he says.

The meetings at Hayfork’s Solid Rock Church saved his life, he says. He goes every Monday and has been sober 10 years.

His health is ok, considering.  He lost his teeth. His bottom denture wore out long ago and his top one is breaking. He has high blood pressure, a detached bicep and hepatitis C from a jailhouse tattoo. He developed chronic Lyme disease because he wasn’t treated right away with antibiotics.

Nowadays, Clarke lives behind the Trinity County Fairgrounds, in a two-room trailer next to the town cemetery. Supported by $889 a month in disability insurance, he spends his time organizing 12-step meetings, reading library books and science magazines, and volunteering as a sound engineer for gigs at a local coffee shop. On good nights, he gets paid a little. Most important to him, he says, is staying as healthy as possible so he can look after 23-year-old Stormy and her 2-year-old son, Tony, who lives with his dad.

Stormy, a tall beauty too insecure to know it, cuts herself and has made several attempts at suicide. Her porcelain arms bear the scars.

“She has no self-esteem,” Clarke says. “She has no faith in love, or trust for any other human beings. She has some real darkness inside her, you know? I’m sure I’m responsible for a majority of that.”

In June, during a fight with her father, she had what Jeff thought was a stroke. En route to Redding in an ambulance, she started seizing so they put her on a chopper. At the hospital, the doctors said she’d had a stress-induced seizure.

After three hours, her doctors released her with a prescription for klonopin to control her seizures and panic attacks, and told her to follow-up with her primary care physician.

“I had to laugh,” Clarke says. “We’re in Hayfork!”

Like losing a limb

Dr. Mercill hung onto his clinic as long as he could, finally selling it to a doctor based in Weaverville. That doctor recently sold it to Trinity Hospital, part of the Mountain Communities Healthcare District, also based in the city.

The saddened community dedicated a clock to him in the town center.  “It was like a limb being cut off,” Barnett says. ”I know at first I didn’t have another doctor for a long time. Other people didn’t either. They bounced around for a long time.”

Every once in a while, Mercill treated people who asked, but he’s 91 now, and hasn’t done that in years.

Two of Mercill’s kids grew up to be medical professionals – one a dentist, another a physical therapist–but they live and practice in bigger towns. The other children also moved away. One son, Steve, moved back from Southern California 21 years ago to care for his mother before she died. Now he’s caring for his dad.

Reichelderfer carried on at his pharmacy after Mercill retired, lending credit to Clarke and others when he could. But the economics of health care shifted under his feet. His business began to struggle. The reimbursements from insurers were too low, he said, and the clinic next door — a long time ally — began referring patients to bigger stores in Weaverville.

In Trinity County, where Hayfork is located, medical services overall became hard to find. In 2012, according to the Office of Statewide Health Planning and Development, there were currently practicing, roughly one per 1,200 residents. Statewide, the ratio is roughly 1 per 300.

Specialists like dentists and psychiatrists are nearly non-existent here. That lack of specialty care – particularly in mental health – wears on some residents. Stormy Clarke says that when she feels a panic attack or depression coming on, she simply tries to breathe deeply and distract herself by keeping busy. She also has a medical marijuana card and smokes regularly.

A county behavioral office offers counseling in Hayfork, but a counselor isn’t there every day and in-person visits are by appointment only. Sometimes the most expedient treatment comes in jail — Clarke calls it the “nudge from the judge.”

He mentions an acquaintance named Robbie, who suffers from paranoid schizophrenia. Since being released from jail, he’s been off his meds, Clarke says. He walks up and down Hayfork’s main strip along Highway 3, muttering to passers-by about the many people who are after him.

“In cities, you have places like outpatient programs for these types of people to go to, every single day,” said Julie Bussman, a psychologist at the Mad River clinic. “It’s a real hardship for people who are severely mentally ill to live out here because there’s not a lot of resources.”

In August, Bussman quit and moved back to Minnesota, leaving no psychologist for miles.

Back on the Bus

After the bus pulls into the Mad River clinic — a remodeled blue cottage that used to serve as a the local forest service office — the riders start their wait. They are used to it by now: The kids pull out games and books; the adults chat in the waiting room or by a weathered picnic table on the back lawn.

Everybody has to be seen before the bus can head back.

On this day, Clarke is among the first in line. The physician’s assistant on duty examines his chest lump and advises against a biopsy, an invasive procedure, because he wants to run more tests. Clarke takes the news with some concern.

“I was pretty freaked out. I went in there with the agenda of the biopsy. They wanted to explore other options,” he says afterward.

By the time the bus gets back to Hayfork, it’s mid-afternoon. He drives back to his trailer, frustrated and spent.

A few Tuesdays later, he takes the bus back to Mad River and is referred to a specialist in Weaverville.

It is another two months before he learns the lump is a side effect of the medications he’s taking — a hypothesis he’d mentioned earlier to physicians and their assistants in Hayfork and Mad River.

Now he has to start thinking about replacing those dentures, which means another bus trip — or several – around the mountain.

The Final Loss

Reichelderfer, 81 and in failing health, began looking earlier this year for someone to buy his store. He looked for months. Even the independents weren’t interested, in part because pharmacists’ family members weren’t keen on moving to Hayfork.

With great sadness, he shut his doors on September 18.

“I wish I could have been able to sell it to somebody,” he said, “for the convenience of the people.”

From now on, Hayforkers will have to get a ride to Owens Pharmacy in Weaverville or to Walmart or CVS in Redding.

It took only a few days to board up a drug store open for 32 years.

It’s a relic now, standing just yards from the clock the town dedicated to Dr. Mercill, with his years of service gratefully memorialized on a plaque.

Heidi de Marco and Carol Eisenberg contributed reporting.

This article first appeared on ºÚÁϳԹÏÍø News and is republished here under a .

He’s also a diabetic, and gives himself insulin injections instead of relying on an automated insulin pump, which he says could be hacked.

“I’d rather stab myself six times a day with a needle and syringe,” Radcliffe recently told security experts meeting near Washington, D.C. “At this point, those devices are not up to standard.”

Concern about the vulnerability of medical devices like insulin pumps, defibrillators, fetal monitors and scanners is growing as health care facilities increasingly rely on devices that connect with each other, with hospital medical record systems and —directly or not — with the Internet.

Radcliffe made headlines in 2011 by showing a hackers’ convention how he could exploit a vulnerability in his insulin pump that might enable an attacker to manipulate the amount of insulin pumped to produce a potentially fatal reaction. Now he talks about going without a pump to raise awareness about the potential for security lapses and the need for better engineering.

While there have been no confirmed reports of cyber criminals  gaining access to a medical device and harming patients, the Department of Homeland Security is investigating potential vulnerabilities in about two dozen devices, according to . Hollywood has already spun worst-case scenarios, including a 2012 episode in the Homeland series portraying a plot to kill the vice president by manipulating his pacemaker.

“The good news is, we haven’t seen actual active threats or deliberate attempts against medical devices yet,” said Kevin Fu, a University of Michigan researcher who has made his career testing the vulnerability of medical systems.

The bad news is that hospital medical devices may be vulnerable to hackers simply because they can be the weak link that gives a criminal access to a hospital’s data system — especially if the devices haven’t been updated with the latest security patches, said Ken Hoyme, a scientist at Adventium Labs, a cybersecurity firm in Minneapolis.

In the real world, he said, a hacker is more likely interested in stealing records he can sell than in harming a patient.

“There are not that many bad…guys whose goal in life is to go and randomly mess with patients in hospitals,” Hoyme said. “They want money, not to shut off the ventilator of a particular patient.”

Hospitals are targets because they collect so much data, from patients’ Social Security numbers and financial information, to diagnosis codes and health insurance policy numbers.

Radcliffe estimates that medical identity information is worth 10 times more than credit card information —about $5 to $10 per record on the black market compared to 50 cents per account for credit card information.

Crooks can use it to apply for credit, file fake claims with insurers or buy drugs and medical equipment that can be resold.

And unlike the victims of credit card theft, those with stolen medical identities might not know for months or even years, giving the thieves more time to use their information.

New FDA Guidelines

Yet there are few cybersecurity standards for medical devices.

In October, developers should bake into their products when seeking approval for a new device.

The guidelines, which aren’t binding, say that when seeking approval for a new device, manufacturers should detail cybersecurity threats they considered and create better ways to detect when it might have been hacked.

They should also build in protections, such as limiting access to authorized users and restricting software updates only to products with authenticated coding.

While a good start, some security experts say the guidelines should be binding. Others fear that giving them the force of regulation could be more harmful because they would become outdated quickly.

Nonetheless, the FDA’s guidance has, in effect, changed the conversation among device makers from, “‘Do I believe this is a real threat?’ to ‘What do I have to do to satisfy the FDA?’” said Hoyme.

By the end of the year, the agency is expected to issue similar recommendations for devices already on the market.

Common Vulnerabilities

One reason many existing devices might be vulnerable is they run on defunct operating systems like Windows XP, which Microsoft stopped supporting in April, meaning there won’t be any new security patches. Other, newer devices may have built-in passwords that are difficult to update. Gaining access to them can be fairly easy which could make them more vulnerable to attack, researchers say. In addition, sometimes, a password is intentionally disabled so it’s easily accessible to medical staff in an emergency.

Hackers can also get into some inadequately protected hospital systems when staff members click on links in emails, not knowing they contain malicious code. Once transmitted to a hospital’s intranet, that malware could find its way into unprotected device software and cause malfunctions, said Hoyme and Fu.

“If cyber criminals decide they can hack into a device to get health records, they won’t think about whether they’re messing with device performance: They’re going after the money,” Hoyme said.

Security experts warn that some of the same design flaws that make medical devices vulnerable would also make breaches hard to track.

“If your iPhone is compromised, it’s a lot more straightforward for someone to determine if it’s been tampered with. We’re not there yet” with medical devices, said Billy Rios, a former Google software engineer turned security consultant.

He describes how he was able to buy a secondhand EKG machine, used to measure the heart’s electrical activity, for just $25 online. Some infusion pumps and patient monitoring systems go for less than $100. That makes devices more readily available to those who want to figure out vulnerabilities to exploit.

“The effort required is so much lower,” he says. “That’s not a good position to be in.”

What Hospitals Are Doing

Hospitals are loathe to talk about device security publicly, but many are working to ensure their systems are stronger.

In a two-year test of information security, experts working for Essentia, a large Midwestern health system. For instance, they found settings on drug infusion pumps could be altered remotely to give patients incorrect doses, defibrillators could be manipulated to deliver random shocks and that medical records could be changed.

Stephen Curran, acting director of the Division of Resilience and Infrastructure Coordination with the Department of Health and Human Services, could not say how many facilities have a chief security officer or someone in charge of cybersecurity.  But even small facilities have some relatively simple options for boosting the security of devices on their networks, he said, including “routine backups and patching of the systems and the use of anti-virus firewalls.”

Still, while “we definitely see a trend in hospitals to improve their security,” says Mike Ahmadi, global director of critical systems security at cybersecurity firm Codenomicon, vendors have to do more to engineer security.

“The bigger issue is that vendors are not held accountable for writing insecure code,” says researcher Rios. “There’s no incentive…so they don’t invest.”

Pressure On Vendors

A few hospitals, including the Mayo Clinic, have started to write security requirements into their procurement contracts.

At the University of Texas MD Anderson Cancer Center in Houston, any new software application has to be approved by the hospital’s security team, headed by Lessley Stoltenberg, chief information security officer.

He says device makers also will have to meet a slew of security requirements: Can the device be encrypted?  Is there a unique identification for users? If the vendor is hosting the device, what does their system look like in terms of firewalls and other protections? Will the manufacturer provide up-to-date security patches?

Some companies, like Ahmadi’s Codenomicon, specialize in selling software to detect software bugs that could lead to security holes.

While Codenomicon has a number of device makers as customers, those are a fraction of the in the U.S., some of which may not be doing even the most basic testing. Most vendors are small — 80 percent have fewer than 50 employees — and many are startups without the capital to invest in a security expert.

So, could hackers target infusion pumps or ventilators?

“Is it possible?” Stoltenberg mused. “Yes. Is it likely? No.  No device in the world is absolutely 100 percent secure.”

This article first appeared on ºÚÁϳԹÏÍø News and is republished here under a .

This post has been updated to reflect the subject’s 2016 insurance coverage. Click here to read.

Leslie Ziegler was, as she puts it, “uninsurable.”

The 31­-year­-old high-­tech entrepreneur and consultant was diagnosed in her 20s with ulcerative colitis, a chronic disease associated with inflammation and ulcers in the large intestine. It has no known cause or cure. Treatment includes expensive medication and, sometimes, costly surgery.

Soon after the diagnosis, she left her job at a startup to help start Rock Health, a San Francisco-based program that mentors budding health companies and provides early funding. The new job didn’t come with benefits, so she looked at her health­ insurance options on the individual market. They were, in a word, bleak.

One carrier told her they’d be more likely to cover her if she’d already had a colectomy, a surgery to remove part of the colon. They didn’t want to be on the hook for that procedure, which can cost thousands of dollars. The others just told her they couldn’t help.

“I was denied coverage by every single major insurance company,” she said.

At the time, she was able to get on her partner’s insurance plan, but when they broke up, she was on her own for coverage. Demoralized by her past encounters with insurance companies, she waited for open enrollment to start for plans on Covered California, the state’s health insurance exchange.

Now, because of the federal Affordable Care Act, insurance companies can’t refuse people coverage or charge more because of pre­existing conditions, and consumers have more flexibility in how they shop for health insurance.

Signing up for Obamacare has freed Ziegler from needing to be tied down to a job or a relationship to get coverage for her chronic condition. Before, she always had to factor in her potential out­-of­pocket healthcare costs when considering taking on new projects that didn’t offer insurance, although she’s healthy otherwise she says.

She now the founder of an insect­ protein­ based food startup dubbed Bitty Foods and an advisor to several health care companies.

“I’ve always felt a little chained to jobs because of my condition. And having the freedom and peace of mind to know that I have access to healthcare any time I need it…is a wonderful thing,” she says.

Recently the White House launched #GeeksGetCovered, a campaign specifically targeted at Silicon Valley ­types. Some preliminary evidence suggests that being able to access affordable health insurance through avenues other than an employer could boost entrepreneurship.

Health reform hasn’t changed the reality that most Americans receive insurance through their employers, who largely dictate which insurance plans employees can access. But it did help ease the shift away from group plans brokered by employers to an online individual market where consumers can directly purchase plans that fit their specific needs.

People like Ziegler represent the future of the individual health ­insurance market in which consumers increasingly will shop for deals aided by government-­run marketplaces like Covered California or HealthCare.gov or private brokers.

At the same time, more data will become available data on pricing and outcomes, insurance and government experts say. If people don’t like the plan they buy initially, they’ll switch, just like they might ditch a shoddy cellphone carrier.

“The availability of data…allows us to create products that allow people to make better decisions in almost every circumstance,” says Bryan Sivak, the chief technology officer at the Department for Health and Human Services. And as a result, companies “will have to compete on the things that matter to people.”

Like many technologically inclined patients, Ziegler is generating her own data, equipping herself with a bevy of apps, gadgets and services — including activity trackers and food logs. She’s been able to use that data to pinpoint the foods that make her bowel flare — arugula, dairy, beer, and rice, to name a few.

“I’m really, really healthy. I self­-tracked myself for a year to figure out what caused problems. I’m like a highly motivated person and none of that mattered [before] when it came to actually getting an insurance policy,” she said.

Soon after open enrollment started in October, she started looking for a plan that would cover medication for her ulcerative colitis, which can cost hundreds of dollars per prescription, and give her access to a gastroenterologist.

Her experience on the Covered California website was good, she says. It took her about an hour to zero in on Blue Shield plan and sign up. She’s paying $400 a month.

Later, she found out her gastroenterologist, who she’d been with for five years and had diagnosed her condition correctly, didn’t take her new plan. She’d spent hours researching her options, but the information on which specialists were available under Blue Shield plan wasn’t clear or easy to find on the company’s website, she says.

“It was really upsetting,” she said.

She was in luck, however. One of her clients is a new organization called Better, a subscription­based health “personal assistant” service that helps consumers navigate the healthcare system online. Though the service, she found a new specialist and got help filling her prescriptions. The transition has been seamless, she says, because Better took care of transferring her electronic medical records to her new provider.

Despite the initial hassle, the Affordable Care Act and her online “personal assistant” have been life­ changing, Ziegler said.

“There’s no way, I would be able to have this degree of flexibility to work with so many companies if I didn’t have it.”

2015 Update

When it came time to re-enroll for 2015, Leslie Ziegler decided not to use an insurance broker. “I did all of the insurance renewal myself,” she said. She chose Blue Shield and opted for a gold plan with a $437 monthly premium. Although her rate went up $37 a month, Ziegler saysthe plan has been working for her.

A few weeks ago she found herself in urgent care after she punctured her foot with a piece of coral. The wound was severe and Ziegler needed to get it surgically removed immediately. “They hooked me up with the world’s best foot surgeon,” she said.

Although being on crutches for a few weeks was a hassle, Ziegler says the experience was better than she anticipated. “It was all resolved the same day,” she said.

The best part for a busy entrepreneur like Ziegler was being able to manage her health care costs efficiently. “I was able to log in to my insurance account to see exactly how much it was going to cost me within a week,” she said.

“The cost … was surprisingly little considering the severity and speed needed to deal with it,” she said. “The total for my care isn’t final yet, but I expect it’ll be under $1,000.”

2016 Update

Leslie Ziegler’s health has been stable for the past year.

“I’ve been quite healthy,” she said. “No colitis episodes in some time.”

She’s satisfied with her coverage and intends to keep the same gold plan from Blue Shield next year, even though she hasn’t had much use for it lately.

“I only use my insurance to cover my prescriptions,” she said.

This article first appeared on ºÚÁϳԹÏÍø News and is republished here under a .

HAYFORK, Calif. — For almost 21 years, Steve Mercill has lived on Doctor Lane, an unmarked, unpaved street off Hyampom Road, about two miles from the center of this tiny mountain town nestled in northern California’s redwood forests.

Doctor Lane is easy to miss, except for a white bridge that marks its start. It was a gift from the town to honor Mercill’s dad, Earl, who for more than 35 years was Hayfork’s doctor. It replaced a makeshift log walkway mill workers laid down years ago so Dr. Mercill could get across the creek to go to work.

Now, the bridge’s upkeep is one of Steve’s chores. He moved here from Napa with his wife and children in 1993 to care for his aging dad and to manage the family’s house and the sprawling property that surrounds it.

Mercill, 59, is one of a growing number of baby boomers leaving their jobs to care for elderly parents, who generally are living longer because of medical advances. Like many of these workers, whose efforts are believed to save millions of dollars in nursing home costs, he’s uninsured.

Before California opened it’s subsidized insurance exchange, about one in three home care workers lacked health insurance, according to the Paraprofessional Healthcare Institute, a New York-based policy organization. It’s unclear how those numbers have changed.

For Mercill, insurance coverage has nearly always been beyond his grasp.

His dad pays him a couple of thousand each month. Steve Mercill’s wife, Mary Elaine, works as a special education aide, bringing their income to about $60,000 a year – but Mercill says it’s not enough to cover him and his youngest daughter, 22, who is a college student.

Mercill has been self-employed or worked jobs, like construction, that didn’t offer health insurance, for most of his life.

Now his household income is too high for Medi-Cal, the free California insurance program for the poor and disabled.

Theoretically, he’s a candidate for subsidized coverage under Covered California, the state’s subsidized insurance marketplace. But when he tried to enroll earlier this year, he couldn’t overcome the technical challenges.

By his own admission, he’s not computer savvy, plus Internet service is temperamental here, and he doesn’t get it at home. Mary Elaine tried to help him by using a computer at her school, but the website wasn’t working well – a problem common throughout the state at the time. She also had some security concerns.

“It popped up saying ‘security risk’ and there was red flashing. I was afraid of doing it that way, so we tried calling,” said Mary Elaine, who also says she’s not good with technology. Their experience with the call center wasn’t much better — the wait was long and the site kept crashing while they were on the line. So they gave up.

Now, she worries that if something happened to her husband they would be on the hook for the bills. For basic care, they’ve relied on their son, who’s a physical therapist, in the past. He helped his dad cope with an injured achilles tendon, for example. But Mercill thinks he probably needed surgery.

For minor procedures, they used to turn to his dad, but Earl Mercill doesn’t practice anymore. The clinic he built in town has been sold off to a regional hospital and is too expensive, Mary Elaine and Steve say. So Mercill’s closest option is a clinic in Mad River, a town about an hour’s drive away on a windy two-lane road.

“I feel terribly guilty that I have insurance and my family doesn’t, but we’re going to try again,” said Mary Elaine, referring to open enrollment for Covered California in the fall. “I’m hoping we can find something through Obamacare that….we can afford.

Mercill and his wife are keeping their fingers crossed that he won’t need expensive medical care between now and October.

As his dad has gotten older and less independent, Mercill said he’s had to give up side jobs he had in town teaching physical education and doing construction. Earl Mercill, 91, is still in relatively good health but has battled prostate cancer, suffered a heart attack and had heart surgery. Recently, he fell off a chair and broke his arm.

Steve’s glad to spend time with his father, but the job can be tough and isolating, he says.

He tries to stay busy by chopping wood, gardening and playing music. That helps keep him from feeling depressed — sometimes more successfully than others. Mercill used to binge-drink, and though he admits he’s had some slip-ups, he’s been able to stay mostly clean because of the support of his family, especially his dad, he says.

Every day around 8 a.m., Mercill walks from his own small white house up the driveway to the brown two-story house where his father lives. He cooks meals and cleans the house, with Mary Elaine’s help. If his father is ill, he bathes and dresses him, helps him use the bathroom and tucks him into bed. When his dad is in good spirits, the two garden together, read the Bible and sing hymns. On Sundays, they go to church.

“It’s not totally my cup of tea — caregiving — but my dad’s done a ton for our whole family, and I’ll do anything [for him] till the day he dies. Whatever it takes,” he says. “He’s got a good sense of humor. If it wasn’t for all that I wouldn’t be able to do it.”

Mercill added that his father has always wanted to die peacefully, at home.

A nursing home “would be a curse of death to him,” Mercill said. “I can’t do that emotionally. If at all possible we’re trying not to.”

2015 Update

Steve Mercill is still uninsured. The ex-surfer says getting health coverage is just not a priority for him right now.

Taking care of his father is a 24-hour-a-day job that leaves him with little time, or motivation, to research his health care options. “I barely hang in there sometimes … mostly [because of] the mental stress of dealing with elder care,” he said.  “Dad is doing better than me.”

For now, Mercill has only dental coverage through his wife’s employer.  Although he is grateful he hasn’t needed urgent medical care in the last year, he knows he needs health insurance.

He recently hired additional people to help him care for his father and hopes the extra help give him time to figure out his health care insurance options.

helps fund KHN coverage of the Affordable Care Act in California.

This article first appeared on ºÚÁϳԹÏÍø News and is republished here under a .