Patients come to the Sierra Nevada Health Center in Carson City when they have no place else to go.
Sandy Parcells is one of them.
"I tried absolutely everything I could do to get some medical attention," says Parcells, who is unemployed and uninsured. "These guys were the only ones who could help me out."
Parcells is one of more than a half million Nevadans who are uninsured. She's at the clinic waiting for a follow-up appointment.
Before she found this safety net clinic, she couldn't afford to go to the doctor to refill her migraine and antidepressant medication.
She says when she ran out, she became a basketcase.
"I even called the suicide hotline when...the day that I came in here. I was absolutely beside myself for help," she says, while sitting in the clinic waiting room.
Parcells has other medical concerns. Her mom died of colon cancer, and she can't afford to get a follow-up colonoscopy.
"So I just wait...hope that I can get a job."
NEVADA CREATES 'SILVER STATE' EXCHANGE
Nevada has always had a high rate of uninsured people - but record high unemployment has made it worse.
The federal health law seeks to reduce the number of uninsured - but states are at various levels of compliance.
"We're in the process of building the exchange as we speak," Nevada's Republican Governor Brian Sandoval told Capital Public Radio. "It will be a place for Nevadans to go and see what the best opportunity is for them."
Nevada was one of the states that challenged the Affordable Care Act at the Supreme Court. After it was upheld, Governor Sandoval said it put a burden on states, and he hoped Congress would act to change it.
But since 2011, Nevada has quietly been implementing the Silver State health insurance exchange. The Governor said Nevada was left with a choice.
"Either the federal government was going to do it, or the state would have the option to do it ourselves. And Nevadans are fiercely independent. And so we made a decision to build the exchange ourselves, which we have done, we're moving forward with that," Governor Sandoval told Capital Public Radio.
NEVADA'S EXCHANGE 'RUNS AS A BUSINESS'
Right now, the exchange is little more than a website and a staff of eight working in Carson City.
"In Nevada, the exchange runs as a business," says CJ Bawden, communications officer for the Silver State exchange.
Bawden ran a large construction company before taking this job.
"We have no general funding from the state of Nevada. We're going to run as a business, charge fees as a business, and stand on our own two feet," he says.
Bawden says Nevada's exchange has been moving so fast, it's
become one of the first to raise questions with the federal government.
He says the federal government has changed rules as a result.
"We've been able to get out in front, and push the edges. They're actually kind of looking at us for some information on different programs," says Bawden.
By many measures, Nevada is advanced in laying the groundwork for the exchange.
It's one of a handful to receive level two federal money. It's developing a web portal and customer call center.
"Right now, we're at a point where we're going to be ready to have a state-based exchange and avoid federal intervention, whereas a lot of the other states that just went along the lawsuit path are scrambling to try to figure out what they can do," adds Bawden.
Bawden says the exchange hopes to help reduce the rate of uninsurance from more than 20% to 8%.
He says the online marketplace will provide little regulation to private insurers, and lots of choices for consumers.
He says political uncertainty about the law's future isn't slowing them down.
"If there were things to change with the law, then we would be looking for jobs elsewhere," says Bawden.
"This isn't a protected job like a lot of state jobs are. Everybody's here because they want to be here and because they're ready to work and they're ready for the challenge ahead."
Governor Brian Sandoval is waiting on another aspect of health care overhaul.
He says he'll decide whether to expand Medicaid in part based on who's in the white house after January of 2013.