On a historic day for the future of health care in America, it was business as usual Thursday at Sacramento County's clinic of last resort.

Inside a tidy brick building at the corner of Stockton Boulevard and Broadway, hundreds of people packed waiting rooms and stood patiently in seemingly endless lines, seeking appointments for broken bones and bad backs, diabetes complications and aching teeth. Young women with worried faces tried to soothe crying babies. Elderly people rested in chairs, staring at muted television screens. A man with a sore leg leaned against a wall, steadying himself with a golf club.

Visitors to the county's Primary Care Clinic are the very Americans who President Barack Obama argues will benefit most from his Affordable Health Care Act, which the Supreme Court ruled constitutional on Thursday. They are considered "medically indigent," with most lacking health insurance coverage of any kind.

"We're the greatest country in the world," said Michael Lilley, who works part time for a nonprofit group and has been without medical coverage for about three years. "Health care absolutely should be a right for everyone."

Lilley, 27, took a tumble from her bicycle a while back and badly twisted her ankle, she said. "I probably needed to get to a doctor, but I couldn't afford it," she said. So she bought a pair of crutches at a thrift store and gutted it out. She needs to replace her contact lenses, but cannot afford to do that, either. She was standing in line Thursday to get a dental appointment to fill a couple of cavities.

"I figure I'd better take care of it now, or else it gets worse," she said with a shrug. "I'm already feeling it, so that's not good."

Lilley and others said they were grateful that they had somewhere to go for help with their health issues. But the clinic, they said, routinely is overcrowded and understaffed. Sometimes, they said, it takes a full day to schedule an appointment for future care. It can take months to actually get in to see that doctor; longer to see a specialist.

Long waits and short tempers make for occasional emotional outbursts and angry flare-ups. Security guards in baby-blue shirts patrol the perimeter of the building and walk its hallways, striving to keep the peace.

Charles Hudson, 45, has been a frequent visitor to the clinic since injuring his back in a car accident last year. "They're backed up," he said. "I won't get a follow-up visit for at least three months."

On Thursday, Hudson declared that the Supreme Court ruling was good for America. But he and others expressed skepticism that their particular situations would improve anytime soon.

"The problem I see is that people who are on fixed incomes still will not be able to afford to buy insurance" under the president's plan, said a woman who identified herself only by her first name, Vicki, because she said she was embarrassed to have to seek help at the county clinic. "Medi-Cal? A lot of doctors don't take it."

Vicki worked for 21 years in the health care field before getting laid off from her job last year and has had no luck finding work since then. "I had always taken care of myself and my kids. Now it's all gone," she said.

Recently her daughter became ill, and Vicki had to spend $400 to pay for her treatment at an urgent care center. That meant stretching her budget for food and rent, she said.

Vicki herself is diabetic, and "right now my sugars are out of control," she said as she waited in line Thursday hoping to schedule for her first appointment. The county clinic "is my only option" right now, she said.

The president's plan, she said, "is a start. But with the politics and everything else going on, I just don't see it helping a lot of people right now."

Melissa Maxey, 45, was more optimistic.

Maxey worked as a house cleaner and got Medi-Cal coverage until last year, when her daughter turned 21, she said. Shortly after she was dropped from Medi-Cal, she broke her leg. She needs surgery to repair it.

"I just want to get back to work, but I've been trying to get seen by an orthopedic surgeon since last July," said Maxey.

Limping along in line in the pharmacy lobby, where she hoped to fill a prescription for pain medication, Maxey mustered a positive attitude about the Obama plan.

"I think we should be like Canada. Everyone deserves health care and everyone should get it," she said. "It might take a while but it will happen eventually. I have to believe that."

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