MILLVILLE - Standing outside an old burger joint Monday in downtown Millville, Gregory Robinson said he has been without health insurance for the past six months. So far he's been able to stay healthy, partly by staying as far away as he can from people who are sick.

Nationally, health coverage varies widely by region, based partly on levels of unemployment. Massachusetts, with its universal coverage law, has fewer than one in 20 uninsured residents - the lowest in the nation. Texas has the highest ratio, at one in four, largely because of illegal Hispanic immigrants excluded from government-sponsored and employer-provided plans.

Demographers said the latest figures are striking confirmation of the social impact of the economic decline as it hit home in 2008. Findings come from the U.S. Census Bureau's annual American Community Survey, a sweeping look at life built on information from 3 million households.

According to the data released today, 12 percent of people in New Jersey are without health insurance. In Cumberland County, the rate is on par with the national average of 15 percent.

"I just don't go to the emergency room," the 55-year-old Millville resident said. "If I get sick, I'm just going to try and fight it out. Things would be a lot better (with health insurance), but I just try to not get sick."

Officials with local outreach programs say the rising unemployment rate - as of the end of August, it was 13 percent in Cumberland County, compared with 9.7 percent nationally and 9.2 percent statewide - is having a dramatic effect on an already-depressed area as more people find themselves without insurance and begin looking for help.

By midafternoon, the Community Health Center on Landis Avenue in Vineland was bustling with activity. Parents and children sat in the pediatric waiting room, a day-time soap opera playing on an aging television overhead.

Curtis Edwards, a coordinator for the health center, said the federally funded operation has been busier lately. The 14 sites, located in Cumberland, Cape May and Gloucester counties, offer health services to those without insurance.

"The numbers have gone up every year that we've been working here. There are a lot of uninsured and underserved people here," Edwards said. "As far as the uninsured go, the numbers have grown, especially this year with unemployment rising."

The health centers do not turn anyone away, Edwards said. The first visit is free, but subsequent visits require a fee based on family size and income.

Uninsured patients also are treated at hospitals, where state law dictates that it is illegal to turn anyone away.

At Shore Memorial Hospital in Somers Point, Chief Financial Officer Jim Foley estimates that slightly more than $18 million was spent on treating charity care patients and bad debt patients in 2008.

Charity care patients are those that simply cannot afford their hospital bills. Bad debt patients can afford the bills but choose not to pay them.

Since government plans such as Medicare and Medicaid keep their rates flat, that debt has to be passed onto patients with private insurance plans, Foley said.

Basic care, however, still eludes some.

Jennifer D'Alessandro, of the Holly City Help Center in Millville, said her organization helps mostly families who have some form of insurance, whether it's through an employer or through public programs such as Medicaid. But some people, she said, do not qualify for anything, despite needing medical help.

In the time she has been with the help center, uninsured clients with serious illnesses such as HIV and AIDS, diabetes and lupus have come looking for assistance. Most of the time they are looking for help paying for their prescription drugs, she said. The cost of medication alone can cripple someone who already is facing poverty.

"The best we can do sometimes is just to link them to other services," she said.

For the past 10 years, Robert Kirby has done without health insurance.

The 40-year-old Millville resident said he's unemployed but does not qualify for any government-funded health care. He has stayed healthy by making regular trips to the doctor - paying out of pocket - and has added things, such as prostate exams, as he has gotten older.

He worries about an extended illness that requires more than just a regular checkup, though.

"I'm health-conscious, but I'm 40 years old right now," Kirby said. "Something is liable to happen sometime."

That's why organizations such as the Community Health Center are adding new locations with extended hours. The organization recently opened a location in the ShopRite in Upper Deerfield Township, where the uninsured can get episodic care for minor things such as colds and the flu, and even get regular checkups.

The primary goal, Edwards said, is accessibility, although Community Health Center workers also want to get people out of the emergency room if they do not need emergency care.

Because hospitals such as Shore Memorial provide millions in charity care, the costs are passed on to carriers. Insurance companies have to raise premiums and the rates employers pay to offset the costs, Foley said.

"It's like hot potato," Foley said. "Who ends up paying in the end?"

Staff writer Ben Leach and The Associated Press contributed to this report.

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