"What's your insurance?" nurse practitioner Christine Phillips asked Wednesday as she gently touched Sou Sae- turn's left ankle, swollen and stained with wide, purple bruises.

"I don't actually have insurance," replied the 27-year-old, who had landed on an opponent's foot playing basketball five days before. He was laid off from an Elk Grove warehouse job a year ago, he said, and his health coverage ended six months later.

Saeturn is just the kind of patient the new nonprofit North Highlands Multi-Service Center is meant to assist. The clinic opened Nov. 1 on Watt Avenue in a community where people's need for affordable health care services has long outstripped the scant medical and dental offices there to serve them.

"North Highlands is a blue collar, working-household neighborhood," said Sacramento County Supervisor Phil Serna, who is chairman of the state-funded First 5 Sacramento children's health program. "A lot of household incomes just aren't enough for families to put food on the table and provide routine dental checks and other health services for their children."

The U.S. government officially names parts of North Highlands as having a shortage of health professionals.

Thirty-six percent of the community's residents under age 65 are covered by public insurance programs like Medi-Cal, compared with 16 percent statewide.

The need has grown more acute, said Serna, since the county closed four of its five public clinics in the past three years, including those in Del Paso and Citrus Heights that bracketed North Highlands.

The new site is run by the Effort, a local nonprofit health care provider that now operates four clinics around Sacramento. Staff said many patients from the North Highlands neighborhood don't have cars and arrive on foot.

The Effort already ran parenting classes, children's mental health programs and other services at the same site.

But it renovated and expanded the space by 2,500 square feet to become a full-fledge primary care center with six exam rooms, plus five chairs for children's dental care.

The $810,000 expansion combined $550,000 from the federal stimulus, or American Recovery and Reinvestment Act, and $260,000 from First 5 Sacramento. Part of a $700,000 grant to the Effort from Kaiser Permanente is covering personnel and startup costs.

The Effort does not accept patients with private insurance, focusing instead on those covered by public plans or those paying out of their own pockets, who are charged on a sliding scale. Federal dollars help make up the difference in its expenses.

Saeturn, for instance, said he paid $42 for his visit and $25 for the X-ray. Another clinic he called had quoted him $100 just for a visit.

Calling his likely sprain "a doozy," Phillips told Saeturn to wear a brace, ice and elevate his ankle and stay on crutches for at least a week.

In the wake of the county clinic closures, Serna said he believes Sacramento County will increasingly rely on nonprofit providers like the Effort to care for low-income and uninsured patients and relieve the "unsustainable" burden on emergency rooms receiving patients whose illnesses should have been treated in primary care.

"We're in the midst of a shift in how health care for the most needy is administered," he said.

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Call The Bee's Grace Rubenstein, (916) 321-1270. Bee staff writer Phillip Reese contributed to this report.

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