AS SHOWN in recent coverage (

Nov. 30, "The Insurance Catch- 22"

), it's often not the poorest who are most affected by our broken health-care system, but those who work and earn too much to qualify for Medicaid but develop health conditions that incur major medical expenses.

Community health centers are all too familiar with these situations as we struggle to offer access to high quality primary care for 270,000 Philadelphians each year, regardless of income or insurance status.

When an uninsured patient has a condition that requires an expensive test or procedure not available on site, our staff have to beg, borrow and call in favors to get the needed care. Health-center staff have gotten very good at making the impossible happen, but this is not a system. Uninsured patients, even when lucky enough to have found a health-care home at a health center, inevitably suffer delays and indignities that would be unthinkable for many of us.

It takes both insurance and access to quality care to make health care work for all Americans. Philadelphia's community health centers urge our senators to join their colleagues in the House and pass real health-care reform.

Natalie Levkovich, Executive Director Health Federation of Philadelphia