For the Clarkes, a family of four in rural Ohio, an afternoon spent outside with their horses is a rare escape from their daily hardships.
"This is America," Mary Clarke said. "You're supposed to be able to work hard, get ahead, but some people are choosing food over health coverage."
Learn more about America's health care crisis, all week long in the ABC News series Perscription for Change
Approximately 115 million Americans -- one-third of the nation's population -- are uninsured or under-insured with skimpy, on-and-off coverage. And it's only getting worse, especially in rural America.
"At this point in our county, there are almost no manufacturers left," said Jack Frech, director of Athens County Job and Family Services. "The last three or four that offered relatively decent jobs with full benefits. … They're all gone."
The Clarkes do what they can to make ends meet.
Mary Clarke is a self-employed real estate appraiser.
Ed Clarke lost a good job with benefits a few years ago and now works part time.
Together, they make around $20,000 per year, just enough to put food on the table and pay the bills.
"You have to figure that we are not going to make enough to spend [$6,000] to $12,000 a year on health insurance," Ed Clarke said.
They are a family caught in the middle. Their combined income puts them at the poverty level so they should be covered by Medicaid.
But if the Clarkes earn even a few dollars over the $20,000 limit, their kids stay covered, but Ed and Mary don't.
"It gets to be too much. You do the best you can to put one foot in front of the other and keep going," Mary Clarke said.
Ed Clarke is often forced to take low-paying jobs, just to keep the health insurance and bring in a little extra money.
Last year he took a well-paying temp job and promptly lost his and his wife's coverage.
"For those few weeks I worked, it was enough to upset the entire balance, but still yet not enough to go out and buy the coverage that you need," he said.
"We had a baby in March, but the cord was around his neck twice and he did not survive," Mary Clarke said.
"You have to rely on each other. … And you pray a lot," she said.
Mary Clarke was covered throughout her difficult pregnancy, but now she desperately needs to see a grief counselor and simply can't afford it.
"No one seems to be feeling like this is a disaster, that this is something we have to deal with right now," Frech said.